Wade histoid leprosy revisited.

An 18-year-old man presented with a 4-year history of erythematous patches on the trunk, followed 2-years later by multiple nodules, mostly located on the limbs, and distal paresthesias. Two close contacts were treated for leprosy during his childhood. Histopathological examination revealed a histiocytic infiltrate with acid-fast bacilli on Ziehl-Neelsen stain. The slit-skin and nasal smears showed numerous acid-fast bacilli. The correlation between clinical, epidemiological, histopathological, and microbiological features allowed the diagnosis of lepromatous leprosy, histoid variant. Multidrug therapy as recommended by the WHO was initiated. A rapid and sustained improvement was seen. Histoid leprosy is a rare manifestation of lepromatous leprosy, first described by Wade in 1960. Since then few cases have been reported, the majority of them from countries with a high prevalence of the disease. Early recognition and treatment are of most importance to prevent neurological disabilities and achieve epidemiological control.

Melanoma in situ or superficial basal cell carcinoma?

Dermoscopy is a non-invasive, in vivo technique that increases accuracy in the diagnosis of both melanocytic and non-melanocytic skin tumors. A 74-year-old woman presented with a 3-year history of a slow-growing, asymptomatic, slightly pigmented plaque on the back. The dermoscopic differential diagnosis of melanoma in situ versus superficial basal cell carcinoma is discussed, based on the presentation of peripheral brown irregular finger-like projections. These were also associated with peripheral fine short telangiectasias, shiny white to red structureless areas, a few brown globules, and small erosions. Histopathological examination confirmed the diagnosis of superficial pigmented basal cell carcinoma. A brief review of the dermoscopic structures associated with this common nonmelanocytic skin tumor is also made.

Alpha-1-antitrypsin deficiency-associated panniculitis: a case report.

Panniculitis is a recognized, but rare complication of α1-antitrypsin (A1AT) deficiency. Less than 60 cases have been reported, mostly in the homozygous PiZZ variant. We report the case of a 55-year old woman with A1AT panniculitis associated with the heterozygous phenotype PiMS and discrete reduction of A1AT serum levels. In addition, the pathophysiology of the disease, clinical and histopathological features, and current treatment possibilities are briefly reviewed.

Dermoscopy in Merkel cell carcinoma: a case report.

Merkel cell carcinoma (MCC) is a rare malignant and primary neuroendocrine carcinoma with several known risk factors. Early diagnosis and aggressive treatment are critical. We report the case of an 82-year old woman with a Merkel cell carcinoma on the face. Clinical and histopathological features are presented. In addition, dermoscopic features and the differential diagnosis of this rare tumor are discussed. Although nodules with atypical dermoscopic vascular pattern and milky-red areas will end up being excised, this report adds more clues to the rarely described dermoscopic morphologic presentation of MCC.

Transient symptomatic zinc deficiency in a preterm exclusively breast-fed infant.

A 5-month-old female infant, preterm, exclusively breast-fed, presented with a 2-month history of erythematous, erosive, and crusted patches and plaques in a peri-oral, scalp, genital, and peri-anal distribution. A clinical diagnosis of zinc deficiency was confirmed by a low serum zinc level in the infant and decreased maternal breast milk zinc. Complete resolution occurred within two weeks of oral zinc supplementation. Acquired zinc deficiency is a rare nutritional disorder of infants. Early diagnosis and adequate treatment will prevent associated morbidity and complications.

Unilateral oral mucous membrane pemphigoid: refractory atypical presentation successfully treated with intravenous immunoglobulins.

A 57-year-old male presented with a 6-month history of blisters and painful erosions on the right buccal mucosa. No skin or other mucosal involvement was seen. The findings of histopathological and direct immunofluorescence examinations were sufficient for the diagnosis of oral mucous membrane pemphigoid in the context of adequate clinical correlation. No response was seen after topical therapies and oral corticosteroids or dapsone. Intravenous immunoglobulin was started and repeated every three weeks. Complete remission was achieved after three cycles and no recurrence was seen after two years of follow-up. The authors report a rare unilateral presentation of oral mucous membrane pemphigoid on the right buccal and hard palate mucosa, without additional involvement during a period of five years. Local trauma or autoimmune factors are possible etiologic factors for this rare disorder, here with unique presentation.

Hemosiderotic dermatofibroma: clinical and dermoscopic presentation mimicking melanoma.

BACKGROUND: Dermatofibromas are common benign skin neoplasms. MAIN OBSERVATIONS: The authors report the clinical, dermoscopic and histopathological features of a hemosiderotic dermatofibroma mimicking melanoma in an 85-year-old woman. CONCLUSIONS: Atypical dermoscopic patterns may prove difficult to differentiate from melanocytic lesions, and because of its polymorphic, melanoma-like presentation, definite diagnosis of hemosiderotic dermatofibroma can be reached by histopathological examination.

Cutaneous infection by different Alternaria species in a liver transplant recipient.

Fungal invasive infections are rare in general population but are an emergent cause of infection in the immunocompromized population, especially in the solid organ transplant recipients. Herein the authors report a clinical case of a liver transplanted patient suffering a cutaneous co-existent infection with A. alternata as well as A. infectoria. To our knowledge this is the first case of cutaneous concomitant infection due to those two species reported not only in Portugal but also worldwide. The patient was treated with surgical excision of the lesions and oral itraconazol without relapse.

Pancreatic panniculitis - a cutaneous manifestation of acute pancreatitis.

BACKGROUND: Pancreatic panniculitis is a rare complication of pancreatic disease occurring in 2% to 3% of all patients, most commonly those with acute or chronic pancreatitis. MAIN OBSERVATIONS: We report the case of a pancreatic panniculitis associated with acute pancreatitis in a 63-year-old man. He presented with a 2-day history of multiple tender subcutaneous nodules, followed by nausea, vomiting, severe epigastric pain and loss of appetite, hours before admission. Laboratory and radiologic findings revealed acute pancreatitis. Histopathological examination from a skin biopsy specimen taken from a nodule showed a mostly lobular panniculitis with "ghost cells", without vasculitis. Nodules disappeared with the resolution of acute pancreatic inflammation, as amylase and lipase levels returned to normal. CONCLUSIONS: Panniculitis may be the first manifestation of pancreatic disease. Therefore clinicians must have a high index of suspicion for the diagnosis of pancreatic panniculitis.

Vascular malformation and common keratinocytic nevus of the soft type: phacomatosis pigmentovascularis revisited.

Phacomatosis pigmentovascularis is a rare syndrome characterized by the coexistence of a pigmented nevus and a cutaneous vascular malformation. We report a 5-year-old boy with all the typical findings of phacomatosis pigmentovascularis type Ia. Although its existence according to the traditional classification has been questioned, this case represents a very rare association of a capillary vascular malformation and a common keratinocytic nevus of the soft type.