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This case report presents the clinical scenario of a 50-year-old man who developed swelling and itching around both eyes after applying tropicamide eye drops for an ophthalmic examination. The swelling appeared suddenly, progressed over time, and was accompanied by redness, watery discharge, and conjunctival congestion. A dermoscopic examination revealed congestion and erythema in the affected area. Visual acuity was compromised in the left eye. Prompt identification of the eyedrops as plain tropicamide with chlorbutol as a preservative enabled timely treatment with intravenous hydrocortisone and topical steroids, resulting in symptom improvement within two days. Allergic reactions to mydriatic agents such as tropicamide are infrequent but should be considered in patients with acute ocular symptoms post-application. This case underscores the importance of recognising and managing allergic reactions to ophthalmic medications for optimal patient care.
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Background Chronic spontaneous urticaria (CSU) is a medical condition characterized by the persistence of urticaria for more than six weeks, primarily caused by mast cell activation. Autoimmune thyroid diseases (AITDs) are the most common cause of dysfunction of the thyroid gland, and they are influenced by both genetic and environmental factors. Mast cell mediators have a significant role in the pathogenesis of CSU through two main pathways: the derangement of intracellular signaling pathways in mast cells and basophils and the production of autoantibodies against these cells. This study aimed to explore the association between AITDs and CSU by examining clinical features and measuring thyroid hormones and anti-thyroid peroxidase (anti-TPO) antibodies in patients. Aim and objectives The primary aims of this study are to investigate the prevalence and clinical characteristics of autoimmune thyroid disorders in patients with chronic spontaneous urticaria. The specific objectives are to evaluate the triiodothyronine (T3), tetraiodothyronine (T4), thyroid-stimulating hormone (TSH), and anti-thyroid peroxidase (anti-TPO) antibody levels in patients and controls and to explore the correlations between these parameters and the development and severity of chronic spontaneous urticaria. Material and method The present study was an observational investigation that enrolled 40 patients, consisting of 20 cases and 20 controls. The inclusion criteria involved patients of both sexes, aged above 18 years, who had chronic spontaneous urticaria and agreed to participate in the study with informed consent. Patients with other skin conditions lacking abnormal thyroid etiopathogenesis were also included. Exclusion criteria included patients with major systemic disease, uncontrolled medical or surgical illness, renal or hepatic disorders, and pregnant or lactating females. Patients with chronic spontaneous urticaria underwent a comprehensive clinical evaluation, and their urticaria severity was scored using an established scoring system. Blood samples were collected from both cases and controls for measuring T3, T4, TSH, and anti-TPO antibody levels. The anti-TPO antibody was processed using the enzyme-linked immunosorbent assay (ELISA) method. The autoimmune thyroid disease was screened by monitoring T3, T4, TSH, and anti-TPO antibody levels. Results There were significant variations observed in thyroid-stimulating hormone and anti-thyroperoxidase antibody levels. Among the cases analyzed, 40% demonstrated an urticaria severity score of one, while 25% reported a duration exceeding eight weeks. Additionally, 25% of patients experienced severe pruritus and intense wheals. Conclusions This research has discovered a robust association between serum anti-TPO antibodies and the occurrence of chronic spontaneous urticaria. To mitigate the potential for chronic spontaneous urticaria to lead to long-term morbidity, it is imperative to consider testing for serum anti-TPO antibodies in conjunction with primary thyroid markers, including T3, T4, and TSH.
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Cutaneous leiomyomas are known to arise from three locations viz, arrector pili muscle, dartos muscle in the scrotal sac, and smooth muscle layer of blood vessels. Cutaneous piloleiomyoma (arising from arrector pili) is an uncommon benign skin tumor presenting clinically as a single or numerous painful nodules. They can either appear diffuse or zosteriform/segmental in rare cases. We report an unusual case of multiple tender papulonodular lesions on the right infrascapular region. Histology from one of the nodules showed a dermal tumor consisting of interlacing fascicles of spindle cells, consistent with the diagnosis of piloleiomyoma. We prescribed our patient with oral calcium channel blocker, amlodipine, to provide symptomatic relief from pain and which can be considered used it to treat similar cases.