Case Reports in Dermatological Medicine https://www.hindawi.com The latest articles from Hindawi © 2017 , Hindawi Limited . All rights reserved. Atypical Histiocyte-Rich Sweet’s Syndrome Wed, 18 Oct 2017 08:21:10 +0000 http://www.hindawi.com/journals/cridm/2017/8150719/ Sweet’s Syndrome is a rare neutrophilic dermatosis thought to be a result of immune dysregulation occurring in the setting of drug exposure, recent infection, pregnancy, and underlying malignancy or idiopathic with specific and widely accepted diagnostic criteria established in the literature. Other organ systems can be involved with varying degrees of severity. An unusual case of Sweet’s Syndrome associated with myopericarditis, acral involvement, and atypical histological findings with predominance of histiocytes is described here. Sharon Chi, Marcia Leung, Mark Carmichael, Michael Royer, and Sunghun Cho Copyright © 2017 Sharon Chi et al. All rights reserved. Basidiobolomycosis Simulating a Mycobacterium ulcerans Infection in a Togolese Rural Child Tue, 17 Oct 2017 00:00:00 +0000 http://www.hindawi.com/journals/cridm/2017/6905783/ Background. Basidiobolomycosis is a deep mycosis which preferentially affects rural young people in tropical countries. We report an atypical case, with multiple ulcers, simulating a Buruli ulcer. Case Report. A 5-year-old boy, living in a rural area, was seen for ulcers on the buttocks and at the back and right flank that had been in progress for 4 months. On examination, we found an infiltrated plaque with sharp edges, little painful, located on the buttocks, back, and the right flank. On this plaque, there were multiple ulcers with polycyclic contours and fibrinous bottom. There were inguinal inflammatory lymph nodes. The patient had an altered general condition. Examination of other organs was normal. The diagnosis of Buruli ulcer was evoked first; the search for Mycobacterium ulcerans by polymerase chain reaction was negative. Histology test performed revealed hypodermic granulomatous inflammation with predominant macrophage and eosinophils. The mycological culture was not done. The child was treated successfully with ketoconazole (10 mg/kg/day) during eight weeks. Discussion. Our observation shows great clinical and epidemiological similarities between basidiobolomycosis and Buruli ulcer. It confirms the efficacy of ketoconazole in severe basidiobolomycosis infection with alteration of general condition. Histopathology is very important for differential diagnosis between these two diseases. Bayaki Saka, Waguena Gnassingbe, Garba Mahamadou, Sefako Akakpo, Julienne Teclessou, Aurel Abilogun-Chokki, Abas Mouhari-Toure, Koussake Kombate, and Palokinam Pitché Copyright © 2017 Bayaki Saka et al. All rights reserved. Erosive Pustular Dermatosis of the Scalp with Urate-Like Crystals Sun, 08 Oct 2017 06:34:51 +0000 http://www.hindawi.com/journals/cridm/2017/1536434/ Follicular urate-like crystals were first described in Necrotizing Infundibular Crystalline Folliculitis (NICF), a rare cutaneous disorder with multiple waxy folliculocentric papules. Similar crystal accumulation may be seen within follicular infundibulae as an incidental finding. We describe a case showing identical crystals occurring within the horn-like crusts of a patient with erosive pustular dermatosis of the scalp (EPDS), a condition which due to its presentation can often be mistaken for nonmelanoma skin cancer. A brief overview of erosive pustular dermatosis of the scalp (EPDS) is presented in this paper. Patrick O. Emanuel and Sharad P. Paul Copyright © 2017 Patrick O. Emanuel and Sharad P. Paul. All rights reserved. Protein C Deficiency Caused by a Novel Mutation in the PROC Gene in an Infant with Delayed Onset Purpura Fulminans Tue, 26 Sep 2017 06:53:53 +0000 http://www.hindawi.com/journals/cridm/2017/8915608/ Protein C is an anticoagulant that is encoded by the PROC gene. Protein C deficiency (PCD) is inherited in an autosomal dominant or recessive pattern. Autosomal dominant PCD is caused by monoallelic mutations in PROC and often presents with venous thromboembolism. On the other hand, biallelic PROC mutations lead to autosomal recessive PCD which is a more severe disease that typically presents in neonates as purpura fulminans. In this report, we describe an 8-month-old infant with autosomal recessive PCD who presented with multiple lumps on his lower extremities at the age of 2 months and later developed purpura fulminans after obtaining a muscle biopsy from the thigh at the age of 5 months. Protein C