Mpox Case Presenting With Genital Lesions and Proctitis.

ABSTRACT: Monkeypox (Mpox) is a zoonotic Orthopoxvirus of the Poxviridae family, endemic to Africa. In August 2022, the US government declared it an emergency because of the worldwide spread. Traditionally, Mpox infection spreads through contact with infected animals. However, the 2022 outbreak Centers for Disease Control and Prevention (CDC) data note that 94% of cases had recent male-to-male sexual or close intimate contact, suggesting a novel sexual transmission. In this article, we report a 39-year-old HIV-positive man presenting with a diffuse cutaneous rash, perianal pain, and bloody stool of 2-week duration. A medical history includes intravenous drug use and multiple sexual partners. Physical examination revealed umbilicated, tan-colored, crusted cutaneous papules scattered across the face, trunk, and genital regions. Perianal lesion biopsy showed an acanthotic epidermis with spongiosis, ballooning degeneration of keratinocytes, and the formation of multinucleated syncytial keratinocytes. A dermal superficial/lichenoid mixed inflammatory cell infiltrate with multinucleated giant cells was noted. Perianal lesion polymerase chain reaction (PCR) was positive for Mpox. Colonoscopy revealed a 3-cm circumferential rectal ulcer with gray exudate and necrosis. A rectal ulcer biopsy showed an ulcerated mucosa with acute proctitis and necrosis. There were scattered macrophages with intranuclear inclusion and glassy vacuolization, and Mpox infection was confirmed by immunostaining with a Mpox-specific anti-Vaccinia virus antibody.

From moulage to metrics: Bibliometric survey of visual arts in dermatopathology and dermatology.

BACKGROUND: Both dermatopathology and dermatology are highly visual medical specialties. We performed a bibliometric literature survey of the visual arts in reference to either discipline to better understand how medical literature approaches art within the context of the two specialties. MATERIALS AND METHODS: We performed a bibliometric analysis of publications found via multiple medical search engines and selected keywords meant to capture art-related publications in dermatopathology and dermatology. Keywords (art, portrait, painting, dermatology, dermatopathology) and keyword combinations were entered into the search engines PubMed, Google Scholar, Science Direct, Pubs Hub, and Scopus. Topics of articles, years of publication, countries of origin, and contributing journals were compiled and analyzed. RESULTS: Eighty publications were retrieved between January 1903 and August 2021. The highest number of articles were found in both PubMed and Google Scholar (n = 55), and the top publication year was 2020 (n = 11). Geographically, the United States of America (n = 38) had the greatest number of articles. The dermatology and art keyword combination yielded the most journal articles (n = 36), and the maximum number of publications were retrieved from JAMA Dermatology (n = 14) followed by the American Journal of Dermatopathology (n = 10). CONCLUSION: Our survey showed an increasing number of publications related to the visual arts and dermatopathology/dermatology during the examined period, and a transition from observational case studies (often relating to art history) to articles examining the incorporation of the visual arts into medical training programs or professional societies.

Cutaneous Intestinal Metaplasia With Adenocarcinoma Treated With Intralesional Fluorouracil.

This case report describes a patient with cutaneous intestinal metaplasia with invasive adenocarcinoma treated successfully with intralesional fluorouracil.

Social media trends in dermatology, dermatopathology, and pathology publications: The social construction of medical subdisciplines.

BACKGROUND: An increase in the number of publications on social media has paralleled the growth of social media use in the past decade. Our study examined the trends in these publications relating to the fields of dermatology, pathology, and dermatopathology. METHODS: PubMed was searched for relevant literature from 2009 to present, using the following key terms: "social media", "dermatology", "dermatopathology", and "pathology." Topics of articles, years of publication, countries of origin, and contributing journals were compiled and analyzed. RESULTS: A total of 99 publications was retrieved during the period between January 2009 and November 2019. Top publication years included 2019 (n = 21), 2018 (n = 24), 2017 (n = 20), and 2016 (n = 13). The most common topic areas noted were related to dissemination of information (n = 17; 17.2%), knowledge exchange for physicians (n = 16; 16.2%), and social networking (n = 15; 15.2%). CONCLUSION: The number of published articles on social media in these specialties has increased since 2009, signifying the widespread use of social media for professional networking, knowledge exchange, real-time communication with patients and colleagues, and patient care. Social media in the areas of dermatology, dermatopathology, and pathology has undergone social construction during the past decade because of changes in technology and ideologies surrounding the use of social media within medicine.

