Mucocele: A case report with brief review

Mucocele is a clinical term that basically includes two phenomenon i.e. mucus extravasation and mucus retention. Cysts arising in connection with minor salivary glands are common and about 90 per cent of cases are of the mucous extravasation type. These lesions are typically painless, dome-shaped, and fluctuant; they appear blue in colour secondary to the presence of mucin under the mucosa. The vesicular appearance created by the superficial nature of the mucin spillage, causes a separation of the epithelium from the connective tissue. The pathologist must be aware of this lesion and should not mistake it microscopically for a vesiculo-bullous lesion, especially mucous membrane pemphigoid. Here, we present a case report on mucocele with a brief review.

Refractory pneumothorax and hemothorax associated with metastatic scalp angiosarcoma

Background Pulmonary metastasis of scalp angiosarcoma (SA) is a rare, but life-threatening disease, challenging to diagnose and manage. We report two cases of pneumothorax and hemothorax with pathologically proven metastasis of SA in the parietal pleura, which was not predictable from images and difficult to manage. Patient A A 73-year-old man with SA underwent chemoradiotherapy and surgical resection for primary skin lesion, was sent to our department to treat right empyema, which was developed during chest tube drainage for pneumothorax. Computed tomography (CT) showed multiple bullous lesions. We performed repetitive video-assisted thoracoscopic surgery (VATS) for the debridement and hemostasis; however, hemothorax was uncontrollable. The repeated cytology of pleural effusion showed no malignancy. We eventually performed fenestration and metastatic SA was pathologically diagnosed by the biopsy of parietal pleura. The patient developed respiratory failure and uncontrolled anemia, which were fatal. Patient B A 71-year-old man with SA previously treated with chemoradiotherapy was referred to our department for left pneumothorax. CT showed multiple bullous lesions at apex without any changes at parietal pleura. VATS was performed and the apex bullous lesion with air leakage was resected. The parietal pleura showed several dark-red spots and the biopsy was undertaken. The pathological diagnosis was a metastasis of SA along with visceral pleura and parietal pleura. The patient then developed right pneumothorax and left hemopneumothorax. Bilateral pleurodesis was ineffective and the patient died due to deteriorating general condition. Conclusions In patients with a history of SA who develop pneumothorax and hemothorax, metastatic SA to visceral and parietal pleura should be always considered. Surgical biopsy, not cytology, is needed for pathological diagnosis. Lesions in the parietal pleura prior to hemothorax were thoracoscopically observed in one case. Surgeons must recognize that conventional surgical intervention or pleurodesis will have unsatisfactory results.

Vajra Bhasma, Ayurvedic medicine: a rare and unusual cause of Lyell’s syndrome and its successful management

Toxic epidermolysis necrosis (TEN) or Lyell syndrome is a potentially life-threatening immunological adverse skin disease, which mostly occurs secondary to the intake of an offending drug. It commonly manifests as a widespread exfoliating bullous lesion in skin and mucous membrane mimicking superficial burns and may result in hypovolemic and/or septic shock. Authors report an unusual case of Lyell’s syndrome in a 42-year-old woman, secondary to the intake of Ayurveda medicine ‘Vajra Bhasma’ (Diamond Ash) prescribed by an Ayurveda physician for treatment of her trigeminal neuralgia. After 8th day of continuous medication intake, she had prodromal illness and rapidly developing exfoliative skin lesion extended over 80% of total body surface area, breathing difficulty, dizziness and anuria. The case was successfully managed by timely diagnosis, adequate hydration and administration of immunoglobulins. After 17 days, the skin epithelium regenerated, and she improved clinically with some depigmented lesions at discharge, which were normalised without any sequel during her further follow-up visits in hospital. Identification and withdrawal of the suspected drug, adequate resuscitation and early immunoglobulin administration are critical in management of TEN.