level was less than 10% and PROC gene sequencing identified a novel homozygous missense mutation, c.1198G>A (p.Gly400Ser). Autosomal recessive PCD typically presents with neonatal purpura fulminans which is often fatal if not recognized and treated early. Therefore, early recognition is critical in preventing morbidity and mortality associated with autosomal recessive PCD. Mariam S. Al Harbi and Ayman W. El-Hattab Copyright © 2017 Mariam S. Al Harbi and Ayman W. El-Hattab. All rights reserved. Diagnostic Challenge: A Report of Two Adult-Onset Still’s Disease Cases Mon, 25 Sep 2017 00:00:00 +0000 http://www.hindawi.com/journals/cridm/2017/3768603/ This study reports two adult-onset Still’s disease (AOSD) cases that met both Yamaguchi’s and Fautrel’s criteria and that presented with notable clinical manifestations. One case presented with atypical dermographism-like rash with an extremely high ferritin level. The other case presented with typical salmon-pink maculopapular rash but had atypical positive rheumatoid factor. This suggests that although negative rheumatoid factor is one of the criteria used for the diagnosis of AOSD, a positive rheumatoid factor result does not exclude AOSD. Beside a classic rash, characterized by transient salmon-pink maculopapular rash, we also find atypical dermographism-like rash. These findings remind us that there exist various types of rash from AOSD. Sakunee Niranvichaiya and Daranporn Triwongwaranat Copyright © 2017 Sakunee Niranvichaiya and Daranporn Triwongwaranat. All rights reserved. Nevus Lipomatosus Superficialis on the Left Proximal Arm Wed, 13 Sep 2017 00:00:00 +0000 http://www.hindawi.com/journals/cridm/2017/6908750/ We report a 58-year-old woman with a solitary type of nevus lipomatosus superficialis on the left proximal arm. To our knowledge, the occurrence of a solitary type of nevus lipomatosus superficialis on the arm has very rarely been reported. A perusal of the literature revealed but one case, to which we are going to add another one. Recognition of this clinical manifestation is important so that a proper diagnosis can be made. Alexander K. C. Leung and Benjamin Barankin Copyright © 2017 Alexander K. C. Leung and Benjamin Barankin. All rights reserved. Sporotrichoid-Like Spread of Cutaneous Mycobacterium chelonae in an Immunocompromised Patient Wed, 23 Aug 2017 08:38:24 +0000 http://www.hindawi.com/journals/cridm/2017/8219841/ Mycobacterium chelonae is a rapidly growing mycobacterium found in water and soil that can cause local cutaneous infections in immunocompetent hosts but more frequently affects immunocompromised patients. Typically, patients will present with painful subcutaneous nodules of the joints or soft tissues from traumatic inoculation. However, exhibiting a sporotrichoid-like pattern of these nodules is uncommon. Herein, we report a case of sporotrichoid-like distribution of cutaneous Mycobacterium chelonae in a patient with systemic lupus erythematosus on significant immunosuppressive medications. Clinicians treating immunocompromised patients should be cognizant of their propensity to develop unusual infections and atypical presentations. Daria Marley Kemp, Anusha G. Govind, Jun Kang, Caroline C. Brugger, and Young C. Kauh Copyright © 2017 Daria Marley Kemp et al. All rights reserved. Insight into Natural History of Congenital Vitiligo: A Case Report of a 23-Year-Old with Stable Congenital Vitiligo Mon, 14 Aug 2017 09:51:57 +0000 http://www.hindawi.com/journals/cridm/2017/5172140/ Vitiligo is a disorder of skin pigmentation. It affects approximately 1% of the world’s population. Vitiligo occurs equally between the sexes with no racial predilections. The majority of cases are acquired and arise between the second and third decades of life. Acquired vitiligo has an unpredictable clinical course. Congenital vitiligo is rare with few reported cases. Due to the rarity of congenital vitiligo, little is known about the clinical course. For patients with acquired or congenital vitiligo, the psychosocial burden can have a profound impact on quality of life. The unknown course of congenital vitiligo can exacerbate the feelings of distress and embarrassment. We report of a case of congenital vitiligo that has been stable for 23 years. The patient had no associated autoimmune disease. The pathogenesis of congenital vitiligo is unknown. This case may be useful to assist clinicians caring for newborns with congenital vitiligo in reassuring parents. Chelsea Casey and Stephen E. Weis Copyright © 2017 Chelsea Casey and