Cutis verticis gyrata secondary to acne scleroticans capitis

We report the case of a 35-year-old patient with secondary cutis verticis gyrata (CVG) that histologically presented as acne scleroticans capitis. Clinically, the diagnosis of acne conglobata was made. The CVG developed under systemic corticosteroid treatment of an ulcerative colitis. Corticosteroids were discontinued and a therapeutic attempt was made with isotretinoin. Although under this treatment the conglobate acne healed, the CVG remained unaltered. Dermatosurgical intervention by a scalp reduction plasty finally resulted in a marked improvement of symptoms and acceptable cosmetic outcome.     

Cerebriform intradermal naevus (a rare form of secondary cutis verticis gyrata)

BACKGROUND: Acquired cerebriform intradermal naevus (CIN) is a rare form of pseudo cutis verticis gyrata. CASE REPORT: A case of acquired CIN of the scalp in a 46-year-old male patient is presented. The clinical and histopathological presentations of CIN are described and the therapeutic possibilities are discussed. CONCLUSIONS: In each individual case the physician must decide whether to do surgery or follow a wait-and-see policy. There is little risk of malignant change of CIN, and surgical excision of such lesions often involves evident mutilation.     

Primary essential cutis verticis gyrata in an adult female patient: a case report

Cutis verticis gyrata (CVG) is a very rare morphological condition of the scalp characterized by ridges and furrows resembling the surface of the brain. Primary or idiopathic CVG occurs in the absence of underlying soft-tissue abnormalities and is often associated with neuropsychiatric disorders. Secondary CVG occurs as a result of a local inflammatory or neoplastic process of the scalp or a systemic illness that produce pathologic changes in the scalp structure. The choice of treatment of CVG is surgical repair which depends on the size and location of the lesion, the underlying disorder, and the wishes of the patient, including primary repair, serial excision, skin grafting, local flaps and tissue expansion. In this case report, we describe the first female patient in the published work with primary essential CVG that appeared at 30 years of age. Because the patient had no cosmetic or functional complaint, no surgical intervention was attempted. Primary essential CVG, a very uncommon disorder, may be encountered in females after the third decade. The classification of CVG is essential to properly diagnose and treat patients who present with these unusual scalp lesions.     

Dynamic evolution of a scalp congenital melanocytic nevus with poliosis and cutis verticis gyrata

Cutis verticis gyrata (CVG), characterized by cerebriform overgrowth of the scalp, is rarely observed in congenital melanocytic nevi (CMN). We describe a 13-year-old male with autism and a large CMN of the scalp with numerous satellite nevi whose scalp nevus exhibited evolution with poliosis and CVG. Given the potential association of CVG (independent of CMN) with seizures, neuropsychiatric, and ophthalmologic disorders, and nevus-associated CVG (cerebriform intradermal nevus) with melanoma, multidisciplinary evaluation of CMN patients with CVG is important to guide management and treatment.     

Cutis verticis gyrata secondary to hypothyroid myxedema

A 62-year-old woman presented with an 11-year history of hypothyroidism and a hysterectomy performed 12 years previously. She was receiving thyroxin treatment and consulted for the appearance of asymptomatic grooves in the scalp over the past 3 years. The grooves had gradually increased in length and size. Exploration revealed multiple asymmetrically arranged grooves with raised areas in between that were especially noticeable upon palpation ( Fig. 1 ). The rest of the physical exploration was normal. Computerized axial tomography (CAT) exploration was performed, along with an electroencephalogram and simple X-ray examination of the skull and hands; no alterations were noted, however. Analytical studies (including hemogram, biochemistry, antinuclear antibodies, and hormones: thyrotropin (TSH), T3, free and total thyroxin, basal cortisol, follicle-stimulated hormone (FSH), luteinizing hormone (LH), progesterone, estradiol, testosterone, prolactin) only found a high cholesterol concentration (274 mg/dL) and low level of growth hormone. The remaining parameters were either normal or negative.

Figure 1 Open in figure viewer PowerPoint Multiple asymmetrically arranged grooves with raised areas in between that were especially noticeable upon palpation     

Cutis verticis gyrata secondary to a cerebriform intradermal nevus

We report the case of a 30-year-old black man with a large mass consisting of longitudinal parallel ridges and furrows on the left parietal region. A small, single, hyperpigmented macule was present at birth and gradually grew and extended over the years. Cutis verticis gyrata was suspected, and an investigation was performed to discharge the possibility of pachydermoperiostosis. However, results of biopsies obtained from 3 different lesional areas showed the same histopathologic features--deep-seated hair follicles and clusters of nevus cells concentrated in the dermis. Cerebriform intradermal nevus is a rare cause of cutis verticis gyrata. Early diagnosis is extremely important to prevent the development of malignant melanoma.     