A Case Report on Idiopathic Severe Bullous Pemphigoid

Bullous Pemphigoid (BP) is an autoimmune disorder which exploits the immune system and affecting sub-epidermal region of skin causing mild itching to infection and blistering of sub-epidermal region. Clinical presentations are pruritis, urticarial, papular lesions. These later evolve to bullae in weeks to months and are typically present in the axillae, on the flexor surface of the forearms, medial thighs, trunk, and abdomen. The treatment for bullous pemphigoid is systemic corticosteroids, topical steroids in combination with nicotinamide plus tetracycline, minocycline or doxycycline have shown success in multiple cases. Immunosuppressive therapy is used when steroids do not control the disease or if patients have contraindications for systemic corticosteroid treatments. Patient was brought to emergency department with chief complaints itching, redness, bullous lesion all over the body for 2 months.Oral complaints including solitary erosion seen on right side of buccal mucosa, pharyngeal erythema. Laboratory investigations were carried out. Patient was diagnosed based on physical examination. Patient was provided with adequate treatment and counseling. Keywords: Bullous Pemphigoid, corticosteroid, Autoimmune disorder, sub-epidermal region.

LINEAR IG A BULLOUS DERMATOSIS – CASE REPORT

Linear IgA bullous dermatosis (LABD) is a rare, immune-mediated cutaneous pathology, characterized by IgA deposits along the basal membrane. Clinically, it manifests as an eruption, consisting of vesicles and bullae, with herpetiform distribution, on erythematous and/or normal skin. The lesions are located symmetrically, at the level of the trunk and extremities. Clinically, diagnosis can be difficult because it can be easily mistaken with dermatitis herpetiformis or bullous pemphigoid. We present the case of a 79-years-old woman, without significant comorbidities, who developed a vasculo-bullous eruption, intensely itchy, located symmetrically on trunk and extremities, evolving for 4 years. We performed a skin biopsy, with histopathological examination and direct immunofluorescence, which revealed: sub epidermal vesicular-bullous lesion and dermal infiltrate with numerous neutrophils and eosinophils; IgA - continuous linear positivity at the dermal-epidermal junction. Thus, the diagnosis of LABD was established. The treatment consisted of systemic corticosteroids, colchicine, and antihistamines, with favorable evolution. The management of these patients can be challenging, as LABD can be induced by certain drugs, and may also be associated with lymphoid malignancies.

Bullous aplasia cutis congenita: A report of two cases and brief review of the selected literature

Introduction. Aplasia cutis congenita (ACC) is a rare condition characterized by the focal absence of skin, and sometimes other underlying structures at birth. It may occur as an isolated defect or associated with other anomalies and defects. Bullous ACC (BACC) is a clinical subtype of the condition with few cases reported in the literature. It presents as a bullous lesion at birth which gradually transforms into an atrophic scar covered by a thin epithelial membrane. It is considered as cutaneous sign of possible neural tube dysraphism. Some cases present with a dark hair around the lesion (the hair collar sign), which can be even more indicative of neural tube defect. However, cases of BACC reported till today are inconclusive regarding this connection. Case report. We report a two cases of BACC of the scalp, in one patient associated with hair collar sign without neural tube defects and the other with hemangioma and we give a brief review of the selected literature. Conclusion. Bullous or membranous aplasia cutis congenita is benign condition, but may represent as a cutaneous marker of occult neural tube defect. Recognising the condition is important in order to rule out associated anomalies.

Bullous keratopathy in a yellow-headed caracara (Milvago chimachima) treated with a modified third eyelid flap

ABSTRACT: A Yellow-headed Caracara (Milvago chimachima) was submitted to the Ophthalmology Service of the Federal University of Bahia with a corneal abnormality. During ophthalmic evaluation the right cornea was stained positively with fluorescein; a blurred bullous lesion, with irregular surface, compatible with the diagnosis of bullous keratopathy was found. This is a rare condition in a bird which was treated successfully with a modified third eyelid flap associated with antibiotic and hyaluronic acid eye drops. The adopted therapeutic proved to be simple to implement and viable for repair of the bullous keratopathy in the Yellow-headed caracara.

Low Molecular Weight Heparin Induced Bullous Hemorrhagic Dermatosis

Heparin-induced bullous hemorrhagic dermatosis is a rare, recently described side-effect of subcutaneous heparin injection. We present a case of a male patient with a bullous hemorrhagic eruption following the administration of subcutaneous LMWH. A diagnosis of Heparin-induced bullous hemorrhagic dermatosis was made by HPE (Histopathological examination) of tissue biopsy from the bullous lesion and the exclusion of other laboratory finding.