scholarly journals Multiple Keratoacanthomas after a Recent Tattoo: A Case Report

2021 ◽  
pp. 23-27
Author(s):  
Fouad Mitri ◽  
Wolfgang Hartschuh ◽  
Ferdinand Toberer
Keyword(s):  
Human Papillomavirus ◽  
Case Report ◽  
Safety Margin ◽  
Skin Lesions ◽  
Pcr Analysis ◽  
History Of ◽  
The Right ◽  
Red And Black Pigments

We report on a 39-year-old man who presented with seven skin lesions on the right thigh 3 weeks after receiving a large tattoo which included red and black pigments. Initially, the lesions grew fast, later their growth stabilized. Histopathology showed well-circumscribed symmetric tumors with a central keratin-filled crater along with further trademarks of a keratoacanthoma. The patient had previously had multiple tattoos with no history of similar lesions. PCR analysis of one of the lesions revealed the presence of human papillomavirus 6. All lesions were excised with a safety margin. A 3-month follow-up revealed no further lesions.

scholarly journals Giant lung metastasis of NRAS-mutant melanoma in a 24-year-old patient with a history of BRAF-mutant conventional melanoma harboring Spitzoid morphology: a case report

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Jiri Vachtenheim ◽  
Roman Kodet ◽  
Ondrej Fischer ◽  
Vitezslav Kolek ◽  
Zuzana Strizova ◽  
...  
Keyword(s):  
Case Report ◽  
Skin Lesion ◽  
Molecular Characterization ◽  
Lung Metastasis ◽  
Skin Lesions ◽  
Lung Tumour ◽  
Spitz Nevus ◽  
History Of ◽  
Braf Mutant

Abstract Background Spitzoid melanocytic lesions represent a heterogeneous group of proliferations with ambiguous and overlapping terminology. The exact distinction of a Spitz nevus from a Spitzoid melanoma can be very difficult or, in some cases, impossible. Among the Spitzoid lesions, there is a lesion termed an atypical Spitz tumour (AST) that has intermediate histopathologic features between those of a Spitz nevus and a Spitzoid melanoma and thus uncertain malignant potential. There are several rare cases of patients with a Spitzoid melanoma initially misdiagnosed as a Spitz nevus or an AST with fatal consequences. It is, therefore, advised to perform a molecular characterization in cases where uncertain skin lesions are presented, as it may provide extended set of information with a possible impact on the treatment options. Furthermore, preventive measures, such as regular physical and skin examinations, as well as thorough scheduling of individual follow-up visits, are essential in patients with potentially malignant skin nevi. Case report We report a case of a young adult female with a history of AST excision with a negative sentinel lymph node biopsy (SLNB) and insufficient follow-up. Four years after the primary dermatological diagnosis, she presented with a giant tumour in the right hemithorax. Radical en bloc resection of the tumour with right pneumonectomy and resection of the pericardium with reconstruction of the pericardium using mesh was performed. A definitive histopathological examination revealed a metastatic melanoma. The association of the previously diagnosed AST and subsequent appearance of melanoma metastases led to a retrospective re-evaluation of the initial lesion. The suspected diagnosis of Spitzoid melanoma, however, was not confirmed. Moreover, the molecular examination revealed a major discordance between the initial lesion and the lung tumour, which most likely excluded the possible association of the lung metastasis with the initial skin lesion. The initial skin lesion was a BRAF-mutant melanoma with Spitzoid features and termed as AST, while the giant lung metastasis was NRAS-mutant melanoma. The subsequent postoperative course was complicated by the appearance of brain metastases that were stereotactically irradiated. Nevertheless, despite complex specialised medical care, the patient’s clinical condition rapidly deteriorated. By this time, no active oncological treatment was possible. The patient was delegated to local hospice for palliative care six months after the surgery and died three weeks later. Conclusions Our patient was surgically treated at the age of 20 for AST and died four years later of metastatic NRAS-mutant melanoma most likely of different occult origin. Molecular characterization, as well as the close clinical follow-up should be always precisely performed in patients with uncertain skin lesions, such as AST.

scholarly journals EP13 A standard case of reactive arthritis? Plot twist!

