Case Reports in Dermatological Medicine https://www.hindawi.com The latest articles from Hindawi © 2017 , Hindawi Limited . 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. Clinical Manifestation, Histopathology, and Imaging of Traumatic Injuries Caused by Brazilian Porcupine (Sphiggurus villosus) Quills Thu, 17 Nov 2016 11:54:39 +0000 http://www.hindawi.com/journals/cridm/2016/7851986/ Injuries to humans caused by porcupines are rare. However, they may occur due to the proximity of urban areas and the animal’s habitat in areas such as the Floresta da Tijuca in Rio de Janeiro. Outdoor sports and leisure activities in areas close to forests or in the rain forest are also relevant for incidents of this kind and a better knowledge of the local forest fauna would prevent such undesirable accidents. Porcupine quills have microscopic barbs at their tips which facilitate skin penetration, but hampering their removal. Once the spines are lodged in tissue, the microscopic backward-facing deployable barbs at the tips cause trauma if anyone tries to remove them. Local haemorrhage and an inflammatory response to the contaminated foreign body occur. Depending on the time lapse in removing the spines either septic or sterile foreign body reactions may occur. There is also the risk of migration of the spines, where fatal cases have been reported in human and veterinary medicine. Herein we report two unusual cases of accidents involving humans and the South American porcupine. The Sphiggurus villosus spines removed from scalp skin were also documented through Scanning Electron Microscopy. Lívia M. Araújo Jorge, Fred Bernardes Filho, Fabrício Lamy, Laila Klotz A. Balassiano, Loan Towersey, Roderick Hay, and Marco Andrey C. Frade Copyright © 2016 Lívia M. Araújo Jorge et al. All rights reserved. Effects of Cryolipolysis on Abdominal Adiposity Tue, 08 Nov 2016 13:48:27 +0000 http://www.hindawi.com/journals/cridm/2016/6052194/ Cryolipolysis is a noninvasive technique of localized fat reduction. Controlled cold exposure is performed in the selective destruction of fat cells. The aim of this study was to investigate the effects of cryolipolysis on adipocytes elimination through histological and sonographic analyses. This study reports the case of a 46-year-old female patient, with complaint of localized abdominal fat and in the preoperative period of abdominoplasty. The patient was submitted to a single 60-minute application of cryolipolysis, temperature of −5°C, on the hypogastrium area, 5 cm below the umbilicus. To study the effects of this treatment, ultrasound images taken before the session and 7, 15, 30, and 45 days after the therapy were analysed. After the abdominoplasty, parts of the treated and the untreated withdrawn abdominal tissues were evaluated macro- and microscopically. In ultrasound images, as well as in macroscopic and histological analyses, significant adipocytes destruction was detected, with consequent fat layer reduction and integrity of areas that were adjacent to the treated tissue. The presence of fibrosis observed during therapy and acknowledged through performed analyses encourages further studies to clarify such finding. Patricia Froes Meyer, Rodrigo Marcel Valentim da Silva, Glenda Oliveira, Maely Azevedo da Silva Tavares, Melyssa Lima Medeiros, Camila Procopio Andrada, and Luis Gonzaga de Araujo Neto Copyright © 2016 Patricia Froes Meyer et al. All rights reserved. Generational Expression of Muir-Torre Syndrome in a Canadian Family Sun, 16 Oct 2016 08:18:30 +0000 http://www.hindawi.com/journals/cridm/2016/1712527/ Muir-Torre syndrome (MTS) is a rare autosomal dominant inherited genodermatosis that is considered to be a phenotypic subtype of hereditary nonpolyposis colorectal cancer (HNPCC), commonly referred to as Lynch syndrome. We describe the clinical course of a 57-year-old female patient with MTS. She has a confirmed HMSH2 mutation. Recently she presented with two nodular lesions. Histologic examination confirmed these lesions to be sebaceous neoplasms. The patient has a history of endometrial and colorectal adenocarcinoma as well as several nonspecific sebaceous lesions throughout her life. She has a confirmed extensive family history of MTS with both male