Acquired Bilateral Nevus of Ota-Like Macules: A Case Report.

Facial melanoses (FM) present complex diagnostic and therapeutic challenges, particularly in the setting of dermal melanocytoses (DM). We present a case that illustrates these challenges as it does not fit within existing classification frameworks. Initially considered as Ota nevus, characterized by blue or dark pigmentation and scleral involvement, histopathological findings suggested acquired bilateral nevus of Ota-like macules (ABNOM). While ABNOM, more common in Asians, rarely affects the sclera or children, recent studies indicate that it may be underdiagnosed in these groups. Differential diagnosis ruled out other FM causes due to mucosal involvement. Correct classification is essential for epidemiological accuracy and treatment decisions, especially given varying responses to Q-switched laser therapy and melanoma risks associated with Ota nevus and ABNOM. While the pathogenesis remains unclear, a two-hit model involving shared melanoma mutations in melanocytes has been proposed and warrants further molecular study.

Peritumoral Clefts in Basal Cell Carcinoma: Matrix Metabolism and Primary Cilium.

The phenomenon of tissue retraction, characterized by peritumoral spaces or clefts, is prominent in basal cell carcinoma (BCC) tumors, yet its underlying mechanisms remain unclear. Proposed factors include changes in cell structures, enzymatic activity, and alterations in the Hedgehog (Hh) signaling pathway. This article discusses these factors and proposes that structural changes in BCC cells' primary cilia may contribute to matrix alterations, leading to the formation of peritumoral clefts. Further research is needed to confirm these hypotheses and understand BCC's unique growth patterns.

Post-traumatic Bullous Pilomatrixoma Exploring the Pathogenesis.

ABSTRACT: This report demonstrates the rare variant of bullous pilomatrixoma in a 10-year-old boy who presented with a rapidly growing, red-colored, bullous nodule on his neck after trauma. The exact etiology of this subtype of pilomatrixoma is unclear, but previous studies have suggested that mechanical trauma may trigger its development.

Sporadic Kaposi Sarcoma Following a COVID-19 Vaccine: Mere Coincidence or Something More?

In this case report, we present a distinctive occurrence of classic Kaposi sarcoma (KS) in an individual of Latin origin, emerging seven days following the administration of the third dose of the ChAdOx1 nCoV-19 (AstraZeneca) vaccine. The progression of KS continued over two months, culminating in the development of a tumor. Given the absence of prior reports on KS development post-COVID-19 vaccination, the primary aim of this report is to explore the potential relationship between the ChAdOx1 nCoV-19 vaccine, reactivation of Kaposi sarcoma-associated herpes virus, and the subsequent onset of KS.

Acro-Ischemia Associated With SARS-CoV-2: A Case Report.

COVID-19 is known to cause various cutaneous lesions, including acro-ischemic lesions (AIL), which are associated with poor prognosis. Anticoagulant therapy has shown positive responses in AIL patients. However, in this case study, we present a fatal AIL case despite anticoagulant therapy. We propose different treatment approaches based on the limited current data on acro-ischemia pathogenesis related to SARS-CoV-2. The clinical case involved a 59-year-old male with severe COVID-19 symptoms, including acrocyanosis and right hemiparesis. Despite receiving anticoagulant therapy, the patient's condition worsened, leading to necrosis in the left foot. The discussion focuses on the high-risk nature of AIL, the potential link between angiotensin-converting enzyme 2 (ACE2) receptors and vasculitis or thromboembolic manifestations, and the role of immune clots in AIL pathogenesis. Behçet syndrome is referenced as a model of inflammation-induced thrombosis, guiding the suggestion for immunosuppressant-based treatment in addition to anticoagulants. Additionally, three substances, N-acetyl cysteine, sulodexide, and hydroxychloroquine, are proposed.

Retrospective Analysis of a Seborrheic Keratosis-Like Melanoma on the Head.

We present a clinical case of a 50-year-old female initially suspected of seborrheic keratosis but later diagnosed with melanoma through biopsy. This case highlights the challenges in distinguishing between these two conditions and emphasizes the importance of accurate diagnosis. Overdiagnosis of malignancy in seborrheic keratosis cases and the accurate identification of melanoma through dermoscopy are discussed. Further research is needed to explore potential mechanistic connections between seborrheic keratosis and melanoma.

