Atypical blastomycosis in a pregnant woman.

Blastomycosis is a rare fungal infection that frequently involves the skin. Atypical presentations are important to identify, especially in pregnant patients, to initiate appropriate therapy and prevent complications. Uniquely, we describe a case of atypical blastomycosis that presented with painful cutaneous abscesses in a pregnant patient, with dissemination to the central nervous system. The case was successfully treated with liposomal amphotericin B transitioned to voriconazole after delivery without complications for the patient or fetus.

Angiolymphoid hyperplasia with eosinophilia treated with Mohs micrographic surgery.

A 60-year-old healthy man presented with several enlarging, tender, spontaneously bleeding, and episodically pruritic nodules on his ear. Five agminated pink-red papulonodules of the superior postauricular sulcus were noted on examination. Pathological examination revealed a lobular dermal vascular proliferation with plump endothelial cells protruding into the lumen in a hobnail pattern, along with a dense perivascular inflammatory infiltrate composed of plasma cells, lymphocytes, and numerous eosinophils. The diagnosis of angiolymphoid hyperplasia with eosinophilia was confirmed. After discussing treatment modalities, the patient opted for Mohs micrographic surgery (MMS). Three stages of MMS were able to remove all large vessel involvement and clear the peripheral margins, but the tumor had a complex branching pattern of growth in the deep bed of the wound with numerous tiny foci remaining. Owing to risk of disfigurement, no further excision was undertaken. The area was reconstructed with a temporalis fascia flap and a full-thickness skin graft. Despite remaining microscopic disease, the patient remained without recurrence or symptoms at one year of follow up.

Reconstruction of Preauricular Wounds Using a Flipped Island Pedicle Flap.

BACKGROUND: Island pedicle flaps (IPFs) are a frequently used reconstructive option in dermatologic surgery. With variations in its execution, the flap can be used for an assortment of facial defects. OBJECTIVE: To describe the execution of a flipped IPF for the reconstruction of medium to large preauricular wounds after Mohs micrographic surgery. MATERIALS AND METHODS: An analysis of the flipped IPF reconstruction of 12 preauricular defects is presented. Patient demographics, surgical defects, aesthetic outcomes, and complications are described. RESULTS: Twelve patients with 12 preauricular tumors (9 basal cell carcinomas, 2 squamous cell carcinomas, and 1 malignant melanoma) were treated using Mohs micrographic surgery. A flipped IPF reconstruction was successfully used with good cosmetic outcomes and no complications in all 12 patients. CONCLUSION: In this series, the authors demonstrate the effective use of flipped IPFs for the reconstruction of medium to large preauricular defects with good aesthetic outcomes and no complications.

Radiation-induced circumscribed superficial morphea after brachytherapy for endometrial adenocarcinoma.

Radiation-induced morphea (RIM) is a rare and underrecognized complication of radiation therapy that most commonly occurs in women after treatment for breast cancer. Although not fully understood, RIM is hypothesized to arise from an increase in cytokines that stimulate collagen production and extracellular matrix formation. Most documented cases of RIM occur 1 year after radiation therapy and are localized to areas that were treated for breast cancer. We report on a case of a female patient with stage IB endometrial adenocarcinoma who was treated with 24 Gray of adjuvant brachytherapy. The patient developed a diffuse morpheaform, pruritic eruption only at distant sites from the brachytherapy treatment field. Although treatment for RIM is generally unsatisfactory, our patient experienced improvement in the pruritus and a regression of the lesions while applying topical 0.1% tacrolimus ointment and 0.1% triamcinolone creme. An early diagnosis of RIM can prevent extensive workup, guide treatment, and improve quality of life for patients.