Intravascular large cell lymphoma

A 19‐year‐old female presented at our hospital with a 1‐year history of a 5‐cm indurated nontender lesion on the left shoulder. Two months later, a similar lesion appeared in the left mammary region, accompanied by necrosis and fever. At admission to our department, she presented disseminated lesions in the left submandibular region, the sternal area and the posterior part of the upper and lower extremities. The lesions were indurated erythematous‐violaceous plaques affecting the adipose tissue, some with ulcerations and necrotic crusting ( Fig. 1 ). The first histopathological report was thrombosis of the capillary vessels and focal vasculitis ( Fig. 2 ).

Figure 1 Open in figure viewer PowerPoint Ulceration and necrotic crusting lesion in the left mammary region     

The papulokeratotic type of solitary benign lichenoid keratosis

A 67‐year‐old housewife was referred to us for a papulonodular keratotic lesion on the left side of the left eyebrow ( Fig. 1 ). The lesion had started to develop 6 months earlier and had gradually reached a size of 2 cm in diameter. It was firm, nonitching, and painless on pressure.

Figure 1 Open in figure viewer PowerPoint Papulokeratotic lesion on the left eyebrow     

Waardenburg syndrome: case report

A 15-year-old Arab boy presented with congenital deafness, heterochromia iridis (right, brown; left, blue), poliosis (white forelock), with an area of leukoderma beneath the forelock, broad nasal root, and lateral displacement of the medial canthi ( Fig. 1 ). Further investigation revealed that one of his siblings was similarly affected. The child was diagnosed with Waardenburg syndrome.

Figure 1 Open in figure viewer PowerPoint Waardenburg syndrome: white forelock, heterochromia iridis, broad nasal root, leukoderma and hypertrichosis of medial eyebrows     

A case of basal cell carcinoma arising in epidermal nevus

A 24‐year‐old man was admitted to our outpatient clinic with lesions in a linear configuration. On dermatologic examination, widespread, dark brown, warty papules and plaques over an erythematous base, following Blaschko"s lines, extended from the middle of the chest to the right arm. These lesions had been present on the chest since birth and had gradually extended during childhood. Recently, a nodular lesion had appeared in the pre‐existing epidermal nevus in the middle part of the chest ( Fig. 1 ). The nodular lesion was totally excised by a plastic surgeon.

Figure 1 Open in figure viewer PowerPoint Basal cell carcinoma (white arrow) appearing on the epidermal nevus in the middle part of the chest     

Barraquer-Simons syndrome with benign infundibulocystic proliferation

A white man attended our outpatient clinic because of soft papules on the second finger of the left hand. They were livid red‐colored, warty surfaced cysts, 1–2 cm in diameter, arranged in an annular configuration ( Fig. 1 ). The patient showed prominent zygomatic bones and symmetric loss of buccal fat pads (Bichat's fats), leading to sunken cheeks ( Fig. 2 ). The history of the patient could not be taken because of his debility.

Figure 1 Open in figure viewer PowerPoint Soft papules on the second finger of the left hand     

Faun tail: a rare cutaneous stigma of spinal dysraphism

A 13‐year‐old girl was referred to our dermatology outpatient clinic for the treatment of a congenital, circumscribed, hypertrichotic area on the lumbosacral region because it was cosmetically embarrassing. Dermatologic examination revealed a 25 × 15 cm circumscribed hypertrichotic area on the lumbosacral region. Coarse, dark, terminal hairs were observed, but the underlying skin was normal ( Fig. 1 ). The lesion had been present since birth. Her history also revealed back pain, which developed by 3 years of age, and a long history of urinary incontinence. On neurologic examination, no motor weakness or sensory changes were observed. On orthopedic examination, minimal atrophy and 2 cm shortening of the right leg were detected, and the right foot was smaller than the left. There was an accentuation of lumbar lordosis. There was no history of a similar lesion in the family. There was no consanguinity in the relatives.

Figure 1 Open in figure viewer PowerPoint Clinical appearance of the patient 6 months after operation     

Three cases of cutaneous sparganosis.

Case 1 A 64‐year‐old man visited our clinic complaining of an asymptomatic nodule on his right thigh, detected 10 days previously. Physical examination revealed a solitary subcutaneous nodule, 1.5 cm in diameter on his right thigh. Twenty years previously the patient had undergone surgery to remove a ‘‘worm’' from his leg. The patient stated that he enjoyed eating raw snakes. On performing excisional biopsy of the lesion, the white, flat, shiny sparganum was detected and removed ( Fig. la ). The histopathological study of the biopsy specimen showed several encapsulated, mummified sparganum pieces and dense lymphohistiocytic infiltration along with neutrophils and eosinophils ( Fig. lb) .