Stephen E. Weis. All rights reserved. Pravastatin-Induced Eczematous Eruption Mimicking Psoriasis Mon, 31 Jul 2017 00:00:00 +0000 http://www.hindawi.com/journals/cridm/2017/3418204/ Background. Statins, an example of the most commonly prescribed medications to the elderly, are not without side effects. Dermatologic events are often overlooked as arising from medications, particularly those which are taken chronically. Moreover, elderly patients are prone to pharmacologic interactions due to multiple medications. In this report, we describe a case of a statin-induced eczematous dermatitis with a psoriasis-like clinical presentation and review the skin manifestations that may arise from statin therapy. Case Presentation. An 82-year-old man with gout and hypercholesterolemia presented to dermatology clinic with new onset of pruritic, scaly erythematous plaques bilaterally on the extensor surfaces of his arms. He had never had similar lesions before. Despite various topical and systemic treatments over several months, the rash continued to evolve. The patient was then advised to discontinue his long-term statin, which led to gradual resolution of his symptoms. He was subsequently diagnosed with statin-induced eczematous dermatitis. Conclusions. This case report describes an adverse cutaneous reaction to statins that is rarely reported in the literature. Medications, including longstanding therapies, should be suspected in cases of refractory dermatologic lesions. Michael P. Salna, Hannah M. Singer, and Ali N. Dana Copyright © 2017 Michael P. Salna et al. All rights reserved. Different Clinical Features of Acral Abortive Hemangiomas Wed, 12 Jul 2017 06:41:36 +0000 http://www.hindawi.com/journals/cridm/2017/2897617/ Some infantile hemangiomas called in literature “minimal or arrested growth hemangiomas” or “abortive hemangiomas” are present at birth and have a proliferative component equaling less than 25% of its total surface area. Often, they are mistaken for vascular malformation. We present five patients (three girls and two boys) with abortive hemangiomas diagnosed between January 2010 and December 2015 localized in acral part of the extremities. They were congenital lesions resembling precursor of hemangiomas but did not show proliferation phase. Immunohistochemical Glut-1 was performed in all of them as a way to confirm the abortive hemangioma diagnosis. The most common appearance was a reticulated erythematous patch with multiple fine telangiectasias on the surface. We remark that one of them presented a segmental patch with two different morphologies and evolutions. The proximal part showed pebbled patches of bright-red hemangioma and presented proliferation and the distal part with a reticulated network-like telangiectasia morphology remained unchanged. We detected lower half of the body preference and dorsal region involvement preference without ventral involvement. The ulceration occurred in three patients with two different degrees of severity. N. Vega Mata, J. C. López Gutiérrez, B. Vivanco Allende, and M. S. Fernández García Copyright © 2017 N. Vega Mata et al. All rights reserved. Photopheresis Provides Significant Long-Lasting Benefit in Nephrogenic Systemic Fibrosis Mon, 12 Jun 2017 00:00:00 +0000 http://www.hindawi.com/journals/cridm/2017/3240287/ Nephrogenic systemic fibrosis (NSF), previously known as nephrogenic fibrosing dermopathy, is a rare complication of exposure to gadolinium-based contrast agents in patients who have significantly decreased renal function. Manifestations include fibrosis of the skin and other tissues. Effective therapies are lacking. Photopheresis has been tried with variable rates of improvement, and small numbers of cases (20 as of 2016) have been reported of NSF patients treated with photopheresis. We report a case of patient with nephrogenic systemic fibrosis who was treated with photopheresis and demonstrated significant lasting improvements. Ranran Zhang and William Nicholas Rose Copyright © 2017 Ranran Zhang and William Nicholas Rose. All rights reserved. A Case of Granuloma Annulare Associated with Secukinumab Use Mon, 22 May 2017 08:36:00 +0000 http://www.hindawi.com/journals/cridm/2017/5918708/ Granuloma annulare (GA) is a benign inflammatory dermatosis characterized clinically by dermal papules and annular plaques. The pathogenesis of GA is not well understood, although it is thought to result from a delayed-type hypersensitivity reaction in which inflammatory cells elicit connective tissue degradation. This condition has been