Disseminated linear calcinosis cutis associated with the Koebner phenomenon in an infant with congenital acute monocytic leukaemia

We present a unique case of an infant with acute monocytic leukaemia who presented at birth with multiple rubbery, erythematous to violaceous subcutaneous nodules secondary to leukaemia cutis. As these infiltrates regressed with chemotherapy, numerous white to yellow linear confluent papules appeared in a scratch-like pattern. These lesions were widely disseminated but were concentrated across her face, trunk and extremities with relative sparing of the napkin area and back. We propose that these lesions represent a form of dystrophic calcinosis cutis that occurred secondary to koebnerization in an infant with congenital leukaemia cutis.     

Skin involvement in chronic myelomonocytic leukaemia as a predictor of transformation into acute myeloid leukaemia.

We report on the case of a patient with myelodysplastic syndrome (MDS) who presented with leukaemia cutis preceding development of acute myeloid leukaemia. Leukaemic infiltration of the skin should be considered an early manifestation of leukaemic transformation and an indicator of poor prognosis in MDS.     

Aleukaemic leukaemia cutis as an initial manifestation of myeloid/NK cell precursor acute leukaemia

Aleukaemic leukaemia cutis is a rare condition characterized by infiltration of leukaemic cells into the skin before they appear in the peripheral blood. We report a case of an aleukaemic leukaemia cutis, which had a history of exposure to atomic bomb radiation. A 57-year-old Japanese woman initially presented with a 20-week history of multiple red papules and plaques mainly over the trunk. Histological examination revealed the infiltration of atypical monocytic cells in the dermis, but no leukaemic cells were detected in the peripheral blood. Twenty-three weeks after the appearance of the eruption, leukaemic cells were detected in the peripheral blood for the first time. The results of immunohistochemistry of the skin biopsy specimen and flow cytometry of the peripheral blood indicated the rare phenotype of myeloid/NK cell precursor acute leukaemia. This is the first case report of myeloid/NK cell precursor acute leukaemia presenting as aleukaemic leukaemia cutis in the English literature, and awareness of this clinical presentation may be important to reach the correct diagnosis.     

Literature review of the mechanisms of acute kidney injury secondary to acute liver injury

People exposed to liver ischaemia reperfusion (IR) injury often develop acute kidney injury and the combination is associated with significant morbidity and mortality. Molecular mediators released by the liver in response to IR injury are the likely cause of acute kidney injury (AKI) in this setting, but the mediators have not yet been identified. Identifying the mechanism of injury will allow the identification of therapeutic targets which may modulate both liver IR injury and AKI following liver IR injury.     

血液及尿液中CysC、KIM-1、NGAL水平在肝硬化继发急性肾功能损伤患者中的诊断价值

目的通过检测血液及尿液中胱抑素C(cystatin C,CysC),肾损伤分子-1(neutrophilgelatinase associated lipocalin,KIM-1)及中性粒细胞相关载脂蛋白(neutrophilgelatinase associated lipocalin,NGAL)的水平,评价其在肝硬化继发急性肾功能损伤患者(acute kidney injury,AKI)中的诊断价值。方法选择2017年1月—2019年9月期间我院住院的肝硬化患者168例,其中肝硬化继发急性肾功能损伤患者84例(AKI组),单纯肝硬化患者84例(非AKI组)及同期体检的健康者102例(NC组),应用酶联免疫吸附法检测血液和尿液中CysC、KIM-1、NGAL、肌酐(serum creatinine,SCr)、肾小球滤过率(glomerular filtration rate,GFR)水平,分析上述各组的表达情况;根据Child-Pugh标准进行肝功能分级,根据2012年KDIGO诊断标准进行AKI的分期,比较不同Child-Puch分级及AKI分期患者血清CysC.SCr,GFR及尿KIM-1,NGAL水平,分析GFR与CysC.KIM-1.NGAL水平的相关性,利用工作特征性曲线(ROC)评价各指标对肝硬化患者发生AKI的诊断价值。结果AKI患者与非AKI组和NC组比较,血清CysC及尿KIM-1,NGAL,SCr水平显著升高,血清GFR显著降低(P<0.05);血清CysC,SCr及尿KIM-1,NGAL随肝硬化失代偿期的Child-Pugh分级及AKI分期加重而显著增加,血清GFR则显著降低(P<0.05);血清CysC及尿KIM-1.NGAL水平与较高的肾损伤指数分期呈正相关,与GFR呈负相关(P<0.05);ROC曲线示,CysC、KIM-1,NGAL水平的曲线下面积分别为0.909,0.790,0.864,敏感性分别为89.6%、78.3%,84.5%,特异性分别为92.0%、79.6%、83.3%。结论血清CysC及尿KIM-1,NGAL水平联合检测作为筛选指标,对失代偿性肝硬化继发AKI的早期诊断有一定的价值。