Rheumatology ◽  
2020 ◽  
Vol 59 (Supplement_2) ◽  
Author(s):  
ANU DESAI ◽  
Elizabeth Justice ◽  
Mahjabeen Rahman ◽  
Aimee Johnson
Keyword(s):  
Synovial Fluid ◽  
Tissue Sample ◽  
Total Duration ◽  
Pcr Analysis ◽  
High Grade Fever ◽  
Standard Case ◽  
Negative Culture ◽  
History Of ◽  
The Right

Abstract Background A 49 year old male patient presented to the acute medical unit with history of acute onset high grade fever with polyarthritis involving right knee, left elbow, both ankles and small joints of right hand preceded by 2 days of diarrhoea and vomiting. He had temperature of 38°C, BP: 156/77 mmHg, Pulse rate: 98/min. Initial blood tests: CRP: 312, ESR: 51, and leucocytosis (WBC count: 17.9 with neutrophilia: 13.1). The medical team considered diagnosis of multifocal septic arthritis and initiated IV flucloxacillin empirically. He had past medical history of recently treated extra pulmonary tuberculosis three months prior to admission. Methods CT thorax abdomen and pelvis scan was organised to rule out reactivation of tuberculosis/Poncet’s arthritis. CT revealed generalised lymphadenopathy and bilateral hip effusions. At this point, a Rheumatology opinion was requested, a synovial fluid aspiration from the right knee, the most affected joint, was performed. The turbid sample had numerous pus cells, but negative gram stain and negative cultures after prolonged culture. AFB stain was negative. He was improving systemically but had intermittent fevers and CRP remained high (155mg/l). Synovial fluid sample was sent for 16S PCR testing and Streptococcus pyogenes ribosomal DNA was detected. Testing for serum ASO titres revealed elevated titres (32000 IU/mL). In conjunction with microbiology team, we augmented antibiotics to IV Gentamicin and IV Ceftriaxone. A careful history revealed transient throat infection of 6 hours duration 10 days prior to onset of arthritis. Urinary dipstick and ACR revealed proteinuria (ACR 84.8). This is under close follow-up with renal team who feel that post Streptococcal Glomerular Nephritis is likely but deferred renal biopsy. 2 DECHO study ruled out valve abnormality. A right inguinal lymph node biopsy was attempted; however, tissue sample was unsuitable. Hepatitis screen was negative and Antibody panel (ANA, ANCA were negative, RF: borderline positive (26) were unremarkable. He received total duration of 31 days of antibiotics. CRP eventually improved to 13, on follow up, in view of persisting arthritis, orals steroids (15mg OD) was prescribed for three weeks. Results Thus, we achieved a compelling diagnosis of acute rheumatic fever, with possible focus in the throat and probably bacteraemic spread to the right knee. PCR analysis of synovial fluid in context of negative culture guided antibiotic therapy choice, duration and cautious approach for immunosuppression. The patient’s story evolved with development of proteinuria suggestive of possible post streptococcal glomerulonephritis which is under follow up. Conclusion Rheumatologists are faced with challenge of reviewing ill patients with joint effusions in whom empirical antibiotics have been started. In this scenario, joint aspiration yields lower positive culture results. 16S PCR analysis can help in guiding antibiotic choice and duration with negative culture. Disclosures A. Desai None. E. Justice None. M. Rahman None. A. Johnson None.

scholarly journals An Atypical Presentation of Sympathetic Ophthalmia in an Intact Globe Following Mechanical Fall: A Case Report and Literature Review

Vision ◽  
2021 ◽  
Vol 5 (1) ◽  
pp. 11
Author(s):  
Chung Shen Chean ◽  
Christina S. Lim ◽  
Periyasamy Kumar ◽  
Bharat Kapoor
Keyword(s):  
Case Report ◽  
Sympathetic Ophthalmia ◽  
Vitreous Haemorrhage ◽  
Keratic Precipitates ◽  
Globe Rupture ◽  
History Of ◽  
The Right ◽  
Comprehensive History ◽  
Penetrating Ocular Trauma