seen following the use of several drugs, including tumor necrosis factor-alpha (TNF-) inhibitors, which paradoxically have also been reported to treat GA. We report the case of a patient who developed GA in association with secukinumab, an interleukin-17A antagonist, and discuss its implications for our understanding of the pathogenesis of GA. Lauren Bonomo, Sara Ghoneim, and Jacob Levitt Copyright © 2017 Lauren Bonomo et al. All rights reserved. Intracorneal Hematoma Showing Clinical and Dermoscopic Features of Acral Lentiginous Melanoma Mon, 08 May 2017 08:33:37 +0000 http://www.hindawi.com/journals/cridm/2017/3509146/ Intra- and subcorneal hematoma, a skin alteration seen palmar and plantar after trauma or physical exercise, can be challenging to distinguish from in situ or invasive acral lentiginous melanoma. Thus, careful examination including dermoscopic and histologic assessment may be necessary to make the correct diagnosis. We here present a case of a 67-year-old healthy female patient who presented with a pigmented plantar skin alteration. Differential diagnoses included benign skin lesions, for example, hematoma or melanocytic nevus, and also acral lentiginous melanoma or melanoma in situ. Since clinical and dermoscopic examinations did not rule out a malignant skin lesion, surgical excision was performed and confirmed an intracorneal hematoma. In summary, without adequate physical trigger, it may be clinically and dermoscopically challenging to make the correct diagnosis in pigmented palmar and plantar skin alterations. Thus, biopsy or surgical excision of the skin alteration may be necessary to rule out melanoma. Ugur Uslu, Franz Heppt, and Michael Erdmann Copyright © 2017 Ugur Uslu et al. All rights reserved. A Severe Case of Lymphomatoid Papulosis Type E Successfully Treated with Interferon-Alfa 2a Sun, 30 Apr 2017 06:08:36 +0000 http://www.hindawi.com/journals/cridm/2017/3194738/ Lymphomatoid papulosis (LyP) is a benign papulonodular skin eruption with histologic features of malignant lymphoma. A new variant of LyP which was termed “type E” was recently described with similar clinical and histological features to angiocentric and angiodestructive T-cell lymphoma. LyP type E is characterized with recurrent papulonodular lesions which rapidly turn into hemorrhagic necrotic ulcers and spontaneous regression by leaving a scar. None of the available treatment modalities affects the natural course of LyP. For therapy various modalities have been used such as topical and systemic steroids, PUVA, methotrexate, bexarotene, and IFN alfa-2b. Here we present a severe and devastating case with a very rare variant of LyP type E, which is, to our knowledge, the first case successfully treated with IFN alfa-2a. Now disease has been maintaining its remission status for six months. Aslı Bilgiç Temel, Betül Unal, Hatice Erdi Şanlı, Şeniz Duygulu, and Soner Uzun Copyright © 2017 Aslı Bilgiç Temel et al. All rights reserved. PUVA Induced Bullous Pemphigoid in a Patient with Mycosis Fungoides Sun, 16 Apr 2017 08:17:19 +0000 http://www.hindawi.com/journals/cridm/2017/6134752/ Background. Bullous pemphigoid is an autoimmune subepidermal blistering skin disease in which autoantibodies are directed against components of the basement membrane. The disease primarily affects the elderly people and in most of the patients inducing factors cannot be identified. Herein, we report a case of BP that occurred in a patient who was receiving PUVA therapy for the treatment of mycosis fungoides. Main Observation. A 26-year-old woman with mycosis fungoides developed blisters while receiving PUVA therapy. On physical examination tense bullae on the normal skin, remnants of blisters, and erosions were observed on her breasts, the chest wall, and the upper abdomen. Histopathological investigations revealed subepidermal blisters with eosinophilic infiltration and in direct immunofluorescence examination linear deposition of IgG along the basement membrane zone was observed. The diagnosis of bullous pemphigoid was also confirmed by ELISA and BIOCHIP mosaic-based indirect immunofluorescence test. Conclusions. PUVA therapy is an extremely rare physical factor capable of inducing bullous pemphigoid. So the development of blistering lesions during PUVA therapy may be suggestive sign of a bullous disease such as bullous pemphigoid and it should be excluded with proper clinical and laboratory approaches immediately after withdrawal of PUVA therapy. Birgül Özkesici, Saliha Koç, Ayşe Akman-Karakaş, Ertan