and female family members harbouring either HMLH1 or HSMH2 mutations. Affected relatives have presented at different ages throughout their lives with cutaneous neoplasms and visceral malignancies, including malignancies rarely associated with MTS. MTS presents a diagnostic challenge for clinicians. The case demonstrates that the management of MTS, a potentially underreported syndrome, requires a multiprofessional approach incorporating vigilance, screening, and expert knowledge for successful diagnosis and potentially improved prognosis for patients and their families. The case also demonstrates the varied heritability of MTS and prompts the question of how MTS is expressed in succeeding generations. Kaitlin Alexandra Vanderbeck, R. Gary Sibbald, and Nirosha Murugan Copyright © 2016 Kaitlin Alexandra Vanderbeck et al. All rights reserved. Sudden Appearance of Indurated Erythematous Plaques on a Man’s Face Thu, 15 Sep 2016 07:44:35 +0000 http://www.hindawi.com/journals/cridm/2016/5192689/ Rosacea fulminans (RF), previously known as pyoderma faciale, is a rare presentation of rosacea mostly seen in young women. RF is seen very rarely in men. We present below a case of a fifty-year-old male who presented with RF and was successfully treated with a combination of corticosteroids and isotretinoin. A. Carter, K. Viswanathan, and K. Shulman Copyright © 2016 A. Carter et al. All rights reserved. Unusual Localisation for Onychomatricoma on the 5th Toenail: A Case Report and Review of the Literature Wed, 13 Jul 2016 11:31:05 +0000 http://www.hindawi.com/journals/cridm/2016/1853495/ Onychomatricoma is a rare and benign tumour of the nail matrix but originates rarely from the ventral portion of the proximal nail fold. This tumour is characterised by fingerlike projections that invade the nail plate. This lesion, of unknown aetiology, is typically asymptomatic with slow progression. Localisation on the finger is the most frequently described. We report the case of a 68-year-old woman who has an onychomatricoma in an unusual location, the fifth toe of the left foot. Due to its clinical appearance, the tumour can be confused with and treated as onychomycosis. However, if it is resistant to an oral antifungal well behaved treatment, one must consider onychomatricoma diagnosis. A. Coutellier, I. Théate, and O. Vanhooteghem Copyright © 2016 A. Coutellier et al. All rights reserved. Mugwort-Mustard Allergy Syndrome due to Broccoli Consumption Wed, 13 Jul 2016 09:02:03 +0000 http://www.hindawi.com/journals/cridm/2016/8413767/ Pollen-food allergy syndrome (PFAS) is a relatively rare form of food allergy which develops in individuals who are sensitized to pollen. Tree pollens, especially birch pollen, frequently induce PFAS; however, the incidence of PFAS due to grass or weed pollens such as ragweed or mugwort is relatively rare. Mugwort-mustard allergy syndrome (MMAS) is an example of a PFAS in which individuals sensitized to mugwort may develop an allergy to mustard and experience severe reactions. We herein describe a case of MMAS due to broccoli consumption. Yuri Sugita, Teruhiko Makino, Megumi Mizawa, and Tadamichi Shimizu Copyright © 2016 Yuri Sugita et al. All rights reserved. Corrigendum to “Cutaneous Plasmacytosis with Perineural Involvement” Mon, 04 Jul 2016 08:21:40 +0000 http://www.hindawi.com/journals/cridm/2016/8614078/ Elizabeth A. Brezinski, Maxwell A. Fung, and Nasim Fazel Copyright © 2016 Elizabeth A. Brezinski et al. All rights reserved. A Challenging Giant Dermatofibrosarcoma Protuberans on the Face Wed, 29 Jun 2016 08:56:48 +0000 http://www.hindawi.com/journals/cridm/2016/5926307/ Dermatofibrosarcoma protuberans (DFSP) is a malignant fibrohistiocytic tumor that appears exclusively on the skin. It is a low-grade malignant soft tissue tumor of subcutaneous tissues that has a propensity for local recurrence but seldom metastasizes. It may rarely occur on the head and neck accounting for less than one percent of total head and neck malignancies. We present a man with a giant DFSP on the face. Oncological, functional, and aesthetic aspects are set forth. Gimena Castro Pérez, Cintia Arias, Paula Luna, Irene Sorín, and Luis Daniel Mazzuoccolo Copyright © 2016 Gimena Castro Pérez et