Periorbital edema associated with alpelisib.

Alpelisib is an alpha isoform-specific phosphatidylinositol 3-kinase (PI3K) inhibitor approved for use in the treatment of hormone receptor (HR)-positive, human epidermal growth factor receptor (HER2)-negative metastatic breast cancer in combination with fulvestrant. Hyperglycemia, rash, and gastrointestinal upset are the most commonly reported adverse events associated with alpelisib. Although rash is a known on-target effect of alpelisib, patients typically present with a morbilliform rash. We describe two cases of periorbital edema associated with alpelisib. We discuss the clinical findings, management, and prognosis of this unique reaction. These cases highlight the importance of early involvement of dermatology to manage adverse cutaneous events associated with alpelisib.

Antimicrobials and resistance part II: Antifungals, antivirals, and antiparasitics.

The available antifungal armamentarium consists of only a few drug classes, many limited in their use by significant toxicities and dangerous drug interactions. Rising opportunistic multidrug-resistant pathogens in the last few decades are further limiting available treatment options in life-threatening invasive fungal diseases. Similarly, antiviral resistance, although uncommon in healthy hosts, remains a challenge in immunocompromised patients with a risk for dissemination and severe disease. As evidenced by a dry pipeline, the gravity of antifungal, antiviral, and antiparasitic resistance has yet to draw the same attention as antibacterial resistance. Resistance disproportionately affects immunocompromised and vulnerable hosts, underscoring the urgent need to develop novel therapeutics. Antifungals, antiparasitics, and antivirals of main significance will be reviewed here, along with resistance concerns and some therapeutic agents under investigation.

Bacterial antimicrobial resistance and dermatological ramifications.

The spread of COVID-19 serves as a reminder of the might of microbes in the era of modern medicine. For years, another threat has preoccupied infectious disease experts and public health officials alike: rising antimicrobial resistance (AMR). Resistance is exceeding stewardship efforts as well as the rates of new drug development and approval in the market. A dry antimicrobial pipeline is threatening regression to a preantibiotic era. While the consequences of resistance may seem far removed from daily clinical practice, awareness of AMR is essential to dermatological care given that dermatologists prescribe more antibiotics per physician than other providers. Antibiotics in dermatology are often used for prolonged courses, with significant potential for microbiome alteration and antibiotic-related adverse effects. Through this review we hope to contribute to efforts of bringing the crisis of AMR to the forefront of daily dermatological practice.

Disseminated cutaneous nocardiosis mimicking cellulitis and erythema nodosum.

Infection with Nocardia asteroides is a rare, life-threatening infection, which is most commonly encountered in immunocompromised patients. Cutaneous involvement is usually seen with disseminated infection but may also occur as primary cutaneous nocardiosis. We present a case of an immunocompromised patient who presented with cellulitis of the right hand and disseminated subcutaneous nodules of the lower extremities resembling erythema nodosum. Cultures from both a skin biopsy of a subcutaneous nodule on the leg as well as a surgical specimen from the debridement of her hand grew Nocardia asteroides. The patient was treated successfully with trimethoprim-sulfamethoxazole. This case likely represents primary cutaneous nocardiosis with secondary dissemination, which has been rarely reported. It also emphasizes that nocardial infection should be considered in the differential diagnosis of lesions suggestive of cellulitis or erythema nodosum in the severely immunocompromised patient.

Distal lower extremity paresthesia and foot drop developing during adalimumab therapy.

The development of tumor necrosis factor inhibitor biologic therapy is arguably one of the most significant achievements in the treatment of rheumatic diseases to date. Neurologic events suggestive of demyelination have been reported for patients receiving treatment with the antitumor necrosis factor agents etanercept and infliximab. We describe the onset of lower extremity paresthesia and foot drop in a patient who was receiving adalimumab for the treatment of psoriasis and examine the relationship of tumor necrosis factor antagonism and demyelinating disease.