Yılmaz, İbrahim Cumhur Başsorgun, and Soner Uzun Copyright © 2017 Birgül Özkesici et al. All rights reserved. A Tale of Two Cysts: Steatocystoma Multiplex and Eruptive Vellus Hair Cysts—Two Case Reports and a Review of the Literature Wed, 05 Apr 2017 09:40:28 +0000 http://www.hindawi.com/journals/cridm/2017/3861972/ Background. Steatocystoma multiplex (SM) and eruptive vellus hair cysts (EVHC) are uncommon benign tumors of the pilosebaceous unit. Both SM and EVHC are characterized by smooth, asymptomatic papules or nodules, most commonly presenting on the chest, limbs, and abdomen. Most cases of SM and EVHC are sporadic, although less common autosomal dominant inherited forms have been reported. Main Observation. In this report we present two cases of cutaneous cysts exhibiting characteristics of either SM or EVHC. Both patients presented with numerous 1-2 mm asymptomatic papules and responded well to surgical expression by incision and drainage (I&D). Conclusion. SM and EVHC are similar in clinical presentation and management. Previously reported “hybrid-type” tumors present strong evidence for a relationship between the two lesions pathologically. Due to potential similarity of EVHC and SM cyst contents, I&D and subsequent microscopic examination cannot definitely differentiate between EVHC, SM, and hybrid cysts. Rachel J. Waldemer-Streyer and Ellen Jacobsen Copyright © 2017 Rachel J. Waldemer-Streyer and Ellen Jacobsen. All rights reserved. Successful Treatment of Facial Acne Fulminans: Antimicrobial Agents and Oral Prednisolone as Promising Regimes Mon, 27 Mar 2017 00:00:00 +0000 http://www.hindawi.com/journals/cridm/2017/7092910/ Acne fulminans (AF), also known as acne maligna, is a rare painful ulcerative form of acne with an abrupt onset and systemic symptoms. Its incidence appears to be decreasing, possibly because of earlier and better treatment of acne. This report highlights a case on a necrotizing facial wound due to AF that was successfully treated with oral prednisolone and antimicrobial medication. Amir Hossein Siadat, Anis Bostakian, Bahareh Abtahi-Naeini, and Masoom Shahbazi Copyright © 2017 Amir Hossein Siadat et al. All rights reserved. Development of Asymmetric Facial Depigmentation in a Patient Treated with Dasatinib with New-Onset Hypovitaminosis D: Case Report and Review of the Literature Thu, 23 Mar 2017 00:00:00 +0000 http://www.hindawi.com/journals/cridm/2017/9359086/ Dasatinib is a second-generation tyrosine kinase inhibitor (TKI) used to treat imatinib-resistant chronic myelogenous leukemia (CML), as well as other Philadelphia chromosome-positive lymphoproliferative disorders. While the most commonly reported cutaneous side effects with this therapy include a morbilliform eruption, skin exfoliation, and skin irritation, pigmentary abnormalities have also been observed, albeit much more rarely. We present the case of a 72-year-old South Asian male with CML who presented with new-onset hypopigmentation of his face and scalp three years after a dose increase of dasatinib therapy, in the setting of newly discovered borderline hypovitaminosis D. Dasatinib and the other TKIs are believed to induce dyschromias via modulation of the c-kit receptor and its associated signaling pathway, which is involved in melanocyte survival, proliferation, and migration. Kirsten C. Webb, Magdalena Harasimowicz, Monica Janeczek, Jodi Speiser, James Swan, and Rebecca Tung Copyright © 2017 Kirsten C. Webb et al. All rights reserved. Eccrine Nevus Presenting with Umbilical Discharge: A Case Report and Review of the Literature Tue, 21 Mar 2017 07:12:22 +0000 http://www.hindawi.com/journals/cridm/2017/9761843/ Eccrine nevus is a rare skin lesion with protean manifestations like hyperhidrosis, discolored nodules, papules, and so forth, which has been reported in various anatomic parts of the body including the forearm, leg, thigh, back, and coccyx. Our patient was a 26-year-old male, who presented with increasing colorless and odorless episodic umbilical discharge. First impression for the patient was an umbilical sinus and the patient underwent surgery. Histopathological study revealed the lesion to be an eccrine nevus of the umbilicus. This is the first case of eccrine nevus presenting with umbilical discharge. We recommend that eccrine nevus should be considered as a differential diagnosis for umbilical discharge. Farahnaz Bidari-Zerehpoosh, Shahram Sabeti, Farid Arman, and Hania Shakeri Copyright © 2017 Farahnaz Bidari-Zerehpoosh et al. All rights reserved. Unusual Sites of