A cutaneous interstitial granulomatous dermatitis-like eruption arising in myelodysplasia with leukemic progression.

Cutaneous manifestations associated with myelodysplastic syndromes (MDS) are uncommon and can occur as specific or nonspecific lesions. Recognizing these cutaneous manifestations is important as they can precede blood or bone marrow transformation to leukemia. Granulomatous reactions have rarely been described as nonspecific lesions of MDS. These rare cases histologically resembled granuloma annulare, sarcoid, and a generalized dermal interstitial granulomatous dermatitis (IGD) which were not associated with leukemic infiltration. The authors report an interesting case of an IGD-like eruption evolving over the course of MDS with eventual progression to systemic leukemia. IGD is an inflammatory reaction that refers to a varied spectrum of histologic patterns and is associated with a variety of systemic illnesses and hypersensitivity reactions, including lymphoma and leukemia. In patients with MDS, surveillance for leukemia is a critical component of their follow-up care. Normally, this surveillance occurs through serial peripheral blood smears and bone marrow studies. IGD-like eruptions are a cutaneous reaction pattern that may serve as an additional clinical indicator of leukemic progression in patients with MDS. Although primarily a reactive pattern, this entity can rarely harbor leukemic blasts.

The association of dermatitis herpetiformis and systemic lupus erythematosus.

Dermatitis herpetiformis (DH) is an immune-mediated cutaneous disease occasionally associated with celiac disease, but rarely associated with systemic lupus erythematosus (SLE). The combination of DH and SLE is immunologically mediated and suggests a relationship between the two conditions. We describe a woman with DH and SLE with a novel HLA phenotype.

Primary cutaneous Richter syndrome: prognostic implications and review of the literature.

The term Richter syndrome (RS) describes the transformation of chronic lymphocytic leukemia into a high-grade lymphoma. RS occurs in 3% to 10% of chronic lymphocytic leukemia cases, and its onset is often characterized by the abrupt development of systemic symptoms (eg, fever in the absence of infection, night sweats, and weight loss), progressive lymphadenopathy, and hepatosplenomegaly. RS frequently arises in the lymph nodes or bone marrow, and rarely presents with extranodal involvement, which includes the gastrointestinal tract, eye, testis, central nervous system, lung, kidney, and skin. We review the literature regarding the clinical course and treatment of RS, present a patient with primary cutaneous RS, and discuss the prognostic implications.

Primary cutaneous cryptococcosis in Hawai'i.

A 72-year-old man developed a primary cutaneous cryptococcal skin infection on the right forearm, which was responsive to oral fluconazole 400 mg per day. After 16 weeks of treatment, the skin lesion completely resolved without any residual scarring.

The additive effects of hepatitis C infection and end-stage renal disease in porphyria cutanea tarda.

Various factors contribute to the development of porphyria cutanea tarda (PCT). In this case report, we describe a patient with hepatitis C infection and chronic renal failure. The individual mechanisms, which promote cutaneous disease, are discussed. Finally, we propose that each factor may have an additive effect in prolonging the skin lesions of PCT.

Giant basal cell carcinoma: report of two cases and review of risk factors.

GBCCs are rare, tend to be multiple, often develop in sun-protected areas, usually occur in Caucasians without a family history of skin cancer, and have no clear association with immunological or psychiatric factors. Fear may be the underlying factor leading to neglect and chronicity of the tumors.

Phaeohyphomycosis caused by Coniothyrium.

A 49-year-old immunosuppressed heart transplant recipient developed a superficial and subcutaneous granulomatous infection caused by Coniothyrium. The patient responded to a combination of surgical excision and antifungal agents. We review phaeohyphomycotic infections including this second report of a Coniothyrium infection.

Zabon phytophotodermatitis: first case reports due to Citrus maxima.

Zabon (Citrus maxima) is a large citrus fruit belonging to the Rutaceae family and containing a variety of psoralens including 5-methoxypsoralen. We describe the first case reports of a phytophotodermatitis caused by zabon.