Red Nodule on the Scalp in a Healthy Young Man.

A man in his 40s was referred for an 8-mm red, firm, mobile nodule with irregular red lacunae and vessels and an absence of septa. What is your diagnosis?

[Neurofibromas in Type I Neurofibromatosis. Description of a clinical case and literature review]. / Neurofibromas en la Neurofibromatosis tipo I. Descripción de caso clínico y revisión de la literatura.

Neurofibromatosis type 1 (NF1) is the most frequent genodermatosis. Its cutaneous findings are key for early diagnosis, as they usually appear at early age. Café-au-lait macules are the most known cutaneous findings. Neurofibromas are the most frequent cutaneous tumors in patients with NF1, showing multiple clinical manifestations. They are classified as superficial and deep lesions, and su perficial neurofibromas are subdivided in cutaneous or subcutaneous. Some neurofibromas may be present since birth; however, most appear during adolescence. Neurofibromas constitute 2 out of 7 of the NIH criteria of Neurofibromatosis type 1. Most of them are benign, do not require treatment and their recognition allows an early diagnosis of the disease. OBJECTIVE: To describe and classify neu rofibromas associated with NF1 through a clinical case. CLINICAL CASE: 18-year-old male diagnosed since childhood with NF1 presents with multiple oval nodules on his face, occipital area, and wrist, multiple blue-red macules on his back and an asymptomatic pink plaque in his thigh. Ultrasound of the nodules was suggestive of neurofibromas and a skin biopsy of the lesions in the back and thigh were consistent with cutaneous neurofibromas. CONCLUSION: This case illustrates the varied clinical manifestations of neurofibromas in adolescence. Recognition of neurofibromas by the pediatrician, pediatric neurologist and/or dermatologist is crucial for the early diagnosis of NF1.

Cutaneous Metastasis From Parotid Tumors: A Report of 2 Cases and Literature Review.

ABSTRACT: Cutaneous metastases from parotid tumors are uncommon and imply a poor prognosis. In this article, we report 2 new cutaneous metastasis cases from 2 different parotid malignancies and 42 additional cases from a literature review. Clinical manifestations, localization, and outcomes of skin metastasis from parotid tumors are described. Although infrequent, parotid neoplasms may develop skin metastasis many years after the initial diagnosis, mostly in the head and neck region. Therefore, long-term follow-up and periodic skin examination of these patients is mandatory. Dermatologists and surgeons must have a high index of suspicion when evaluating any skin lesion arising on these patients because cutaneous metastasis from parotid neoplasms generally implies a poor prognosis.

Dermoscopy of primary cutaneous B- and T-cell lymphomas and pseudolymphomas presenting as solitary nodules and tumors: a case-control study with histopathologic correlation.

BACKGROUND: Primary cutaneous lymphomas (PCLs) and pseudolymphomas presenting as single pink-red nodules/tumors are highly unspecific and include a wide differential diagnosis. OBJECTIVE: To describe the dermoscopic characteristics of PCL/pseudolymphoma. METHODS: In this retrospective, case-control study, we evaluated the dermoscopic features of patients with solitary PCL/pseudolymphoma tumors and compared them to a control group of non-lymphomatous, nonpigmented, solitary tumors (e.g., basal cell carcinoma, amelanotic melanoma, etc). RESULTS: We included 14 patients with PCL/pseudolymphomas and 35 controls. T-cell and B-cell lymphoma proportions were 28.6% (n = 4) and 71.4% (n = 10), respectively. Compared to controls, most lymphomas presented dermoscopically with orange color (71.4% vs. 14.2%, P < 0.001), follicular plugs (85% vs. 2.8%, P < 0.001), and as  organized lesions (85% vs. 31.4%, P = 0.001). Coexistence of orange color and follicular plugs had an odds ratio (OR) of 2.8 (P < 0.001), highly suggestive of PCL . The kappa index for independent observers was 0.66, 0.49, 0.43 for orange background, follicular plugs, and organized lesion, respectively. Histopathologic correlation was performed in six PCL cases and showed dense diffuse and perifollicular lymphocytic infiltrate in all cases and keratin plugs in five of six cases, possibly correlating with the orange color and the follicular plugs, respectively. CONCLUSION: Primary cutaneous lymphomas/pseudolymphomas present with characteristic dermoscopic findings irrespective of immunohistochemical subtype.