Figure 1 Open in figure viewer PowerPoint (a) A flat, band‐like, white glistening sparganum being removed from the right thigh of case 1. (b) An encapsulated, mummified sparganum piece showing degenerated internal organs (hematoxylin and eosin × 40)     

Bowen's disease: an uncommon presentation

A 60‐year‐old man presented with a lesion over the abdomen of 12–13 years’ duration. The lesion had been gradually progressing over the years and was asymptomatic. It had been treated by application of 5‐fluorouracil in 1993, which had resulted in partial regression; however, it started to grow again. A similar lesion had occurred over the left thigh, 2 years after the abdominal lesion appeared, and was excised. Past personal and family history was noncontributory. General and systemic examination revealed no abnormality. Dermatologic examination revealed a plaque, 18 cm × 15 cm in size, over the abdomen. It was well defined and erythematous. In places, hyperpigmented, verrucous, firm papules of various sizes were seen at the periphery and center of the lesion. There was no atrophy, ulceration, bleeding, and lymphadenopathy ( Fig. 1 ). A differential diagnosis of hyperkeratotic lupus vulgaris, Bowen's disease, pagetoid type of basal cell carcinoma, squamous cell carcinoma, and superficial spreading melanoma was considered.

Figure 1 Open in figure viewer PowerPoint Clinical photograph of lesion over the abdomen     

Purpuric pityriasis rosea

A 17‐year‐old young man presented with a 2‐week history of an asymptomatic widespread eruption affecting the trunk and arms. On physical examination we observed multiple, oval purpuric macules and papules, 1–3 cm in diameter, distributed in a “christmas tree” pattern on the trunk and arms ( Figs 1 and 2 ). There was no sign of a herald patch and mucosal examination was normal.

Figure 1 Open in figure viewer PowerPoint Lesions distributed in christmas tree pattern on the trunk     

Warty and clear cell Bowen's disease

A 54-year-old man presented with multiple lesions (seven) on the lower extremities and abdomen. These lesions had been present for at least 12 years with gradual growth and some had spontaneously disappeared; all were asymptomatic. Some of them had been treated with topical steroids and antimycotic creams with poor results. Past personal history was uneventful, but family history revealed the death of a son from metastatic visceral carcinoma. On dermatologic examination, six erythematous plaques of similar appearance were observed on the legs, abdomen and buttocks. All averaged 3 × 4 cm, with well-defined but irregular borders that did not seem to be infiltrated. On the skin surface, thick scales and crusts were present. Areas of spontaneous involution with residual hypopigmentation were present. On the dorsum of the left foot the biggest lesion was observed, measuring 4 × 8 cm. Unlike other lesions this was verrucous in appearance, with peripheral inflammation ( Fig. 1 ). No ulceration or regional lymphadenopathies were present. General physical examination was unremarkable.

Figure 1 Open in figure viewer PowerPoint The warty lesion located at the ankle     

Infraorbital eyelid edema as the presenting sign of bronchogenic carcinoma

A 59‐year‐old man presented at our department with a 4‐week history of persisting and therapy‐refractory infraorbital edema ( Fig. 1 ). There was no previous history of eyelid edema, allergic reactions, autoimmune diseases, or new medications. Earlier therapy with corticosteroids and antihistamines was ineffective.

Figure 1 Open in figure viewer PowerPoint Persistent swelling of both infraorbital folds     

Cutaneous and neurologic manifestations of biotinidase deficiency

A male newborn with no obstetric or familial antecedents, except that his parents were cousins, developed hypotonia, lethargy, and feeding problems from birth. Analysis revealed a marked metabolic acidosis and hyperammonemia. Three weeks later, he was admitted to hospital in order to receive parenteral nutrition and to undertake a study for metabolic diseases. The boy did not improve in spite of the use of parenteral nutrition and began to present with inspiratory stridor and tachypnea. One week later, he presented with an erythematous scaling eruption, which was especially intense in the lumbosacral region ( Fig. 1a,b ).The scalp was only slightly affected.

Figure 1 Open in figure viewer PowerPoint Erythematous scaling eruption, more intense in the lumbosacral region     

Prolidase deficiency

A 32‐year‐old mentally retarded woman was admitted to hospital with recurrent ulcers on her legs, which appeared for the first time at 8 years of age. Apart from recurrent lower respiratory tract infections and chronic otitis media, her personal history was unremarkable. Her parents were second‐degree relatives. The family history showed no similar disease or mental retardation. Physical examination revealed that the patient had an unusual facial appearance, with a high‐arched palate; she had multiple tooth caries ( Fig. 1 ).