al. All rights reserved. Idiopathic Sporadic Onychomadesis of Toenails Wed, 29 Jun 2016 08:27:40 +0000 http://www.hindawi.com/journals/cridm/2016/6451327/ Onychomadesis is a clinical sign of nail plate separation due to transient or permanent arrest of nail matrix activities. Onychomadesis can be considered as a severe form of Beau’s line. This condition usually occurs after trauma, causal diseases, or medications, yet it rarely occurs as an idiopathic condition. We report a case of a 38-year-old Thai female who developed recurrence onychomadesis in several toenails in the absence of predisposing factors or associated conditions. To the best of our knowledge, our patient is the first reported case of idiopathic onychomadesis limited to toenails. Poonkiat Suchonwanit and Sunatra Nitayavardhana Copyright © 2016 Poonkiat Suchonwanit and Sunatra Nitayavardhana. All rights reserved. Familial Pemphigus Vulgaris Occured in a Father and Son as the First Confirmed Cases Wed, 15 Jun 2016 10:34:37 +0000 http://www.hindawi.com/journals/cridm/2016/1653507/ Pemphigus vulgaris (PV) is a chronic autoimmune bullous disease of the skin and mucous membranes. Although there is some evidence pointing towards a genetic predisposition by some human leukocyte antigen (HLA) genes, familial occurrence of PV is very rare. Most of the familial PV cases so far reported have been in mother and daughter and in siblings. PV in father and son, as presented here, has not been reported in the literature before, except an unconfirmed report. The diagnosis of PV was established by histologic, cytologic studies and enzyme linked immunosorbent assay (ELISA) in Case and by ELISA and BIOCHIP indirect immunofluorescence test in Case . The son was responsive to moderate doses of methylprednisolone, with the treatment continuing with tapered doses. The father was in a subclinic condition; consequently, only close follow-up was recommended. HLA typing studies revealed identical HLA alleles of HLA-DR4 () and HLA- in both of our cases; this had been found to be associated with PV in prior studies. Familial occurrences of PV and related HLA genes indicate the importance of genetic predisposition. The first occurrence of confirmed familial PV in father and son is reported here. Ali Haydar Eskiocak, Birgul Ozkesici, and Soner Uzun Copyright © 2016 Ali Haydar Eskiocak et al. All rights reserved. Mutation in LEMD3 (Man1) Associated with Osteopoikilosis and Late-Onset Generalized Morphea: A New Buschke-Ollendorf Syndrome Variant Mon, 13 Jun 2016 09:36:20 +0000 http://www.hindawi.com/journals/cridm/2016/2483041/ Introduction. Buschke-Ollendorf syndrome (BOS) is an uncommon syndrome characterized by osteopoikilosis and other bone abnormalities, accompanied by skin lesions, most frequently connective tissue nevi. BOS is caused by mutations in the LEMD3 gene, which encodes the inner nuclear membrane protein Man1. We describe a unique case of osteopoikilosis associated with late-onset localized scleroderma and familial LEMD3 mutations. Case Report. A 72-year-old woman presented with adult-onset diffuse morphea and bullous skin lesions. Evaluation revealed multiple hyperostotic lesions (osteopoikilosis) suggestive of BOS. DNA sequencing identified a previously undescribed nonsense mutation (Trp621X) in the LEMD3 gene encoding Man1. Two additional family members were found to have osteopoikilosis and carry the same LEMD3 mutation. Conclusions and Relevance. We report a unique familial LEMD3 mutation in an individual with osteopoikilosis and late-onset morphea. We propose that this constellation represents a novel syndromic variant of BOS. Benjamin Korman, Jun Wei, Anne Laumann, Polly Ferguson, and John Varga Copyright © 2016 Benjamin Korman et al. All rights reserved. Focal Hyperhidrosis Associated with Recurrent Urinary Tract Infections Thu, 09 Jun 2016 11:24:45 +0000 http://www.hindawi.com/journals/cridm/2016/3842984/ Hyperhidrosis affects almost 3% of the population and is characterized by sweating that occurs in excess of that needed for normal thermoregulation. It can occur as a primary disease or secondary to underlying clinical conditions. Hyperhidrosis can stem from neurogenic sympathetic over activity involving normal eccrine