Sebaceous Adenoma: A Dermoscopic Case Perspective.

This report focuses on sebaceous skin tumors, specifically sebaceous adenoma, sebaceoma, and sebaceous carcinoma, along with their association with Muir-Torre syndrome (MTS). A clinical case of a 25-year-old male with a suspected sebaceous neoplasm based on dermoscopy appearance is presented. The histopathological examination confirmed the diagnosis and surgical management resulted in successful treatment. The report highlights the importance of considering differential diagnoses and utilizing dermoscopy for accurate evaluation of these rare skin tumors.

Basal Cell Carcinoma in the Periungual Region: A Rare Case and Pathogenesis Insights.

This case report presents a rare occurrence of basal cell carcinoma (BCC) in the periungual region of the thumb. BCC is the most common type of skin cancer, typically found in sun-exposed areas. The discussion explores the underlying pathogenesis mechanisms, including the role of ultraviolet exposure, the absence of pilosebaceous units, and the involvement of the sonic hedgehog (SHH) pathway. Understanding the complexities of BCC in atypical locations is essential for effective prevention and treatment strategies.

Oral Focal Mucinosis of the Tongue: A Rare Localization for a Rare Entity.

ABSTRACT: Oral focal mucinosis (OFM) is a rare connective tissue disorder that is characterized by the excessive production of hyaluronic acid due to myxoid degeneration of submucosal connective tissue. The disorder typically presents as an asymptomatic nodule or mass in the gingiva or hard palate, and OFM of the tongue is even more unusual. In this report, we present a case of OFM on the tongue in a 72-year-old female patient who presented with a symptomatic lump that had been growing for 6 months on the dorsum of her tongue. The patient reported discomfort and pain while speaking and swallowing, and the lump was visually apparent on examination. OFM is a benign condition that does not have any specific clinical or radiographical features that distinguish it from other more common oral lesions, such as lipoma or fibroma. Therefore, histopathological examination is essential for a definitive diagnosis. The management of OFM typically involves surgical excision of the lesion. In this case, complete surgical removal of the lesion under general anesthesia was performed, and the patient was followed up for 10 months postoperatively. During the follow-up period, there was no evidence of recurrence, and the patient reported significant improvement in her symptoms. In conclusion, OFM is a rare connective tissue disorder that can occur in the oral cavity. Although OFM of the tongue is even rarer, it should be considered in the differential diagnosis of oral lesions. Histopathological examination is essential for definitive diagnosis, and surgical excision is typically the preferred treatment modality.

Changes in the epidemiology of invasive fungal disease in a Pediatric Hematology and Oncology Unit: the relevance of breakthrough infections.

BACKGROUND: Invasive fungal disease (IFD) is a significant cause of morbimortality in children under chemotherapy or hematopoietic stem cell transplant (HSCT). The purpose of this study is to describe the changes in the IFD epidemiology that occurred in a Pediatric Hematology-Oncology Unit (PHOU) with an increasing activity over time. METHODS: Retrospective revision of the medical records of children (from 6 months to 18 years old) diagnosed with IFD in the PHOU of a tertiary hospital in Madrid (Spain), between 2006 and 2019. IFD definitions were performed according to the EORTC revised criteria. Prevalence, epidemiological, diagnostic and therapeutic parameters were described. Comparative analyses were conducted using Chi-square, Mann-Whitney and Kruskal-Wallis tests, according to three time periods, the type of infection (yeast vs mold infections) and the outcome. RESULTS: Twenty-eight episodes of IFD occurred in 27 out of 471 children at risk (50% males; median age of 9.8 years old, [IQR 4.9-15.1]), resulting in an overall global prevalence of 5.9%. Five episodes of candidemia and 23 bronchopulmonary mold diseases were registered. Six (21.4%), eight (28.6%) and 14 (50%) episodes met criteria for proven, probable and possible IFD, respectively. 71.4% of patients had a breakthrough infection, 28.6% required intensive care and 21.4% died during treatment. Over time, bronchopulmonary mold infections and breakthrough IFD increased (p=0.002 and p=0.012, respectively), occurring in children with more IFD host factors (p=0.028) and high-risk underlying disorders (p=0.012). A 64% increase in the number of admissions in the PHOU (p<0.001) and a 277% increase in the number of HSCT (p=0.008) were not followed by rising rates of mortality or IFD/1000 admissions (p=0.674). CONCLUSIONS: In this study, we found that yeast infections decreased, while mold infections increased over time, being most of them breakthrough infections. These changes are probably related to the rising activity in our PHOU and an increase in the complexity of the baseline pathologies of patients. Fortunately, these facts were not followed by an increase in IFD prevalence or mortality rates.

