Miliarial gout: Clinical case and a brief review.

Miliarial gout is a rare clinical variant of chronic tophaceous gout characterised by tiny milia-like papules containing chalky tophaceous material. In this report, we present a case of miliarial gout in a patient with known history of gouty arthritis and review the reported cases of miliarial gout in the literature to discuss its characteristics, diagnosis and treatment.

Atypical manifestations of graft-versus-host disease.

BACKGROUND: Cutaneous graft-versus-host disease (GVHD) is classically described as morbilliform when acute and lichen planus-like or sclerotic when chronic. In addition to these well-known clinical forms, there are many other presentations of GVHD that are important to recognize. As the number of patients undergoing stem cell transplantation increases and the survival after transplantation improves, the prevalence of GVHD is expected to rise, and its various presentations will be increasingly encountered in clinical practice. OBJECTIVE: We sought to report unusual manifestations of skin GVHD and provide a summary of typical and atypical presentations of GVHD reported in the literature. METHODS: Patients with stem cell transplantation who developed unusual eruptions after transplantation had biopsy specimens taken to evaluate for histopathologic evidence of GVHD. RESULTS: Six patients presented with unusual cases of biopsy-proven GVHD, including follicular hyperkeratosis, thick-appearing white tongue, inverse pityriasis rosea-like, and eczema craquelé-like GVHD. LIMITATIONS: This study is limited by case number. CONCLUSIONS: Because of the high rate of cutaneous involvement with GVHD, the accessibility of the skin for diagnosis, and the morbidity associated with severe or long-standing skin involvement, it is important for dermatologists to recognize and accurately diagnose cutaneous GVHD in all its protean manifestations.

Anaplastic Large Cell Lymphoma in Pregnancy. A Case Report.

BACKGROUND: Anaplastic large cell lymphoma is rarely diagnosed during pregnancy, and patients may be erroneously diagnosed with a dermatosis. CASE: A 34-year-old female was diagnosed with pruritic urticarial papules and plaques of pregnancy in the third trimester. She underwent elective repeat cesarean section with a postoperative course complicated by skin and gingival ulcers and persistent fever. Imaging revealed lung and brain nodules. Video-assisted thoracic surgery lung biopsy demonstrated anaplastic large cell lymphoma. CONCLUSION: It is important to consider the diagnosis of anaplastic large cell lymphoma in a pregnant patient who presents with cutaneous symptoms.

A case of verru plana on tattoo.

Tattoo is a popular cosmetic decoration, however several different tattoo-induced complication have been described. Several tattoo related cutaneous reactions such as allergic, granulomatous, lichenoid reactions, and infections have been reported. A 20 year-old male presented with multiple papules on the dragon shaped tattoo. The clinical and histopathological assessments were consistent with verrucas. Tattoo has become increasingly popular among young people. People interested in tattoos should be informed on its related infections and complications during and following tattooing. Herein, we present this rare tattoo induced verru plane to point out tattoo related complications and its treatments.

Cutaneous signs of classical dermatomyositis.

Idiopathic immune myopathies (IIM) are an heterogeneous group of autoimmune muscle disorders characterized by progressive muscle involvement. Dermatomyositis (DM) is the most common form of IIM. It is a multisystem disorder characterized by symmetric proximal, extensor, inflammatory myopathy, vascular involvement and a characteristic cutaneous eruption. Six types of DM have been identified: idiopathic, juvenile (JDM), cancer-related other autoimmune diseases-related, iatrogenic DM and amyopathic DM. Cutaneous manifestations of DM are the most important aspect of this disease and can precede from several months to years muscle or systemic involvement. Three groups of signs have been described: pathognomonic, highly characteristic and compatible. Although differences exist among the different clinical presentation of skin lesions, they share common histological findings including the presence of interface dermatitis with epidermal atrophy, basement membrane degeneration, vacuolar alteration of basal keratinocytes, and dermal changes consisting of interstitial mucin deposition and a sparse lymphocytic infiltrate. DM is a serious disease; the correct evaluation of any skin lesion suggesting an early diagnosis is of utmost importance. Skin signs may, also, represent a marker of treatment efficacy even though systemic symptoms worsening may not always be followed by more severe skin lesions.

Unilateral favre-racouchot disease: evidence for the etiological role of chronic solar damage.

Favre-Racouchot disease commonly presents as comedones, cysts and elastosis in the periocular region of older men. Its etiology has been linked to several exogenous factors. Here we present 2 patients with strictly unilateral manifestation of the disease and a corresponding history of predominantly one-sided chronic occupational sun exposure and smoking, making the case for the causative role of these two factors.

Granulocyte and monocyte adsorption apheresis as an effective treatment for Reiter disease.

Reiter disease (RD) is characterized by a triad of sterile arthritis, urethritis and conjunctivitis. The conditions occur concomitantly or sequentially, and are associated with mucocutaneous features such as circinate balanitis and stomatitis. Arthritis usually occurs in attacks followed by recovery, but it sometimes progresses to permanent damage of the affected joints. Because the symptoms of this disorder are attributable to activated neutrophils, we assessed the efficacy of granulocyte and monocyte adsorption apheresis (GCAP) in a 73-year-old man with RD who had skin rashes on his penis, scrotum and right hand, with severe arthralgia. The patient's skin rash and joint pain responded dramatically to five sessions of GCAP delivered at intervals of 5 days. We present a detailed description of the patient and discuss the mechanisms of GCAP, and suggest that GCAP may be useful for treating RD.