Figure Figure 1  Open in figure viewer PowerPoint Facial appearance of the patient     

Granuloma faciale associated with adenocarcinoma of the prostate

A 65‐year‐old man presented to the Dermatology Outpatient Department complaining of an eruption of 10 years’ duration. He also suffered from hypertension, coronary artery disease, and diabetes mellitus for which he received mononitrate isosorbide, propranolol, nifedipine, aspirin, and glimepinide; he showed well‐controlled hypertension and blood glucose. He had consulted several dermatologists since the appearance of the eruption. A diagnosis of cutaneous leishmaniasis had been made. Although the diagnosis had not been confirmed by histology, the patient had received injections of steroids without any apparent improvement. On clinical examination, the eruption was noticed on the front and anterior area of the scalp ( Fig. 1 ). It consisted of pink‐ to red‐colored papules, which had become confluent and formed large plaques. The lesions had extended with time and were totally asymptomatic.

Figure Figure 1  Open in figure viewer PowerPoint Clinical appearance at initial consultation     

Metastatic gastric cancer presenting as a solitary axillary cutaneous nodule

An 84‐year‐old man, with a medical history of dilated cardiomyopathy, was admitted to our hospital with a nodular lesion in his right axilla of 6 weeks’ duration. There was no history of weight loss, nausea, or vomiting. Physical examination revealed a red–violet axillary nodule, 7 cm in diameter and 3 cm thick, with an ulcerated surface ( Fig. 1 ). A palpable right adenopathy was also found. The rest of the physical examination was normal.

Figure 1 Open in figure viewer PowerPoint Cutaneous nodule located on the right axilla     

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     

Lyme disease presenting with multiple erythema migrans lesions: an illustrative case

A 39‐year‐old, previously healthy male park ranger presented to the emergency room with a 24‐h history of a rapidly progressive, widespread, painful skin eruption associated with severe viral illness‐like symptoms of fever as high as 40 °C, generalized migratory arthralgias, exhaustion, and malaise with prostration. On physical examination, confluent urticarial plaques, many with dusky and bruise‐like central discoloration, were observed involving approximately 90% of the skin, sparing the scalp, palms, and soles ( Fig. 1 ). He was febrile with a temperature of 39 °C, and had signs of dehydration with orthostatic hypotension. Physical examination, including cardiovascular and neurologic examination, was otherwise normal. There was no evidence of lymphadenopathy.

Figure 1 Open in figure viewer PowerPoint Confluent urticarial plaques     

Treatment of cutaneous T-cell lymphoma with alitretinoin gel

A 62‐year‐old man with a 5‐year history of tumor stage cutaneous T‐cell lymphoma (CTCL) used alitretinoin gel, 0.1% twice daily on a right sole tumor. The treatment at the time of topical therapy included acitretin, 35 mg daily, and psoralen with ultraviolet A radiation (PUVA) twice weekly. Previous therapy included topical mechlorethamine, etretinate, and topical glucocorticoids. After 6 weeks, he discontinued alitretinoin gel upon noting that the treated tumor site had turned black. Two weeks later (2 months after the initiation of therapy) he presented with a 6‐cm keratotic plaque on the treated area with a 1‐cm eschar. No lymphadenopathy, peripheral erythema, or tenderness was noted. He started amoxicillin/clavulanate, 875 mg twice daily, and 2% mupirocin ointment. One month later, the foot lesion had completely eroded into a 6‐cm plaque ( Fig. 1 ). There were no changes in the tumors on his trunk, face, and extremities.

Figure 1 Open in figure viewer PowerPoint Foot lesion eroded into a 6‐cm plaque.     

Erythema annulare centrifugum and pregnancy

A 28‐year‐old woman came to our attention in the 33rd week of her first pregnancy with a 2‐week history of asymptomatic skin eruptions on the arms and legs. She was otherwise well and no other symptoms were present. She used only vitamin and iron supplements during pregnancy. The eruption began as erythematous papules before spreading peripherally while clearing centrally. This produced polycyclic plaques with indurated margins and trailing scales on the inner aspect of the advancing edge. The diameter of the lesions varied from a few to several centimeters ( Fig. 1 ).

Figure 1 Open in figure viewer PowerPoint Superficial erythema annulare centrifugum: a central clearing and “trailing scale” behind an advancing, annular, erythematous border     

Bullous pemphigoid in a 2-month-old infant

Brazil A 2.5-month-old male infant (born by cesarean section, weighing 3650 g) received one dose of DPT vaccine (against diphtheria, whooping cough, and tetanus), one dose of SABIN vaccine, and one dose of Vaxgrip, a vaccine of purified inactivated myxovirus influenza on September 6, 1996. Five days later, he developed symmetric, pruritic, vesiculobullous lesions which began on the trunk and, over five days, progressively spread to the upper and lower extremities, hands, feet, and face. The clinical appearance is illustrated in Fig. 1 . Laboratory studies performed at the time revealed a white blood cell (WBC) count of 8800, with 6% eosinophils, and negative serologic tests for syphilis and urine culture.

Figure 1 Open in figure viewer PowerPoint Clinical appearance of lesions in 2.5-month-old child with bullous pemphigoid