Cutaneous Tuberculosis: A Report of Two Cases Mon, 27 Feb 2017 08:10:53 +0000 http://www.hindawi.com/journals/cridm/2017/7285169/ Cutaneous tuberculosis (CTB) is an uncommon small subset of extrapulmonary tuberculosis, comprising 1–1.5% of all extrapulmonary tuberculosis manifestations, which manifests only in 8.4–13.7% of all tuberculosis cases. Lupus vulgaris (LV) and tuberculosis verrucosa cutis (TBVC) are forms of reinfection tuberculosis and often occur in presensitized patients, by exogenous inoculation. We report two cases of cutaneous tuberculosis at unusual sites. A 35-year-old female having a forehead lesion for 2 years was diagnosed as having tuberculosis verrucosa cutis and another 16-year-old girl with lesion in left axilla for 10 years was proven to have lupus vulgaris. The delayed diagnosis was possibly due to lower clinical suspicion due to the presentation of CTB at unusual sites. This highlights the importance of keeping TB as an important differential as misdiagnosis or delayed diagnosis of this entity can lead to prolonged morbidity. Dimple Chopra, Vishal Chopra, Aastha Sharma, Siddharth Chopra, Shivali Aggarwal, and Deepak Goyal Copyright © 2017 Dimple Chopra et al. All rights reserved. An Unusual Location of Subungual Warty Dyskeratoma: A Case Report and Review of the Literature Thu, 23 Feb 2017 00:00:00 +0000 http://www.hindawi.com/journals/cridm/2017/3613109/ Warty dyskeratoma is an uncommon entity characterized by a solitary keratotic papule or nodule usually located in the head and neck of young adults. The histopathology shows a pattern of acantholytic dyskeratosis. We report a 32-year-old man who presented pain, serous exudation, a distal onycholysis with subungual hyperkeratosis, and roundish erythronychia in the nail plate of his left first toe 2 years ago. A histopathologic diagnosis of subungual warty dyskeratoma was made. When dealing with focal acantholytic dyskeratosis several differential diagnoses should be considered including Darier’s disease, transient focal acantholytic dyskeratosis or Grover disease, and Hailey-Hailey disease. We present an unusual location of warty dyskeratoma in the nail bed using a clinicohistopathological correlation for the diagnosis. Elena Vargas-Laguna, Adrián Imbernón-Moya, Antonio Aguilar-Martínez, and Fernando Burgos Copyright © 2017 Elena Vargas-Laguna et al. All rights reserved. A Case of Nonuremic Calciphylaxis in a Caucasian Woman Mon, 16 Jan 2017 00:00:00 +0000 http://www.hindawi.com/journals/cridm/2017/6831703/ We report a case of nonuremic calcific arteriolopathy (NUCA) in an 82-year-old Caucasian woman from rural Australia. The patient had no history of kidney disease or dialysis. NUCA is rare disease suspected on cutaneous and clinical features and diagnosed by characteristic findings on skin biopsy and vasculature imaging. Calcification induced microvascular occlusion in the absence of renal failure may not be immediately apparent. Clinical suspicion and appropriate investigations are essential for making a diagnosis. A diagnosis of NUCA may be missed given the rarity of the disease, and dermatologists and patients alike would benefit from a greater awareness of this disease. Bonnie Fergie, Nishant Valecha, and Andrew Miller Copyright © 2017 Bonnie Fergie et al. All rights reserved. A Rare Case of Vancomycin-Induced Linear Immunoglobulin A Bullous Dermatosis Tue, 10 Jan 2017 08:24:43 +0000 http://www.hindawi.com/journals/cridm/2017/7318305/ Linear IgA bullous dermatosis (LABD) is an autoimmune vesiculobullous disease, which is typically idiopathic but can also rarely be caused by medications or infections. Vancomycin is the most common drug associated with LABD. Lesions typically appear 24 hours to 15 days after the first dose of vancomycin. It is best characterized pathologically by subepidermal bulla (blister) formation with linear IgA deposition at the dermoepidermal junction. Here we report an 86-year-old male with a history of left knee osteoarthritis who underwent a left knee arthroplasty and subsequently developed a prosthetic joint infection. This infection was treated with intravenous vancomycin as well as placement of a vancomycin impregnated joint spacer. Five days following initiation of antibiotic therapy, he presented with a vesiculobullous eruption on an erythematous base over his trunk, extremities, and oral mucosa. The eruption resolved completely when intravenous vancomycin was discontinued and colchicine treatment was begun. Curiously, complete resolution occurred despite the