Physiological consequences of inactivation of lgmB and lpxL1, two genes involved in lipid A synthesis in Bordetella bronchiseptica.

To develop a Bordetella bronchiseptica vaccine with reduced endotoxicity, we previously inactivated lpxL1, the gene encoding the enzyme that incorporates a secondary 2-hydroxy-laurate in lipid A. The mutant showed a myriad of phenotypes. Structural analysis showed the expected loss of the acyl chain but also of glucosamine (GlcN) substituents, which decorate the phosphates in lipid A. To determine which structural change causes the various phenotypes, we inactivated here lgmB, which encodes the GlcN transferase, and lpxL1 in an isogenic background and compared the phenotypes. Like the lpxL1 mutation, the lgmB mutation resulted in reduced potency to activate human TLR4 and to infect macrophages and in increased susceptibility to polymyxin B. These phenotypes are therefore related to the loss of GlcN decorations. The lpxL1 mutation had a stronger effect on hTLR4 activation and additionally resulted in reduced murine TLR4 activation, surface hydrophobicity, and biofilm formation, and in a fortified outer membrane as evidenced by increased resistance to several antimicrobials. These phenotypes, therefore, appear to be related to the loss of the acyl chain. Moreover, we determined the virulence of the mutants in the Galleria mellonella infection model and observed reduced virulence of the lpxL1 mutant but not of the lgmB mutant.

Poor increase on HAV vaccination coverage among people living with HIV after an immunization-based intervention.

OBJECTIVES: To assess HAV serologic and vaccination status among people who live with HIV (PLWH), and to evaluate the impact of a vaccination-based strategy on HAV-negative patients in Seville, Spain. METHODS: Study with two time-overlapping phases: (i) cross-sectional study of HAV immunity prevalence among PLWH followed at a Spanish hospital between August 2019 and March 2020. (ii) Patients seronegative for HAV, reliably unvaccinated were included in a before-and-after quasi-experimental study, with an intervention focused on HAV vaccination according to national recommendations in force. RESULTS: Six hundred and fifty-six patients were included, of which 111 [17%, 95% confidence interval (95% CI) 14-20%] were seronegative for HAV. Of these, 48 [43% (95% CI, 34-53%)] individuals were MSM. The absence of HAV immunity was attributed in 69 [62% (95% CI, 52-71%)] patients to non-referral to vaccination, followed by lack of achievement of a correct vaccination scheme [n=26; 23% (95% CI, 16-32%)]. After the program implementation, 96 [15% (95% CI, 12-18%)] individuals were seronegative (17% vs. 15%, p=0.256), of whom 42 [41% (95% CI, 32-51%)] were MSM. The absence of immunity after the intervention was mainly attributed to: adherence failure in 23 [24.0% (95% CI, 15.8-33.7%)] patients, on-course immunization scheme in 34 [33% (95% CI, 24-43%)] individuals and pending appointment at the vaccine delivery unit in 20 [20.8% (95% CI, 13.2-30.3%)] patients. CONCLUSIONS: A sizeable proportion of PLWH remains susceptible for HAV infection in future outbreaks. A program based on referral to the vaccine delivery unit yields poor results, largely due to program adherence failures. New strategies are needed to increase HAV vaccination coverage.

Correction: Bullous Pilomatrixoma After COVID-19 Vaccination.

[This corrects the article DOI: 10.7759/cureus.32370.].

