Nicolau syndrome and localized panniculitis: a report of dual diagnoses with an emphasis on morphea profunda-like changes following injection with glatiramer acetate.

Glatiramer acetate, given as a 40 mg subcutaneous injection thrice weekly, was recently approved by the FDA based on data suggesting better compliance and a more favorable side effect profile compared to lower dose, daily dosing. The most commonly reported adverse events are transient injection site reactions involving redness and pain at the site; however, more pronounced panniculitis and lipoatrophy have also been reported. Here, we present the case of a 51-year-old female treated with higher dose glatiramer acetate who presented with a cutaneous injection site reaction consistent with Nicolau syndrome. The excised specimen revealed typical glatiramer acetate-associated panniculitis, alongside subcutaneous sclerosis. This case shows the spectrum of cutaneous complications possible with glatiramer acetate injections, the finding of sclerosis being relatively infrequently reported. Given the relatively short duration of trials leading to FDA approval of thrice weekly dosing of glatiramer acetate, clinicians should perform careful clinical and histopathological evaluation and reporting of patients who experience injection site reactions.

Squamous cell carcinoma in the setting of chronic hidradenitis suppurativa; report of a patient and update of the literature.

Squamous cell carcinoma (SCC) developing in chronic hidradenitis suppurativa (HS) is rare, but failing to recognize the condition may have significant consequences. Dermatologists must be aware of the potential for malignant transformation and should have a low threshold for biopsy when clinical presentation is atypical. Herein we describe a 64-year-old woman with metastatic vulvar SCC that developed within an area of chronic HS. Like SCC associated with other chronic inflammatory disorders (Marjolin's ulcers), mortality is significant. Past reviews have reported death rates above 40% and our most recent update continues to support poor prognoses for these patients.

Mixed Pneumocystis and Cryptococcus cutaneous infection histologically mimicking xanthoma.

Cutaneous Pneumocystis jirovecii infection is rare. It is thought that the disease emerges from a latent infection delivered via hematogenous and/or lymphatic dissemination from a primary lung infection in immunocompromised individuals. A 32-year-old human immunodeficiency virus-positive male was admitted for headache and vomiting. He was diagnosed with meningitis due to Cryptococcus neoformans and sputum tested positive for Pneumocystis. Six months later, he presented with a slightly crusted yellowish brown plaque and 2 similar but smaller papules with telangiectasia near the right angle of the mouth. Biopsy of the area featured histiocytes expanded by foamy cytoplasm as in a xanthoma except that the vacuoles were coarser. Special stains ultimately demonstrated the characteristic disks of Pneumocystis accompanied by a minor component of budding yeasts (Cryptococcus) in the same fields. This case illustrates the utility of adequate special stains in recognizing a mixed cutaneous infection, particularly in human immunodeficiency virus-positive patients, when microscopy presents an odd xanthoma-like lesion.

Digital mammography: its impact on recall rates and cancer detection rates in a small community-based radiology practice.

OBJECTIVE: The purpose of our study was to retrospectively evaluate the impact on recall rates and cancer detection when converting from film-screen to digital mammography in a small community-based radiology practice. MATERIALS AND METHODS: Audits of our institution's records were compiled during a 4-year period: the year before conversion to digital mammography, and the first, second, and third years after conversion. We found that 4,838 film-screenings were performed during the period of audit 1 without the use of the digital system; 6,875 screenings were performed using the digital system during audit 2; 7,379 screenings during audit 3; and 7,294 during audit 4. Cancer detection and recall rates for each of the audits were determined retrospectively. Results were compared between audits using the chi-square test. RESULTS: Cancer detection rates increased from 4.1/1,000 during film-screenings to 7.9/1,000 (p = 0.01) the year after the introduction of digital mammography. Recall rates also increased the year after digital mammography was introduced, from 6.1% to 10.2% (p < 0.001). Audit 3 showed no statistically significant difference in cancer detection rates from those in audit 1, decreasing to 5.1/1,000 (p = 0.42). However, audit 4 noted an increase in the cancer detection rate to 6.9/1,000. CONCLUSION: In this community-based mammography practice, an increase in the cancer detection rate occurred initially during the conversion from film-screen to digital mammography, which subsequently decreased but remained higher than before digital conversion. This study suggests that the new technology alone is responsible for the increased number of cancers detected in patients with dense breasts that were not previously found using film-screening.