Gadolinium-induced nephrogenic systemic fibrosis in a patient with an acute and transient kidney injury.

Nephrogenic systemic fibrosis (NSF) describes a characteristic fibrosing disorder which typically presents with indurated plaques on the trunk and extremities of patients with advanced renal disease. We present a case of biopsy-confirmed NSF in a patient with severe acute kidney injury with no prior history of renal disease. A 64-year-old man with an acute and severe decrease in glomerular filtration rate underwent magnetic resonance imaging studies with gadolinium contrast (Omniscan) and subsequently developed NSF. His renal disease had normalized at the time his skin disease developed. Skin biopsies revealed findings of NSF and scanning electron microscopy with energy-dispersive X-ray spectroscopy confirmed insoluble gadolinium within lesional tissue.

Granular cell dermatofibroma. A benign tumor that can simulate malignancy.

We report on an unusual dermatofibroma with granular cells. The dermatofibroma contained mitotic figures raising a differential diagnosis that included malignant granular cell tumor. Granular cell dermatofibroma is an uncommon variant, but one that clinicians and surgeons should become aware of to ensure accurate diagnosis.

Recurrent cutaneous vasculitis in cystic fibrosis.

We treated a patient with cystic fibrosis who experienced recurrent episodes of palpable purpura and arthralgias associated with exacerbations of her pulmonary disease. Skin biopsy demonstrated the classic findings of leukocytoclastic vasculitis, and C3 deposits were detected in the dermal blood vessels. Chronic bacterial infection and antibiotics are possible sources of antigen involved in immune complex formation in patients with chronic lung diseases.

Ectodermal defects and chronic mucocutaneous candidiasis in idiopathic hypoparathyroidism.

Idiopathic hypoparathyroidism is a rare disorder produced by parathyroid hormone deficiency of unknown cause. It is often associated with other endocrine abnormalities. Patients with idiopathic hypoparathyroidism frequently develop ectodermal disease, including dry, rough skin: coarse, brittle hair; and lusterless, distally split nails. All of these complaints are relatively common in a dermatologic practice. Chronic mucocutaneous candidiasis is also a manifestation of idiopathic hypoparathyroidism. A patient is presented with a prominent ectodermal dysplasia and a chronic mucocutaneous candidiasis that were due to the underlying idiopathic hypoparathyroidism. A brief review of idiopathic hypoparathyroidism is included, as well as the implications of this diagnosis in terms of differential diagnosis, associated endocrine disorders, and therapy.

Chronic perianal herpes simplex in immunocompromised hosts.

Four immunosuppressed patients are described with chronic ulcerative herpes simplex virus infection in the sacral and perianal area. Three of these patients were evaluated for decubitus ulcers. Prompt diagnosis was possible when the characteristic morphologic features were recognized and when viral culture and Tzanck smear specimens were obtained. Previously reported cases are reviewed as well. Chronic mucocutaneous herpes simplex infections are complications of immunocompromised hosts and should be recognized early if appropriate therapy is to be initiated.

Avascular necrosis of bone in dyskeratosis congenita.

A case of dyskeratosis congenita, a rare X-linked disorder, is presented. The patient had the classic triad of cutaneous findings: reticulated hyperpigmentation, nail dystrophy, and leukoplakia. In addition, a previously unreported finding developed, avascular necrosis of bone without systemic steroid therapy. Recognition of this disorder is important because pancytopenia and malignancy develop in up to 50 percent of patients.

Cutaneous metastases from chondrosarcoma.

This report describes a patient with histologically confirmed multiple cutaneous metastases from a skeletal chondrosarcoma and reviews the two previously published cases of this very unusual pattern of metastasis. We conclude that metastatic chondrosarcoma should be considered in the differential diagnosis of multiple cartilaginous tumors of the skin, and that radiotherapy may play a role in the management of metastatic chondrosarcoma.