glands. We report the interesting case of a 75-year-old male patient with a 6-month history of new onset secondary focal hyperhidrosis of buttocks, pelvis, and upper thighs. Each time his symptoms worsened he was found to have culture positive urine samples for Escherichia coli (E. coli). He underwent urological investigation and was found to have urethral strictures and cystitis. The hyperhidrosis improved each time his urinary tract infection (UTI) was treated with antibiotics and continued to remain stable with a course of prophylactic trimethoprim. We hypothesize that the patient’s urethral strictures led to inhibition in voiding which in turn increased the susceptibility to UTIs. Accumulation of urine and increased bladder pressure in turn raised sympathetic nerve discharge leading to excessive sweating. We recommend that a urine dip form part of the routine assessment of patients presenting with new onset focal hyperhidrosis of pelvis, buttocks, and upper thighs. Timely urological referral should be made for all male patients with recurrent UTI. To the authors’ knowledge, there have been no other reports of UTI-associated focal hyperhidrosis. Dina Ismail, Vidya Madhwapathi, and Evmorfia Ladoyanni Copyright © 2016 Dina Ismail et al. All rights reserved. Cutaneous Squamous Cell Carcinoma with Invasion through Ear Cartilage Mon, 16 May 2016 12:52:12 +0000 http://www.hindawi.com/journals/cridm/2016/9067428/ Cutaneous squamous cell carcinoma of the ear represents a high-risk tumor location with an increased risk of metastasis and local tissue invasion. However, it is uncommon for these cancers to invade through nearby cartilage. Cartilage invasion is facilitated by matrix metalloproteases, specifically collagenase 3. We present the unusual case of a 76-year-old man with an auricular squamous cell carcinoma that exhibited full-thickness perforation of the scapha cartilage. Permanent sections through the eroded cartilage confirmed tumor invasion extending to the posterior ear skin. Julie Boisen, C. Helen Malone, Brent Kelly, and Richard F. Wagner Jr. Copyright © 2016 Julie Boisen et al. All rights reserved. Paraneoplastic Pemphigus Associated with Follicular Dendritic Cell Tumor in the Mediastinum Mon, 11 Apr 2016 14:27:18 +0000 http://www.hindawi.com/journals/cridm/2016/6901539/ Paraneoplastic Pemphigus (PNP) is an autoimmune bullous disease characterized by severe stomatitis, polymorphous skin eruptions, and underlying neoplasms. Diagnosis of cutaneous paraneoplastic disorders requires high index of suspicion. We describe a patient with PNP associated with follicular dendritic cell (FDC) tumor in the mediastinum, a rare neoplasm originating from follicular dendritic cells. Its management requires identification of underlying malignancy and treatment of the same. Our patient showed remission of PNP upon excision of the tumor and remained disease-free for 8 years. Aparna Mullangath Prakasan, Anne Jennifer Prabhu, Kanmani Velarasan, Selvamani Backianathan, and Thomas Samuel Ram Copyright © 2016 Aparna Mullangath Prakasan et al. All rights reserved. A Case of Hereditary Leiomyomatosis and Renal Cell Carcinoma Wed, 06 Apr 2016 08:08:49 +0000 http://www.hindawi.com/journals/cridm/2016/3793986/ A 49-year-old lady presented with multiple recurring painful lesions over her thighs, arms, and back. Past medical history included a left sided nephrectomy for renal cell carcinoma and a hysterectomy for multiple uterine fibroids (leiomyomas). Histopathological examination revealed changes consistent with pilar leiomyomas. Gene mutation analysis confirmed a diagnosis of hereditary leiomyomatosis and renal cell carcinoma. Hereditary leiomyomatosis and renal cell carcinoma is an uncommon autosomal dominant condition characterised by the concurrent presentation of cutaneous and uterine leiomyomas. Renal cell carcinoma associated with this condition is more aggressive and a significant cause of mortality. Due to this association with potentially fatal renal cell carcinoma we felt that it was important to highlight this case with an update on pathophysiology and management. Sarah Mehrtens, David Veitch, Elizabeth Kulakov, and Conal M. Perrett Copyright © 2016 Sarah Mehrtens et al. All rights