Purpose: To describe an atypical case of sympathetic ophthalmia presenting after blunt trauma causing disinsertion of the iris in an intact globe. Methods: Case report. Results: A 71-year-old lady presented to the Emergency Department following a mechanical fall. On examination, she was noted to have periocular haematoma, subconjunctival haemorrhage, hyphaema, and vitreous haemorrhage in the left eye, but there was no evidence of globe rupture. The presenting visual acuity was 6/18. As the hyphaema and vitreous haemorrhage settled, a complete loss of the iris was noted with normal fundus. She was re-admitted a month later under the medical team with urinary tract infection and reduced vision in both eyes. On examination, there was mild conjunctival injection, keratic precipitates, anterior chamber flare, 180-degree posterior synechiae, and vitritis with no fundal view of the right eye. She was diagnosed with sympathetic ophthalmia and was treated with topical and systemic corticosteroid. Her vision improved gradually with treatment and was stable at 6/6 on the right (sympathising) eye and 6/9 on the left (excited) eye at final follow-up. Conclusion: Sympathetic ophthalmia may result from non-penetrating ocular trauma. Comprehensive history of mechanism of injury and ophthalmic examination is essential so that prompt treatment can be given to improve the visual prognosis of affected patients.

scholarly journals Hydatid bone disease of the humerus: A case report from East Africa

2021 ◽  
Vol 2 (4) ◽  
Author(s):  
Antonio Loro ◽  
◽  
Francesca Loro ◽  
Niall Brown ◽  
◽  
...  
Keyword(s):  
Case Report ◽  
Bone Disease ◽  
Appendicular Skeleton ◽  
First Case ◽  
Healing Fracture ◽  
Health Centres ◽  
Diagnostic Difficulties ◽  
History Of ◽  
The Right

Skeletal hydatidosis is extremely rare and involvement of the long bones of the appendicular skeleton is exceptional. We report on a case of a 68-year-old Ugandan woman who presented with a long standing history of a non-healing fracture of the mid-diaphysis of the right humerus. She had undergone multiple surgeries in peripheral health centres during the previous years. A shoulder disarticulation was carried out in our facility in agreement with the patient, who refused any other attempt of bone reconstruction. A diagnosis of hydatid bone disease was confirmed intra-operatively. There is no recurrence of the disease for a two-year follow-up period. To our knowledge this is the first case report of skeletal hydatosis in Uganda. It emphasises the diagnostic difficulties and delays, and how this led to inadequate management for the patient in this case.

scholarly journals  Erythema multiforme minor in a dog following inappropriate intranasal Bordetella bronchiseptica vaccination: a case report

2011 ◽  
Vol 56 (No. 11) ◽  
pp. 568-572 ◽  
Author(s):  
MH Kang ◽  
HM Park
Keyword(s):  
Case Report ◽  
Erythema Multiforme ◽  
Clinical Signs ◽  
Skin Lesions ◽  
Bordetella Bronchiseptica ◽  
Hydropic Degeneration ◽  
First Case ◽  
History Of ◽  
One Year

A one-year-old, intact female, Yorkshire terrier dog was presented with a six-month history of multifocal, polycyclic erythematous lesions with epidermal collarette formation at the axillae, the trunk and ventral abdomen. The dog had a history of an inappropriate vaccine administration one day prior to the onset of clinical signs. The histopathology of the lesions revealed apoptosis of keratinocytes in the overlying epidermis, hydropic degeneration and lymphocytic exocytosis. The clinical signs and histopathology of the lesions were compatible with erythema multiforme. The skin lesions resolved after treatment with prednisolone combined with azathioprine for one month. No recurrence of clinical signs occurred during the follow-up period (four months). This is the first case report of erythema multiforme associated with an accidental subcutaneous injection of a Bordetella bronchiseptica vaccine.  

scholarly journals Composite Pheochromocytoma With Ganglioneuroblastoma: A Case Report

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A994-A995
Author(s):  
Paola M Lockhart Pastor ◽  
Beatrice Y Wong ◽  
Simona Stefan
Keyword(s):  
Case Report ◽  
Clinical Status ◽  
Adrenal Incidentaloma ◽  
Uncontrolled Hypertension ◽  
Catecholamine Excess ◽  
History Of ◽  
The Right ◽  
Hormonal Evaluation ◽  
Composite Pheochromocytoma