[An atypical skin rash in a setting of antiphospholipid syndrome]. / Éruption cutanée atypique au cours d'un syndrome des antiphospholipides.

BACKGROUND: Antiphospholipid syndrome (APS) is characterised by arterial or venous thrombosis combined with the presence of specific antibodies known as antiphospholipids. It is commonly associated with cutaneous signs. Herein we report a case of atypical cutaneous eruption occurring during the course of APS and we discuss the possible mechanism. PATIENTS AND METHODS: A 45-year-old woman consulted twice within six months for an erythematosus papular eruption around the neckline. She was being followed-up for antiphospholipid syndrome treated with fluindione (Préviscan®), and her International Normalized Ratio (INR) was consistent with the prescribed anticoagulation target. Blood tests confirmed the presence of anticardiolipin and antiphospholipid antibodies, but no laboratory evidence of lupus was seen. Histopathological examination of a skin biopsy demonstrated the presence within the vascular lumen of a weakly eosinophilic anhistic substance positive for PAS stain. The patient was given acetone salicylic acid (Kardégic®) combined with fluindione, and four years later, she had presented no relapses. DISCUSSION: Despite a clinically evocative appearance, the diagnosis of lupus tumidus was ruled out in our patient by histopathological features, and associated systemic lupus erythematosus was repeatedly refuted on the basis of clinical and laboratory data. We suggest that the specific histological images of intraluminal deposits within the dermal vessels seen in this patient, although not typical of thrombosis, are associated with APS. The clinical remission seen from the start of antiplatelet treatment could be due to the action of these drugs against the obstruction of small-calibre dermal vessels.

Unilateral colloid milium: a rare presentation.

We report a case of a 31-year-old man with asymptomatic papules on one side of his face that had been present for 31 months. On physical examination, he had clusters of 1 to 4 mm skin colored translucent and dome-shaped, papules forming a plaque with a size of 4 x 3 cm on his left mandibular angle. Histopathology revealed atrophy of the epidermis with extensive deposition of pale eosinophilic homogenous deposits containing artifactual fissures that were PAS positive, diastase resistant, and Congo red negative. The final diagnosis was unilateral colloid milium.

Leukemia cutis in B-cell chronic lymphocytic leukemia presenting as an episodic papulovesicular eruption.

A 53-year-old man presented with a recurrent pruritic eruption accompanied by oral sores. His past medical history was significant for subclinical B-cell chronic lymphocytic leukemia (CLL), which had never been treated. On exam, there were erythematous papules and plaques studded with vesicles on the neck, trunk, and upper extremities. Two skin biopsies showed common features of a perivascular and periadnexal lymphocytic infiltrate in the superficial to mid-dermis. Immunohistochemical staining of the lymphocytes showed co-expression of CD20, CD23, CD5, and CD43, consistent with a diagnosis of cutaneous involvement by the patient's CLL. This case highlights the importance of considering leukemia cutis in patients with underlying CLL presenting with unusual clinical features.

Papuloerythroderma 2009: two new cases and systematic review of the worldwide literature 25 years after its identification by Ofuji et al.

BACKGROUND: Even after the description of papuloerythroderma of Ofuji (PEO) in 1984, little is known about this clinical entity. OBJECTIVE: To report on 2 new cases of PEO and review of the worldwide literature on this topic. METHODS: Article citations were searched on several biomedical search engines (PubMed, EMBASE, SCOPUS, Google Scholar). Papers were retrieved either online or in print. RESULTS: A grand total of 170 PEO cases were identified. Most patients were older than 55 years and of Asian or white descent, with an overall male/female ratio of 4.0. Itch and the deck-chair sign were observed in all patients. Peripheral eosinophilia, lymphocytopenia and increased serum IgE were common findings. Histopathology mostly showed aspecific inflammation, while 17 showed histological features of cutaneous T-cell lymphoma (CTCL). Atopy, malignancies, infections and drugs were rarely linked to PEO. CONCLUSION: PEO represents a rather monomorphous entity both clinically and, with the remarkable exception of CTCL, also histologically. Nonetheless, no causative factor could be identified in the vast majority of cases. An etiological classification and diagnostic criteria are proposed in the attempt to contribute framing this puzzling clinical entity.

Multiple myeloma presenting as a novel mucocutaneous eruption.

A 71-year-old woman presented with exquisitely tender mucosal erosions, a diffuse polymorphous eruption, and night sweats. Workup revealed multiple myeloma with a monoclonal IgG-kappa paraprotein in the serum. Her severe oral involvement was suggestive of paraneoplastic pemphigus, but direct and indirect immunofluorescence tests were negative. A skin biopsy showed spongiosis and a sparse perivascular lymphocytic infiltrate, with occasional CD8-positive lymphocytes in the epidermis. Her lesions improved with intravenous immune globulin. Immunohistochemical staining on the formalin-fixed biopsy specimen was strongly positive for IgG and IgG-kappa in an epidermal "chicken-wire" pattern, but negative for IgG-lambda. Her pulmonary tissue stained negative for IgG-kappa, suggesting clinical relevance of the myeloma paraprotein in her epidermis. To our knowledge, this is the first report of a multiple myeloma patient with such an eruption.