presence of the vancomycin containing joint spacer. The diagnosis of vancomycin-induced linear IgA bullous dermatosis was made based on characteristic clinical and histopathologic presentations. Pinky Jha, Kurtis Swanson, Jeremiah Stromich, Basia M. Michalski, and Edit Olasz Copyright © 2017 Pinky Jha et al. All rights reserved. Pseudohypertension-Like Presentation: An Exceptionally Rare Presentation in an Athletic Female Patient with Morphea Thu, 29 Dec 2016 14:05:48 +0000 http://www.hindawi.com/journals/cridm/2016/7027352/ Introduction. Pseudohypertension is a condition which mainly occurs due to thickening-calcification of tunica intima of the arterial wall, leading to a faulty measurement of the intra-arterial blood pressure. To the best of our knowledge, this is the first case report in literature, of a pseudohypertension-like presentation in association with Morphea en plaque. Case Presentation. This is a rare presentation of a young athletic female and a professional tennis player, with pseudohypertension-like presentation. The patient had a traumatic injury to the right elbow joint; the injury occurred during a professional tennis match. The injury was managed by immobilization, physiotherapy, and Low-Level Laser Therapy. Soon after that, the patient had a circumscribed sclerotic ivory plaque affecting the skin of the right cubital fossa. The histopathology analysis, together with the serological-hematological tests and the clinical picture, along with positive Osler’s signs, leads to the conclusive diagnosis of Morphea en plaque. The peculiar anatomic localization of the plaque anterior to the brachial artery leads to faulty blood pressure measurement as recorded by mercurial sphygmomanometer. Conclusion. This unique presentation of Morphea en plaque carries an important message in relation to the basic medical practice and in relation to the accurate measurement of the vital signs. Ahmed Al-Imam Copyright © 2016 Ahmed Al-Imam. All rights reserved. Acrokeratosis Paraneoplastica Associated with Cervical Squamous Cell Carcinoma Thu, 22 Dec 2016 13:51:17 +0000 http://www.hindawi.com/journals/cridm/2016/7137691/ Background. Acrokeratosis paraneoplastica, or Bazex syndrome, is a paraneoplastic syndrome characterized by cutaneous psoriasiform lesions with associated acral erythema and scale, as well as nail changes, including onycholysis and ungual dystrophy. Its most advanced, severe form involves the trunk, elbows, and knees. It is typically associated with upper aerodigestive tract malignancies in males. Rare cases associated with gynecological cancers have been reported, including uterine adenocarcinoma, as well as ovarian and vulvar squamous cell carcinomas. Cutaneous manifestations often precede cancer diagnosis. In most reported cases, skin changes resolve when the underlying malignancy is adequately treated. Main Observations. We present the case of a 56-year-old female diagnosed with acrokeratosis paraneoplastica following the discovery of FIGO stage IIB cervical squamous cell carcinoma (SCC). Scaling, hyperpigmentation, xerosis, and fissuring were noted on the patient’s hands, feet, legs, arms, and lower back. Pitting was noted on her fingernails. Her cervical cancer was successfully treated with chemoradiotherapy, after which her cutaneous lesions persisted for two months before resolving. Conclusions. The presentation of acrokeratosis paraneoplastica in this context is atypical. Reports of associations with gynecological cancers, as in our patient’s case, are exceedingly rare. Bryan Squires, Steven D. Daveluy, Michael C. Joiner, Newton Hurst, Michael Bishop, and Steven R. Miller Copyright © 2016 Bryan Squires et al. All rights reserved. Mycosis Fungoides of the Oral Cavity: Fungating Tumor Successfully Treated with Electron Beam Radiation and Maintenance Bexarotene Thu, 15 Dec 2016 11:21:27 +0000 http://www.hindawi.com/journals/cridm/2016/5857935/ Oral involvement in mycosis fungoides is unusual and portends a poor prognosis. The clinical findings of three new cases are described along with a differential diagnosis and review of the literature. For brevity, only one patient is discussed in detail below whereas the other two cases are solely described in table form. The patient had a four-year history of mycosis fungoides before developing an exophytic tongue tumor. He was treated with local electron beam radiation and is disease-free to date while being on maintenance therapy with oral bexarotene. Analysis of the data collected from our review of the literature