Abstract Introduction: A composite pheochromocytoma (PC) is an adrenal tumor that is often diagnosed post-operatively on histopathology. PCs are unique in that it is a combination of typicalpheochromocytoma and neural crest derived tumors. The incidence is reported to be less than 3%of adrenal neoplasms. The most common co-existing tumor within a PC is a ganglioneuroma. Wepresent a rare case of PC containing ganglioneuroblastoma (PC-GNBL) in a woman withoutsignificant biochemical manifestation of excess catecholamine production. Case Report: A 63-year-old woman with a prolonged history of uncontrolled hypertension on 4 oral anti-hypertensive medications (Amilodipine 10mg daily, Valsartan/HCTZ 320/25mg daily andClonidine 0.1mg/24h patch) and uncontrolled type 2 diabetes on insulin was diagnosed with a1.5x1.8x1.5cm right adrenal incidentaloma 2 years prior on CT imaging for abdominal pain. Hormonal evaluation was notable for plasma free metanephrine of 66 (<57pg/ml),normetanephrine 229 (<148pg/ml), and total metanephrines of 295 (205 pg/ml). However, 24-hour urine metanephrine evaluation was normal on two occasions: metanephrine 121 and 168mcg/24h (90-315), norepinephrine 237 and 336 mcg/24h (122-676) and total metanephrines 358and 504mcg/24 h (224-832). Hyperaldosteronism and hypercortisolism were ruled out. Follow-up CT scan 14 months later demonstrated growth of the right adrenal nodule to 1.7x2x2cm with49% washout. She underwent laparoscopic right adrenalectomy without perioperativecomplications. Pathology was consistent with a PC-GNBL. The PASS score was 7, consistentwith malignant pheochromocytoma. Within weeks of surgery, she had marked clinicalimprovement. Blood pressure was controlled on one anti-hypertensive and Hgb A1c decreased to7.1% from 11% without requiring insulin. CT abdomen/pelvis 6 months post-operatively did notshow evidence of metastasis. She was referred for genetic testing. Conclusion: This case highlights an unusual presentations of pheochmocytoma. It’s important to recognizethat resistant hypertension can present without episodic headaches, diaphoresis, palpitations, andwithout biochemical evidence of catecholamine excess. Composite PCs are indistinguishableclinically or radiologically from ordinary pheochmocytomas. These exceedingly rare mixedtumors are only diagnosed via surgical pathology. To date, there are only a few cases reported inthe medical literature of co-existing PC-GNBL tumors. Due to the scarcity of composite PCscases, important information regarding its presentation and prognosis are unknown. It remains tobe seen whether the GNBL part of the tumor changes the prognosis of the tumor. However, inour case, the clinical status of our patient improved.

Popliteal artery thrombosis secondary to a tibial osteochondroma

VASA ◽  
2011 ◽  
Vol 40 (3) ◽  
pp. 251-255 ◽  
Author(s):  
Gruber-Szydlo ◽  
Poreba ◽  
Belowska-Bien ◽  
Derkacz ◽  
Badowski ◽  
...  
Keyword(s):  
Case Report ◽  
Magnetic Resonance Angiography ◽  
Popliteal Artery ◽  
Doppler Ultrasonography ◽  
Histopathological Examination ◽  
Previous History ◽  
Plain Radiography ◽  
Artery Thrombosis ◽  
History Of ◽  
The Right

Popliteal artery thrombosis may present as a complication of an osteochondroma located in the vicinity of the knee joint. This is a case report of a 26-year-old man with symptoms of the right lower extremity ischaemia without a previous history of vascular disease or trauma. Plain radiography, magnetic resonance angiography and Doppler ultrasonography documented the presence of an osteochondrous structure of the proximal tibial metaphysis, which displaced and compressed the popliteal artery, causing its occlusion due to intraluminal thrombosis..The patient was operated and histopathological examination confirmed the diagnosis of osteochondroma.

