Cooks syndrome: a case report and brief review.

Congenital anonychia is rare, particularly when all 10 toenails are absent. When anonychia is associated with absence of distal phalanges, a diagnosis of Cooks syndrome must be considered. We present a case and discussion of a patient with congenital anonychia, absent distal phalanges, and rudimentary hypoplastic middle phalanges and brachydactyly, consistent with Cooks syndrome.

Wells' syndrome presenting as a noninfectious bullous cellulitis in a child.

Wells' syndrome is a rare disease that is even more uncommon in childhood. This case report illustrates the potential devastating extent of the disease and highlights the unusual presentation of bullae in a child. It is imperative to consider Wells' syndrome in patients with presumed cellulitis and eosinophilia who fail to respond to antibiotics.

Patient with giant Becker's nevus and epidermal nevus.

Becker's nevus is a cutaneous hamartoma that may be present at birth, but more commonly is noticed during puberty. It classically manifests unilaterally on the shoulder and upper trunk as a tan to brown patch or thin plaque. "It typically has an irregular margin, breaks up into islands at the periphery, and has an average size of 125 square centimeters. Numerous skin, soft-tissue, and bony anomalies have been reported in association with Becker's nevus. We describe a patient with Becker's nevus of considerable size who has a concurrent epidermal nevus.

Giant verrucous nodules in a patient with tuberculosis.

Sarcoidosis is a systemic inflammatory disorder characterized histologically by noncaseating granulomas in affected organs. Cutaneous manifestations of the disease such as papules, nodules, plaques, and ulcerations occur in approximately 25% of the patients. Sarcoidosis can present with multiple different morphologies including annular, psoriasiform, ichthyosiform, morpheaform, and verrucous. In this study, we report a 30-year-old African American man with a history of spinal tuberculosis as a child and slowly enlarging verrucous nodules that appeared at the age of 5 years. After an extensive infectious disease evaluation, the diagnosis of verrucous sarcoidosis was established with the presence of noncaseating granulomas and a completely negative workup for infectious etiologies.

Cactus spine granuloma.

We describe the case of a 45-year-old woman with a 2-week history of painful erythematous papules on the palmar aspect of the fingertips of her right hand, resulting from contact with a cholla cactus 3 weeks prior in Arizona. The patient initially was given clobetasol propionate ointment, resulting in some improvement; however, the lesions resolved only after punch biopsies were performed to confirm the diagnosis of cactus spine granuloma.

Furuncular myiasis secondary to Dermatobia hominis.

Dermatobia homininis is the most common cause of furuncular myiasis in Central and South America. It is diagnosed based on a history of travel to an endemic region and the characteristic cutaneous lesion. We present a 54-year-old patient who presented with both a travel history and cutaneous findings of furuncular myiasis.

Tuberous and tendinous xanthomata secondary to ritonavir-associated hyperlipidemia.

Xanthomas most often occur in conjunction with a primary or secondary disorder of lipid metabolism. A range of metabolic disturbances has been described in association with protease inhibitors, including lipodystrophy, hyperglycemia, and hyperlipidemia. Ritonavir has been repeatedly shown to be the most common protease inhibitor to induce these metabolic abnormalities. This report highlights a case of both tuberous and tendinous xanthomata secondary to ritonavir-associated hyperlipidemia.