Cervicofacial actinomycosis: a unique diagnostic challenge.

Actinomycosis is a rare, chronic bacterial infection caused by Actinomcyes israelii. This anaerobic filamentous gram-positive bacterium frequently colonizes the human mouth, digestive, and genital tracts. Cervicofacial actinomycosis infections have a proclivity for affecting the upper and lower mandibles and occur in 50% of cases. Most cases present in immunocompetent individuals and almost always involve some degree of pre-existing mucosal trauma through either recent dental procedures or poor dental hygiene. Herein, we present a 54-year-old man diagnosed with cervicofacial actinomyces infection in the absence of periodontal disease or recent dental procedures. The purpose of this testimony is to discuss the pathogenesis and clinical and histologic findings of actinomycosis. In addition, we review diagnostic techniques and the current breadth of treatment options. It is our hope that this manuscript will serve as a guide for physicians of all specialties in accurately recognizing and promptly treating actinomycosis.

Sclerosing perineurioma: a rare benign tumor in a pediatric patient.

A 15-year-old boy presented to outpatient dermatology clinic for evaluation of a lesion on the hand. Originally small and asymptomatic, the lesion had rapidly enlarged in the six months prior to evaluation. A shave biopsy was performed and histopathologic evaluation demonstrated a well-circumscribed nodular proliferation of dense, bland, epithelioid to spindle cells on a fibrillary background. Tumor cells were diffusely epithelial membrane antigen (EMA) positive; S100 and Melan-A were negative. These findings are consistent with a diagnosis of sclerosing perineurioma. This case illustrates the presentation of sclerosing perineurioma in a pediatric patient and we review the pertinent pathologic and immunohistochemical findings necessary for diagnosis. It is imperative to distinguish this entity from other soft tissue tumors on the hand, both benign and malignant, to avoid overly aggressive surgical intervention.

Compartment Syndrome of the Hand Presenting as Bullous Edema.

Compartment syndrome of the hand can be a challenging diagnosis to ascertain. The difficulty in diagnosis is in part due to the absence of an established diagnostic criteria. Additionally, when a patient presents obtunded or with an altered sensorium, the identification of compartment syndrome of the hand can be further complicated. Despite the potential difficulty in diagnosis, it is of upmost importance for orthopedic surgeons to recognize and treat this entity in an expeditious manner. Without prompt treatment, the risk is increased morbidity including possible amputation. Here, we present a unique and thought-provoking case along with a review of the literature. The purpose of sharing this case is to highlight potential clues to aid in prompt diagnosis and improve patient outcomes.

Drug-induced anti-Ro positive subacute cutaneous lupus in a man treated with olmesartan.

A 66-year-old man presented to the outpatient dermatology clinic with a chief complaint of a pruritic rash on his upper trunk and proximal upper extremities, which had been present for three weeks. Upon examination, he was found to have an erythematous, annular, and polycyclic eruption on the chest, upper back, and proximal extremities. A clinical diagnosis of subacute cutaneous lupus erythematosus (SCLE) was made. The patient was found to have a positive anti-nuclear antibody (ANA) in a speckled pattern and a positive anti-Ro antibody. A biopsy revealed an interface and lichenoid dermatitis with dermal mucin deposition, consistent with subacute cutaneous lupus erythematosus. The patient reported that he had recently been diagnosed with hypertension and began treatment with olmesartan, a potassium-sparing diuretic that blocks the angiotensin II receptor, commonly used as an antihypertensive or in patients with heart failure. Cutaneous reactions to olmesartan are rare and reported in <1% of patients in post-marketing surveillance. The patient discontinued use of olmesartan and the rash completely resolved within three weeks. To date, there are no other reported cases of drug induced SCLE in patients taking olmesartan to our knowledge.

Scarring and persistent erythema after fractionated ablative CO2 laser resurfacing.

The adverse affects of traditional CO2 laser resurfacing have been well reported including scarring and hypopigmentation. With the advent of new technology, continuous research and development of new devices are being conducted to minimize these side effects, yet provide substantial results. The fractionated CO2 laser is a recently available product. The authors encountered a case of a 55-year-old female who presented 9 days posttreatment with a fractionated ablative CO2 laser resurfacing with similar side effects as seen with traditional ablative CO2 laser resurfacing.