and the present cases reveal key insights. Juri Bassuner, Roberto N. Miranda, Drew A. Emge, Beau A. DiCicco, Daniel J. Lewis, and Madeleine Duvic Copyright © 2016 Juri Bassuner et al. All rights reserved. Radiation-Induced Alopecia after Endovascular Embolization under Fluoroscopy Thu, 15 Dec 2016 07:53:27 +0000 http://www.hindawi.com/journals/cridm/2016/8202469/ Radiation-induced alopecia after fluoroscopically guided procedures is becoming more common due to an increasing use of endovascular procedures. It is characterized by geometric shapes of nonscarring alopecia related to the area of radiation. We report a case of a 46-year-old man presenting with asymptomatic, sharply demarcated rectangular, nonscarring alopecic patch on the occipital scalp following cerebral angiography with fistula embolization under fluoroscopy. His presentations were compatible with radiation-induced alopecia. Herein, we also report a novel scalp dermoscopic finding of blue-grey dots in a target pattern around yellow dots and follicles, which we detected in the lesion of radiation-induced alopecia. Vipawee Ounsakul, Wimolsiri Iamsumang, and Poonkiat Suchonwanit Copyright © 2016 Vipawee Ounsakul et al. All rights reserved. Unusual Presentation of Gianotti-Crosti Syndrome due to Epstein-Barr Virus Infection Mon, 05 Dec 2016 12:38:54 +0000 http://www.hindawi.com/journals/cridm/2016/1017524/ Gianotti-Crosti syndrome (GCS) is viral exanthema of childhood. It typically presents with a symmetric erythematous papular and papulovesicular eruption. It has been classically associated with hepatitis B virus, as well as rarely with Epstein-Barr virus (EBV). We report a case of GCS related to EBV infection without the classical systemic symptoms in a five-year-old male patient. Hind Saif Al Dhaheri, Amani Al Kaabi, Yasmin Kara Hamo, Aysha Al Kaabi, Salwa Al Kaabi, and Hossam Al Tatari Copyright © 2016 Hind Saif Al Dhaheri et al. All rights reserved. Nodular Fasciitis Complicating a Staged Surgical Excision of Dermatofibrosarcoma Protuberans Sun, 27 Nov 2016 12:43:51 +0000 http://www.hindawi.com/journals/cridm/2016/6074182/ Dermatofibrosarcoma protuberans (DFSP) is an unusual spindle cell tumor with a high rate of local recurrence with traditional excision. Fortunately, Mohs micrographic surgery yields excellent cure rates for this neoplasm due to contiguous tumor spread and meticulous tumor mapping and margin analysis. We present the unique case of a patient treated with a modified Mohs technique with an analysis of the final margin with permanent sections, who developed a spindle cell neoplasm in the margins of her second stage excision consistent with nodular fasciitis. Distinguishing residual DFSP from a benign reactive process was an essential and challenging component of this patient’s management. C. Helen Malone, Brandon Goodwin, Richard F. Wagner, Vicente Resto, and Brent Kelly Copyright © 2016 C. Helen Malone et al. All rights reserved. Evolution of Skin during Rehabilitation for Elephantiasis Using Intensive Treatment Thu, 24 Nov 2016 07:54:31 +0000 http://www.hindawi.com/journals/cridm/2016/4305910/ The objective of this study is to describe the evolution of the skin during rehabilitation for elephantiasis using intensive treatment. We report on the case of a 55-year-old patient with a seven-year history of leg edema. The patient reported that it began with repeated outbreaks of erysipelas over several years. One leg evolved with significant edema leading to an inability to ambulate and for about one month the patient said that he could not get out of bed. Moreover the patient was obese weighing 130 kilos and with a BMI of 39. Intensive treatment was performed over three weeks resulting in a significant reduction in limb volume. The treatment consisted of Mechanical Lymphatic Therapy (RAGodoy), Cervical Lymphatic Stimulation (Godoy & Godoy technique), and a custom-made inelastic stocking of a grosgrain textile. What caught the attention during therapy were the open wounds resulting from fragmentation of the plaque as the edema reduced; the plaque was about 0.5 cm thick. As the treatment evolved the plaque disappeared and the wounds healed. The limb size decreased by more than 80% in three weeks after which the patient began to be treated in an outpatient setting with ambulation using a grosgrain stocking. Henrique Jose Pereira de Godoy, Ricardo Budtinger Filho, Maria de Fatima Guerreiro Godoy, and José Maria Pereira de Godoy Copyright © 2016 Henrique Jose Pereira de Godoy et al. All rights reserved.