Subcutaneous panniculitis-like T-cell lymphoma and lupus erythematosus profundus: a diagnostic dilemma.

A white Caucasian woman in her 30s presented with an indurated lesion on her right upper arm. Panniculitis was clinically suspected. Antinuclear antibody testing was positive but incisional biopsy showed subcutaneous panniculitis-like T-cell lymphoma (SPTCL), although with some unusual features more in keeping with lupus. Initial treatment was with oral prednisolone and radiotherapy but with only partial response. A second biopsy was taken from an area of presumed residual disease. This displayed histological features that were much more typical of lupus erythematosus profundus (LEP) but with tiny foci suggesting concomitant microscopic areas of SPTCL. Immunofluorescence for IgM was positive. This case highlights the rare occurrence of a patient with overlapping clinical and pathological features of SCPTL and LEP. It emphasises the need for close clinicopathological correlation in the workup of patients with suspected panniculitis and the importance of careful pathological examination for features of both diseases.

Unveiling the Connections Between Melanoma Differentiation-Associated Gene 5 (MDA5)-Positive Dermatomyositis and Its Potential Association With COVID-19: A Report of Two Cases.

Dermatomyositis is a rare inflammatory condition affecting the skin, muscles, and joints. This series of anti-melanoma differentiation-associated gene 5 (anti-MDA5) autoantibody-positive cases highlights a possible link between anti-MDA5-positive dermatomyositis and COVID-19 exposure. A retrospective analysis was performed on anti-MDA5-positive dermatomyositis patients at a district general hospital between January 2021 and July 2023. Information was gathered on the clinical profiles, diagnostics, management, and disease course. The two cases are as follows: (1) A 44-year-old Asian female presented with back pain, tender proximal muscles, symmetrical synovitis, and Gottron's papules, which gradually began after a COVID vaccine and worsened after COVID-19 infection. Despite prompt management, she required finger amputation and a switch to immunomodulators to achieve arthritic disease control. (2) A 49-year-old Caucasian female presented with progressive dyspnea, polyarthralgia, dusky maculopapular rash, and oral ulcers, which began after a COVID vaccine and worsened after COVID-19 infection. Steroids and immunomodulators improved mobility and respiratory symptoms, while biologics subdued her skin symptoms. This case study provides growing evidence for an intriguing association between COVID-19 exposure and anti-MDA5 antibody-positive dermatomyositis. Further research is required to elucidate the underlying pathogenic mechanism. Early involvement of a multidisciplinary team, consideration of symptom variety, infection vigilance, and impact on quality of life are important factors for clinicians to consider when tailoring the management of these patients for optimized outcomes.

Syncope: a fall from grace.

Falls by the elderly are not always what they appear to be on the surface. In the following paper, a woman must experience a long process of trial and error, as well as injury and suffering, before the underlying condition is finally uncovered by an astute nurse practitioner. The path to the diagnosis of syncope is a complex one, with economic, physical, and even social and psychological repercussions. Grace's "fall" not only contributes to burns and fractures, but damages her self-esteem and threatens her very independence. Armed with a thorough assessment, complete history, and the use of cardiac event recorders, a cardiovascular nurse has the unique opportunity to make a difference in the life of a patient suffering from suspicious falls and help her maintain a high quality of life.

Lessons learned from telehealth pioneers.

Just as American pioneers imagined a future in the West, telehealth visionaries envisioned a new way of delivering healthcare. Four home care telehealth innovators share their experiences including the support and barriers associated with this new technology. Each of the users interviewed in this article were pioneers in using the LifeSigns telehealth monitor, which consists of a monitor that measures a patient's blood pressure, pulse, ECG, and oxygen saturation in the home. Each user adopted the technology in various ways that would meet their specific needs, making their experiences both similar and unique. Their responses will assist home care organizations, clinicians, and clinical managers in recognizing how telehealth can be efficiently implemented in their settings. Survey participants were Baptist Home Care (BHC), New Brunswick Heart Center in Canada (NBHC), University of Tennessee Medical Center (UTMC), and Cardiovascular Home Care (CHC), Fort Worth, TX.

Looking for clues. A discussion of cardiac event recorders in home healthcare practice.

Home healthcare nurses have a unique opportunity to observe patients closely as they go about their activities of daily living within their own environment. But nurses must be alert to assess for all signs and symptoms and not ignore those that do not relate solely to the primary diagnosis care.