Psoriasis and the Digital Landscape: YouTube as an Information Source for Patients and Medical Professionals.

Background: YouTube is the second most commonly accessed website worldwide, but little is known about the accuracy of its medical content. We performed a review to analyze the type and quality of content in a YouTube search with respect to the treatment of psoriasis. Methods: The first 10 result pages of YouTube were searched using the term psoriasis treatment with applied filters. One-hundred and eighty-two videos were reviewed and characterized by the source of content. Results: Of the identified videos, 7.1 percent had medical institutions or verified physicians as authors; 12.1 percent had a media-affiliated author; 1.6 percent were posted by a pharmaceutical company; 11.5 percent contained "miracle-type" product advertisements with included links to product purchase websites; and 69.2 percent were holistic in nature, describing "natural" supplements and diets necessary for adequate psoriasis treatment and cure. Conclusion: This review emphasizes the need for an increase in the online presence of medical institutions to augment the dissemination of correct health information.

Annular atrophic lichen planus responds to hydroxychloroquine and acitretin.

Annular atrophic lichen planus (AALP) is a rare variant of lichen planus. The clinical presentation of AALP shows distinct atrophic plaques with elevated borders on the trunk and extremities. Histopathologic findings generally reveal a lichenoid dermatitis in active lesions with a distinct loss of elastic fibers in the center of the lesions. We report a unique case of AALP, which highlights the chronicity of the eruption. Our patient showed early signs of improvement with hydroxychloroquine and acitretin, suggesting a role for systemic therapy in the treatment of AALP.

Predictors of positive sentinel lymph node in thin melanoma.

BACKGROUND: The treatment of thin melanoma (Breslow thickness <1.0 mm) may include sentinel lymph node (SLN) biopsy (SLNB). The validity of SLNB for thin melanoma remains widely debated. The purpose of this study was to elucidate pathologic factors that are predictive of SLN positivity. METHODS: A retrospective analysis of a prospective database revealed 1,199 patients diagnosed with primary cutaneous melanoma. Multiple logistic regression was used to determine an association between pathologic factors and SLN positivity. RESULTS: Thin melanomas were identified in 469 patients (39%). Of these, 147 patients (31%) underwent SLNB. Positive SLNs were found in 16 patients (11%). Multiple logistic regression demonstrated that both ulceration (odds ratio, 5.27; P = .047) and thickness (odds ratio, 46.69; P = .022) were associated with SLN positivity. CONCLUSIONS: Patients with thin melanomas >.75 mm and/or ulceration should be considered for SLNB.

Pityriasis rubra pilaris exacerbation with topical use of imiquimod.

The role of immune response modifiers is increasing in the treatment of dermatologic diseases. Imiquimod, a toll-like receptor agonist, results in up-regulation of proinflammatory cytokines for improved immune surveillance. Although topical use is generally well-tolerated, imiquimod can potentially result in systemic effects and exacerbate generalized inflammatory papulosquamous diseases of the skin. We report the case of a 67-year-old man who was treated with imiquimod for actinic keratosis and developed fever and a progressive erythematous papulosquamous eruption that was histologically consistent with pityriasis rubra pilaris.

Minocycline-induced cutaneous polyarteritis nodosa.

Minocycline is a tetracycline derivative with multiple clinical uses including the treatment of various infections, acne vulgaris, and rosacea. Numerous adverse events have been reported ranging from minor complaints such as nausea, to serious life-threatening toxicities such as acute renal failure, hepatotoxicity, and systemic lupus erythematosus. We report the case of an 18-year-old female patient who developed minocycline-induced cutaneous polyarteritis nodosa after taking minocycline for acne vulgaris. The vasculitis resolved after discontinuation of the minocycline without need for corticosteroids. This case is the eighth biopsy-confirmed case of minocycline-induced polyarteritis nodosa. Although minocycline is an effective medication with a wide variety of clinical uses, clinicians must be aware of its potential side effects including autoimmune-related disorders such as polyarteritis nodosa or systemic lupus erythematosus.