Giant Nevus Lipomatosus Cutaneous Superficialis in the Vulva: Finding the Best Treatment.

This report presents a rare case of a giant Nevus Lipomatosus Cutaneous Superficialis (NLCS) on the vulva of a 38-year-old female. The patient underwent excisional surgery and electrodesiccation for complete lesion removal. Recurrence following CO2 laser treatment was observed. The study highlights the challenges in managing large NLCS lesions in challenging locations and emphasizes the importance of combining surgical excision and electrodesiccation for successful treatment. Further research and reported cases are needed to enhance our understanding of this rare condition and guide optimal treatment strategies.

Retinal Lesion Segmentation Using Transfer Learning with an Encoder-Decoder CNN / Segmentación de Lesiones en la Retina Usando Transferencia de Conocimiento con CNN Encoder-Decoder

ABSTRACT Deep learning (DL) techniques achieve high performance in the detection of illnesses in retina images, but the majority of models are trained with different databases for solving one specific task. Consequently, there are currently no solutions that can be used for the detection/segmentation of a variety of illnesses in the retina in a single model. This research uses Transfer Learning (TL) to take advantage of previous knowledge generated during model training of illness detection to segment lesions with encoder-decoder Convolutional Neural Networks (CNN), where the encoders are classical models like VGG-16 and ResNet50 or variants with attention modules. This shows that it is possible to use a general methodology using a single fundus image database for the detection/segmentation of a variety of retinal diseases achieving state-of-the-art results. This model could be in practice more valuable since it can be trained with a more realistic database containing a broad spectrum of diseases to detect/segment illnesses without sacrificing performance. TL can help achieve fast convergence if the samples in the main task (Classification) and sub-tasks (Segmentation) are similar. If this requirement is not fulfilled, the parameters start from scratch.

RESUMEN Las técnicas de Deep Learning (DL) han demostrado un buen desempeño en la detección de anomalías en imágenes de retina, pero la mayoría de los modelos son entrenados en diferentes bases de datos para resolver una tarea en específico. Como consecuencia, actualmente no se cuenta con modelos que se puedan usar para la detección/segmentación de varias lesiones o anomalías con un solo modelo. En este artículo, se utiliza Transfer Learning (TL) con la cual se aprovecha el conocimiento adquirido para determinar si una imagen de retina tiene o no una lesión. Con este conocimiento se segmenta la imagen utilizando una red neuronal convolucional (CNN), donde los encoders o extractores de características son modelos clásicos como VGG-16 y ResNet50 o variantes con módulos de atención. Se demuestra así, que es posible utilizar una metodología general con bases de datos de retina para la detección/ segmentación de lesiones en la retina alcanzando resultados como los que se muestran en el estado del arte. Este modelo puede ser entrenado con bases de datos más reales que contengan una gama de enfermedades para detectar/ segmentar sin sacrificar rendimiento. TL puede ayudar a conseguir una convergencia rápida del modelo si la base de datos principal (Clasificación) se parece a la base de datos de las tareas secundarias (Segmentación), si esto no se cumple los parámetros básicamente comienzan a ajustarse desde cero.

Bullous Pilomatrixoma After COVID-19 Vaccination.

Pilomatrixoma, or calcifying epithelioma of Malherbe, is a benign tumor with differentiation toward the hair matrix cells and is one of childhood's most common epithelial tumors. Bullous pilomatrixoma has an extremely low incidence of occurrence, usually appears in the upper extremities, and is frequently associated with trauma. We report the case of a bullous pilomatrixoma in a patient with a rapid-growing neoformation one month after receiving a coronavirus disease 2019 (COVID-19) vaccine in his left upper arm, and we discuss whether the bullous appearance is part of the biology of the tumor or a secondary anetoderma.

Anti-Hu-mediated paraneoplastic chronic intestinal pseudo-obstruction associated with extraskeletal myxoid chondrosarcoma.

Chronic intestinal pseudo-obstruction (CIPO) is characterized by symptoms and signs of bowel obstruction in the absence of an anatomical cause. Almost 50 % of cases are secondary to systemic diseases of neurological, paraneoplastic, autoimmune, metabolic, or infectious origin.