A novel predictive method for risk stratification in acne patients receiving isotretinoin: an analysis of laboratory abnormalities and changes in inflammatory parameters.

INTRODUCTION: Isotretinoin is a widely used, effective medication for moderate to severe acne. It is typically used for several months, which necessitates regular laboratory monitoring. However, consensus on the optimal assessment frequency is lacking. METHOD: This is a single-center retrospective study on 1182 patients who received isotretinoin for acne at the Dermatology Clinic in Jordan University Hospital over 5 years. RESULTS: Of the 1182 patients, 892 (76.57% females) met the inclusion criteria. An increase in the proportion of patients with abnormal triglycerides and total cholesterol levels from baseline to the sixth month was observed (p < 0.05). Conversely, differences in the number of patients with abnormal AST, ALT, and CBC were not found throughout treatment (p > 0.05). Moreover, there was a decrease in the neutrophil-to-lymphocyte ratio (NLR) ratio and systemic inflammatory index (SII) after the sixth month of isotretinoin treatment compared to the baseline (p = 0.012 and p = 0.021, respectively). CONCLUSIONS: We found that a baseline cholesterol level of 163.9 mg/dl and a baseline triglycerides level of 85.5 mg/dL are highly specific and sensitive in detecting grade 1 abnormalities at the one-month follow-up. This novel prediction approach serves as an effective risk stratification method for isotretinoin acne patients.

Epithelioid Hemangioendothelioma Presenting as Necrotizing Pneumonia.

Epithelioid hemangioendothelioma (EHE) is a very rare vascular neoplasm that is often asymptomatic. A 40-year-old woman presented to the emergency department for evaluation of a nonproductive cough, chest pain, and dyspnea. A chest computed tomography angiography (CTA) demonstrated necrotizing pneumonia, a loculated left-sided pleural effusion, and an acute pulmonary embolus. She was started on broad-spectrum intravenous antibiotics and heparin infusions, and a chest tube was placed. After minimal improvement in her pleural effusion following instillation of fibrinolytics, she underwent video-assisted thoracoscopic surgery with decortication, and a pleural biopsy was performed. Her presenting symptoms resolved shortly thereafter. Following discharge, surgical pathology resulted in a diagnosis of EHE. She was not a candidate for surgical resection and remained under surveillance. A year later, she was found to have metastatic disease, and radiotherapy was initiated. Our case, which presented as necrotizing pneumonia associated with pulmonary EHE, highlights the challenges in diagnosing this disease given its extreme rarity and discusses its management.