reserved. Confluent and Reticulated Papillomatosis of Gougerot-Carteaud on Black Skin: Two Observations Tue, 05 Apr 2016 12:47:51 +0000 http://www.hindawi.com/journals/cridm/2016/2507542/ Confluent and reticulated papillomatosis of Goujerot-Carteaud is a rare and benign skin disease characterized by flat papules taking a reticulated appearance. It is a skin disease of unknown etiology and nosology that is always discussed. This disease preferentially involves the chest and interscapular regions. It is a condition probably underdiagnosed in black skin because it generally simulates a pigmented tinea versicolor. This pathology withstands antifungal treatment but has a particular sensitivity to cyclines thus constituting a distinguishing criterion, useful for diagnosis which should be evoked in front of these reticulated confluent papules. Kouadio Celestin Ahogo, Patrice Ildevert Gbery, Vagamon Bamba, Yao Isidore Kouassi, Elidje Joseph Ecra, Kouame Alesandre Kouassi, and Ange Sylvain Allou Copyright © 2016 Kouadio Celestin Ahogo et al. All rights reserved. Dabigatran in the Treatment of Warfarin-Induced Skin Necrosis: A New Hope Sun, 27 Mar 2016 08:50:28 +0000 http://www.hindawi.com/journals/cridm/2016/3121469/ Warfarin-induced skin necrosis is an infrequent and well-recognized complication of warfarin treatment. The incidence was estimated between 0.01% and 0.1% whereas a paradoxal prothrombotic state that arises from warfarin therapy seems to be responsible for this life-threatening disease. To the best of our knowledge we present the first case of an old woman diagnosed with warfarin-induced skin necrosis, in whom novel oral anticoagulants and extensive surgical debridement were combined safely with excellent results. Christos Bakoyiannis, Georgios Karaolanis, Nikolaos Patelis, Anastasios Maskanakis, Georgios Tsaples, Christos Klonaris, Sotirios Georgopoulos, and Theodoros Liakakos Copyright © 2016 Christos Bakoyiannis et al. All rights reserved. Acquired Localized Hypertrichosis Induced by Rivastigmine Thu, 17 Mar 2016 09:54:31 +0000 http://www.hindawi.com/journals/cridm/2016/7296572/ Hypertrichosis is the excessive hair growth in any area of the skin surface. Acquired localized hypertrichosis may be secondary to multiple causes and there is a secondary form due to several drugs, which is usually reversible with discontinuation of the causative agent. Rivastigmine is a reversible and competitive inhibitor of acetylcholinesterase and butyrylcholinesterase used for symptomatic treatment of Alzheimer dementia and Parkinson’s disease. It has an adequate safety profile and cutaneous side effects are unusual. Irritant contact dermatitis, allergic dermatitis, baboon syndrome, and cutaneous rash due to rivastigmine have been reported. We report on a Caucasian 80-year-old male with personal history of Alzheimer’s disease. The patient started therapy with oral rivastigmine one month prior to clinical presentation of localized hypertrichosis on both forearms. Norgalanthamine has been shown to promote hair growth activity via the proliferation of dermal papilla. Acetylcholinesterase inhibitors can induce hair growth. Adrian Imbernón-Moya, Sebastian Podlipnik, Fernando Burgos, Elena Vargas-Laguna, Antonio Aguilar-Martínez, Eva Fernández-Cogolludo, and Miguel Angel Gallego-Valdes Copyright © 2016 Adrian Imbernón-Moya et al. All rights reserved. A Case of Bullous Skin Disease Presenting with Odynophagia: A Diagnostic Challenge Mon, 14 Mar 2016 12:25:22 +0000 http://www.hindawi.com/journals/cridm/2016/2839104/ We report a case of Epidermolysis Bullosa Acquisita (EBA) that presented as a diagnostic challenge. A 60-year-old Qatari lady presented with odynophagia, oral ulceration, and weight loss. Multiple physicians investigated her for over 6 months with a multitude of tests and serial gastroscopies, all of which failed to reach a conclusive diagnosis. Only after referral to a dermatologist and full body examination was diagnosis finally achieved. After reviewing the literature, we provide a summary of EBA and highlight the importance of comprehensive clinical reviews in order to avoid unnecessary morbidity. G. Kravvas, D. Veitch, and C. M. Perrett Copyright © 2016 G. Kravvas et al. All rights reserved.