Dermatomiofibroma lineal: reporte de un caso / Linear dermatomyofibroma: report of a case

El dermatomiofibroma es un tumor benigno infre-cuente de origen mesenquimático. Generalmente, se presenta como un tumor rosado nodular, espe-cialmente en mujeres en la década de los 30, en hombros y axila. Clínica e histológicamente puede simular otros tu-mores mesenquimáticos como el dermatofibroma , leiomioma y el dermatofibrosarcoma protuberans. Se presenta caso de dermatomiofibroma lineal, para describir sus características clínicas e histo-lógicas, necesarias para su correcto diagnóstico y enfrentamiento terapéutico.

Dermatomyofibroma is an uncommon mesen-chymal benign tumor. It usually presents in wo-men at their thirties, as a pink nodular tumor on the shoulder and axilla. Clinically and histologically it may mimic other mesenchymal tumors such as dermatofibroma, leiomyoma and dermatofibrosarcoma protube-rans. We present the case of a linear dermatomyofi-broma and describe its clinical and histological characteristics, which may help the clinician in the correct diagnosis and therapeutic approach of this rare but benign tumor.

Variables clínicas, de laboratorio e histopatológicas en Síndrome de hipersensibilidad o erupción por drogas con eosinofilia y síntomas sistémicos (DRESS) / Drug reaction with eosinophilia and systemic symptoms (DRESS)

INTRODUCCIÓN: La reacción a drogas con eosinofilia y síntomas sistémicos (DRESS) es una rara enfermedad que puede ser letal. OBJETIVOS: Describir los hallazgos clínicos, de laboratorio e histopatológicos en pacientes con DRESS. MATERIALES Y MÉTODOS: Estudio retrospectivo de fichas clínicas de pacientes con DRESS entre los años 2007 y 2017 con score regiSCAR mayor o igual a caso probable. RESULTADOS: Se estudiaron 24 pacientes: 14 fueron mujeres (58,3%), 2 tuvieron enfermedad autoinmune (8,3%), la edad promedio fue 45,04 años DS 17,2 (16-78). Los medicamentos frecuentemente implicados fueron Lamotrigina (33,3%) y Carbamazepina (20,8%). La latencia fue 28 días DS 17,7 (10-90). La clínica más frecuente fue prurito 87,5%, fiebre 75%, edema facial 62,5% y adenopatías 45,8%. En laboratorio lo más alterado fueron pruebas hepáticas (70,8%) y eosinofilia (45,8%). 11 pacientes (45,8%) presentaron eosinófilos en la histopatología y 21 pacientes (87,5%) fueron tratados con corticoides. La mortalidad fue 11,1% (2 pacientes, por causas distintas a DRESS). DISCUSIÓN: DRESS es una reacción adversa a medicamentos severa con variados hallazgos clínicos y analíticos que requieren de su conocimiento para no retrasar el diagnóstico y su tratamiento.

INTRODUCCIÓN: Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare disease that can be lethal. OBJECTIVE: To describe the clinical, laboratory and histopathological findings in patients with DRESS. MATERIALS AND METHODS: Retrospective study of clinical records of patients with DRESS between 2007 and 2017 with RegiSCAR score greater than or equal to probable case. RESULTS: 24 patients were studied: 14 were women (58.3%), 2 had autoimmune diseases (8.3%), the average age was 45.04 ± 17.2 years (16-78). The medications frequently implicated were Lamotrigine (33.3%) and Carbamazepine (20.8%). The latency was 28 ± 17.7 days (10-90). The most frequent symptoms were 87.5% pruritus, fever 75%, facial edema 62.5% and lymphadenopathies 45.8%. In the laboratory, the most disturbed were liver tests (70.8%) and eosinophilia (45.8%). 11 patients (45.8%) presented eosino-phils in histopathology and 21 patients (87.5%) were treated with corticosteroids. Mortality was 11.1% (2 patients) due to other causes than DRESS. DISCUSSION: DRESS is an adverse reaction to severe medications with a varied clinical and la-boratory finding, requiring knowledge in order to not to delay diagnosis and treatment.Key words: DRESS; Eosinophilia; ADR, Drug rash

