Staphylococcal toxic shock syndrome because of skin infection - a case report.

Staphylococcal toxic shock syndrome (STSS) is a toxin-mediated disease. It is a severe fatal disease inducing immune-mediated inflammatory reaction and occurs because of exotoxin produced by Staphylococcus aureus. Common signs and symptoms at the time of presentation lead to misdiagnosis and delay in initiation of treatment. Prognosis depends primarily on early diagnosis and prompt treatment. This is a case of a young adult male presented with fever, rash, and hypotension and diagnosed with STSS.

Dog tick (Rhipecephalus) causing Lyme disease in an adult human.

Lyme disease is a tick-borne multisystem disorder transmitted by the family of Ixodes and caused by a spirochete, Borrelia. An early manifestation of the disease presents with skin lesions typically called Erythema chronicum migrans (ECM). Doxycycline should be the antibiotic of choice used for its treatment. However, we present the case of Lyme's disease in an adult male with dog tick, Rhipecephalus as a vector.

Optic nerve sheath diameter and its implications in the evaluation of cerebral venous sinus thrombosis.

Purpose: To ascertain the role of optic nerve sheath diameter (ONSD) in the evaluation of cerebral venous sinus thrombosis (CVST). Material and methods: A retrospective study with convenient sampling was done during the period November 2018 to January 2020. Forty-one patients across all age groups with magnetic resonance venography (MRV) diagnosis of CVST and 82 gender-matched controls were included in the study. ONSD was measured on axial T2-weighted magnetic resonance images. CVST was identified on axial TOF-MRV including the stage, degree, and location. Intraparenchymal infarction and haemorrhage were also noted with their stage and size. The distribution of values for ONSD was tested for equality of variances using independent samples t-test. A cut-off value for ONSD was derived using ROC analysis. Results: The mean difference between ONSD of cases and controls was 0.84 mm (95% CI: 0.61-1.06) and was statistically significant at p < 0.001. Mean ONSD in cases was 5.33 ± 0.66, and in the control group it was 4.49 ± 0.31. The cut-off value for ONSD was taken as 4.57 mm, derived using the ROC analysis (AUC was 0.876 suggesting good diagnostic accuracy). ONSD showed a sensitivity of 87% and a negative predictive value of 89% in predicting CVST. However, we found no statistical significance between ONSD in patients with acute or chronic thrombosis or in those with neuroparenchymal complications. Conclusions: ONSD is a valid triage tool with high sensitivity and negative predictive value, and it can be used in the evaluation of CVST.

Phase 1 Evaluation of 11C-CS1P1 to Assess Safety and Dosimetry in Human Participants.

This study evaluated the safety, dosimetry, and characteristics of 3-((2-fluoro-4-(5-(2'-methyl-2-(trifluoromethyl)-[1,1'-biphenyl]-4-yl)-1,2,4-oxadiazol-3-yl)benzyl)(methyl-11C)amino)propanoic acid (11C-CS1P1), a radiotracer targeting sphingosine-1-phosphate receptor (S1PR) 1 (S1PR1). S1PR1 is of clinical interest because of its role in multiple sclerosis (and other conditions), with an expanding class of S1PR modulators approved for relapsing multiple sclerosis. 11C-CS1P1 binds S1PR1 with high specificity and has shown promise in animal models of inflammatory diseases. Methods: 11C-CS1P1 was injected into 5 male and 6 female healthy participants. Ten participants were imaged with PET using a multipass whole-body continuous-bed-motion acquisition, and one had dedicated head and neck PET and MRI. Participants were continuously monitored for safety events. Organ time-activity curve data were collected, integrated, and normalized to the injected activity. Organ radiation doses and effective dose were computed using the adult male and female models in OLINDA, version 2.2. SUV images were evaluated for qualitative biodistribution. Results: No adverse events were observed after the dose, including no bradycardia. The liver was the critical organ from dosimetry analysis (mean ± SD: female, 23.12 ± 5.19 µSv/MBq; male, 21.06 ± 1.63 µSv/MBq). The whole-body effective dose (as defined by International Commission on Radiological Protection publication 103) was 4.18 ± 0.30 µSv/MBq in women and 3.54 ± 0.14 µSv/MBq in men. Using a maximum delivered dose of 740 MBq (20 mCi), the effective dose for women would be 3.1 mSv (0.31 rem), with a liver dose of 17.1 mSv (1.7 rem); the effective dose for men would be 2.6 mSv (0.26 rem), with a liver dose of 15.6 mSv (1.56 rem). Brain uptake was seen predominantly in gray matter and correlated with regional S1PR1 RNA expression (r = 0.84). Conclusion: These results support the safety of 11C-CS1P1 for evaluation of inflammation in human clinical populations. Dosimetry permits repeated measures in the same participants. Brain uptake correlates well with known target topography.

Rowell's Syndrome to ds-DNA Negative Lupus Nephritis: A Yet Unreported Progression.

Rowell's syndrome is now identified as a subtype of subacute lupus erythematosus (LE) with erythema multiforme-like skin lesions, positive serum rheumatoid factor, anti-Ro La positivity and speckled pattern of antinuclear antibodies. Here we describe a case of Rowell's syndrome in an 18-year-old female who was found to be ds-DNA negative, who later progressed to develop stage V lupus nephritis (LN) over a course of 4 months. Although extremely rare, most cases of LN are drug induced. Of only seven cases of non-drug induced LN with negative dsDNA, none had cutaneous involvement. Ours was a unique case of progression of Rowells syndrome to ds-DNA negative LN.

Solitary superficial acral angiomyxoma: an infrequently reported soft tissue tumor.

Superficial angiomyxomas (SA) are clinically variable, infrequent, benign skin lesions. They are usually located on the trunk, but can also appear on the lower limbs, head, and neck. The present case, hence, is unusual, because the lesion developed on the toe. They are diagnosed histologically, and are characterized by being poorly delimited tumors with the presence of interstitial myxoid material and scanty cellularity. We discuss the clinical and histological features of digital SA as well as a brief outline of other myxoid lesions.

Late onset palmar angiokeratoma circumscriptum: An unusual presentation.

Angiokeratomas (AK) are a group of capillary vascular malformations encompassing several unrelated conditions, predominantly seen on the lower extremities. AK can be classified into localized and diffuse forms. The diffuse forms comprise Fabry's disease, which is the result of α-galactosidase deficiency. The cutaneous AK includes the Mibelli type, the Fordyce type, angiokeratoma circumscriptum (AC), and 'solitary and multiple papular angiokeratoma'. We describe a case of AC with unusual features including late onset and palmar affection. Amongst the possible therapeutic options, cryotherapy was considered. However, the patient was lost to follow up.

Classical Sweet's syndrome.

A 38-year - old female came to us with sudden eruptions of painful edematous lesions which appeared pseudovesicular on cutaneous examination. Histopathology supported the diagnosis of sweet's syndrome and she responded to a combination of dapsone and oral steroids, after having relapsed on self-discontinuation of monotherapy with dapsone.