Adenoid cystic carcinoma of the labium oris with rare metastasis to the pleural cavity

2021 ◽  
Vol 14 (1) ◽  
pp. e237622
Author(s):  
Osama Mosalem ◽  
Anas Alsara ◽  
Fawzi Abu Rous ◽  
Borys Hrinczenko
Keyword(s):  
Side Effects ◽  
Adenoid Cystic Carcinoma ◽  
Pleural Cavity ◽  
Epigastric Pain ◽  
Asian Woman ◽  
Upper Lip ◽  
Adenoid Cystic ◽  
History Of ◽  
The Right

A 57-year-old Southeast Asian woman with a remote history of adenoid cystic carcinoma (ACC) of the right labium superius oris (upper lip) presented to the hospital with vague epigastric pain. On workup, she was found to have multiple pleural nodules. Histopathology confirmed the diagnosis of metastatic ACC. After 8 months of active surveillance, evidence of disease progression was found and the patient was started on pembrolizumab. Follow-up after starting pembrolizumab showed stable disease with no significant side effects.

scholarly journals COVID-19-associated rhino-orbital mucormycosis (CAROM)—a case report

2021 ◽  
Vol 52 (1) ◽  
Author(s):  
Humsheer Singh Sethi ◽  
Kamal Kumar Sen ◽  
Sudhansu Sekhar Mohanty ◽  
Sangram Panda ◽  
Kolluru Radha Krishna ◽  
...  
Keyword(s):  
Case Report ◽  
Health Care Professionals ◽  
Opportunistic Infections ◽  
Fungal Spores ◽  
Nasal Discharge ◽  
Contributing Factors ◽  
Post Discharge ◽  
Pulmonary Mucormycosis ◽  
The Right

Abstract Background There has been a rapid rise in the number of COVID-19-associated rhino-orbital mucormycosis (CAROM) cases especially in South Asian countries, to an extent that it has been considered an epidemic among the COVID-19 patients in India. As of May 13, 2021, 101 CAROM cases have been reported, of which 82 cases were from India and 19 from the rest of the world. On the other hand, pulmonary mucormycosis associated with COVID-19 has a much lesser reported incidence of only 7% of the total COVID-19-associated mucormycosis cases (Singh AK, Singh R, Joshi SR, Misra A, Diab Metab Syndr: Clin Res Rev, 2021). This case report attempts to familiarize the health care professionals and radiologists with the imaging findings that should alarm for follow-up and treatment in the lines of CAROM. Case presentation Rhino-orbital mucormycosis (ROM) is a manifestation of mucormycosis that is thought to be acquired by inhalation of fungal spores into the paranasal sinuses. Here, we describe a 55-year-old male, post COVID-19 status with long standing diabetes who received steroids and ventilator therapy for the management of the viral infection. Post discharge from the COVID-19 isolation ICU, the patient complained of grayish discharge from the right nostril and was readmitted to the hospital for the nasal discharge. After thorough radiological and pathological investigation, the patient was diagnosed with CAROM and managed. Conclusion Uncontrolled diabetes and imprudent use of steroids are both contributing factors in the increased number of CAROM cases. Our report emphasizes on the radiological aspect of CAROM and reinforces the importance of follow-up imaging in post COVID-19 infection cases with a strong suspicion of opportunistic infections.

scholarly journals Urrets-Zavalia Syndrome Following Cataract Surgery

2021 ◽  
pp. 659-663
Author(s):  
Shimon Kurtz ◽  
Maayan Fradkin
Keyword(s):  
Intraocular Pressure ◽  
Case Report ◽  
Cataract Surgery ◽  
Anterior Chamber ◽  
Inflammatory Reaction ◽  
Intraocular Lens Implantation ◽  
Postoperative Course ◽  
Lens Implantation ◽  
The Right

We describe a case of Urrets-Zavalia syndrome (UZS) in a healthy 56-year-old woman who underwent femtosecond-assisted phacoemulsification with intraocular lens implantation in both eyes. One month after an uneventful postoperative course in the left eye, the right eye was operated. Dilated pupil which was nonreactive to light appeared on day 21 postoperatively. This was discovered upon examination following anterior chamber inflammatory reaction which occurred 2 weeks following her surgery. Our case report emphasizes the importance and danger in developing UZS even if the reaction in the anterior chamber does not occur immediately after surgery. In addition, the importance of intraocular pressure follow-up in the period after UZS is acknowledged.

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