Vasculitis séptica por Listeria monocytogenes / Septic vasculitis caused by Listeria monocytogenes

Septic vasculitis is a medium and small-vessel vasculitis caused by direct action of pathogens, associated with bacteremia. It is an uncommon condition; clinical manifestations include purpura, ulcers and vesicles-pustules. Most cases of septic vasculitis are related to meningococcemia. There are no cases reported in medical literature associated to Listeria spp. We report a case of a 71 year-old man who presented sepsis by Listeria monocytogenes, and then evolved with purpuric skin lesions. Skin biopsy revealed a septic vasculitis.

La vasculitis séptica es una inflamación de los vasos sanguíneos de pequeño y mediano calibre causada por la acción directa de agentes patógenos en el contexto de una sepsis. Es una condición infrecuente y se manifiesta clínicamente por lesiones cutáneas como púrpura, vesículo-pústulas e incluso úlceras. La mayoría de los casos de vasculitis séptica se asocian a una meningococcemia. No se han reportado casos en la literatura médica de vasculitis séptica secundaria a Listeria spp. Se presenta el caso de un hombre de 71 años, con cuadro de sepsis por Listeria monocytogenes y que presentó lesiones purpúricas con una biopsia compatible con una vasculitis séptica.

Exantema asimétrico en una niña

El exantema laterotorácico unilateral es un exantema poco frecuente, de etiología incierta y curso benigno autolimitado. Nuestro objetivo fue describir este diagnóstico poco conocido y ayudar al pediatra en el reconocimiento de esta entidad. Presentamos una paciente de sexo femenino de 23 meses de edad, con pápulas y placas dérmicas pruriginosas en dorso, axila y brazo derecho posterior a infección respiratoria por virus influenza, sin respuesta a hidrocortisona tópica. Se diagnosticó exantema laterotorácico unilateral y se indicó hidroxicina para manejo sintomático. El exantema laterotorácico unilateral afecta a niños de 2 años en promedio, con predominio estacional, frecuente pródromo y distribución característica. A pesar de ser benigno, es importante reconocerlo para realizar un adecuado manejo del paciente y de las inquietudes familiares.

Unilateral laterothoracic exanthem is an infrequent condition, of unknown cause and benign self-limited course. Our goal was to describe this rare entity and to help the pediatrician in its recognition. We present a 23-months-old girl with pruritic eccematous papules and plaques on her right back, axilla and arm after influenza infection, without response to topical hydrocostisone. Unilateral laterothoracic exantema was diagnosed. Hydroxyzine was indicated for symptomatic relief. Unilateral laterothoracic exanthem usually affects two year-old children, with a seasonal pattern, frequent prodromic symptoms and characteristical distribution. Despite being a benign condition, it is important to recognize it for adequate management of the patient and the family’s worries.

[Septic vasculitis caused by Listeria monocytogenes]. / Vasculitis séptica por Listeria monocytogenes.

Septic vasculitis is a medium and small-vessel vasculitis caused by direct action of pathogens, associated with bacteremia. It is an uncommon condition; clinical manifestations include purpura, ulcers and vesicles-pustules. Most cases of septic vasculitis are related to meningococcemia. There are no cases reported in medical literature associated to Listeria spp. We report a case of a 71 year-old man who presented sepsis by Listeria monocytogenes, and then evolved with purpuric skin lesions. Skin biopsy revealed a septic vasculitis.