Basal cell carcinoma with pulmonary and lymph node metastasis causing death.

BACKGROUND: The incidence of metastatic basal cell carcinoma ranges from 0.003% to 0.55%. The 230 reported cases most often occurred in long-standing recurrent lesions and appeared in regional nodes or the lungs. OBSERVATIONS: The stromal dependence of the tumor provides an explanation for the nonmetastasizing nature of basal cell carcinoma. The dense fibrous stroma of the lymph node in the case of metastatic basal cell carcinoma reported in the present study is similar to other reported cases with metastases to lymph nodes, bone, bone marrow, glands, and subcutaneous tissue. CONCLUSIONS: This metastatic basal cell carcinoma demonstrated lymphatic and hematogenous dissemination to the lungs and lymph nodes. A dense accumulation of microvessels was present at the boundary of the tumor nests and dermal stroma and in the stroma surrounding the tumor in the lymph node.

Kaposi's sarcoma-associated herpesvirus latency-associated nuclear antigen induces expression of the helix-loop-helix protein Id-1 in human endothelial cells.

Kaposi's sarcoma (KS)-associated herpesvirus (KSHV) (also known as human herpesvirus 8) is a gamma-2 herpesvirus believed to be the etiologic agent responsible for KS. The pathogenesis of this potentially life-threatening neoplasm is complex and unclear, and it is currently unknown how KSHV causes KS. Id (named for inhibitor of DNA binding or inhibitor of differentiation) proteins were identified in 1990 and found to be naturally occurring dominant-negative inhibitors of basic helix-loop-helix transcription factors. Id-1, the most well-studied member of this family, has since been shown to play a key role in several biological systems including cellular differentiation, cell cycle regulation, and tumorigenesis. In this report, we demonstrate that Id-1 is expressed at high levels in KS tumor cells both in vitro and in vivo but is expressed at relatively modest levels in endothelial cells (ECs), the likely precursor of the KS tumor cell. Infection of precursor cells with KSHV may be responsible for this enhanced expression, as KSHV infection induced Id-1 27-fold in ECs under our experimental conditions. Furthermore, we demonstrate that the KSHV-encoded latency-associated nuclear antigen (LANA) protein appears to be involved. Expression of LANA in ECs resulted in Id-1 induction that was almost identical to the induction seen with KSHV-infected ECs. These results demonstrate the expression of Id-1 in KS tumor cells and indicate the KSHV LANA protein may be, at least in part, responsible. This may be an important mechanism by which KSHV allows KS tumor cells to escape normal cell cycle regulation and enhances their proliferation.

Analysis of c-kit protein expression in small-cell lung carcinoma and its implication for prognosis.

Recently, therapies targeting signaling pathways involved in the pathogenesis of different tumors have been developed. Studies have shown that the tyrosine kinase inhibitor STI-571 (Gleevec) is used successfully against tumors expressing the c-kit oncogene, such as gastrointestinal stromal tumors (GISTs). A recent in vitro study also demonstrated an antiproliferative effect of STI-571 on small-cell lung cancer (SCLC) cell lines. To determine the expression of c-kit in SCLC, we retrospectively analyzed presence of c-kit by immunohistochemistry in biopsy samples from patients with SCLCs. Formalin-fixed, paraffin-embedded archival tissue samples from 30 SCLCs were stained with an antibody directed against c-kit (CD117) by immunohistochemistry. Thirty cases of SCLCs, including 17 males (age 44 to 89) and 13 females (age 21 to 85), were examined. Sixteen of 30 (53.3%) SCLCs showed c-kit expression. Kaplan-Meier survival analysis with a log-rank test revealed that patients with c-kit expression had a tendency toward lower survival than c-kit-negative patients (median survival, 6 months versus 31 months, P =.062). Based on previously established anti-c-kit effects of STI-571 on SCLC cell lines and our findings, clinical trials may be considered for selected SCLC patients with c-kit expression. Furthermore, determination of c-kit in SCLC may have a prognostic value in SCLC patients.