Bullous Fixed Drug Eruption Following Ibuprofen Ingestion.

Fixed drug eruption (FDE) is a drug reaction involving skin and less commonly mucosal membranes. The common manifestation is localized well-demarcated patches or plaques appeared following receiving of a culprit drug. When re-exposure occurs, the rashes will appear at areas involved in previous episodes. Limited reports on bullous FDE due to ibuprofen have been documented before. Herein, we described an elderly man who experienced multifocal lesions in his oral mucosa, penis, and multiple sites of skin following ibuprofen ingestion confirmed as FDE by pathological studies. The culprit drug had been discontinued. Systemic and topical glucocorticoids as well as supportive care had been instituted. The patient's outcome was favorable and his lesions had been recovered within the next weeks. Patient's follow-up showed that he had received ibuprofen again sometime later resulting in anal mucosal lesion and similar penile involvement. In routine clinical practice, mucocutaneous adverse drug reactions should be considered. A high index of suspicion, the detailed medication history, the course of the symptoms, and distributing pattern of the lesions are essential clues for the diagnosis. However, judicious and prompt pathological studies can help to differentiate multifocal bullous FDE from major skin drug reactions such as Stevens-Johnson syndrome/toxic epidermal necrolysis.

Rituximab for refractory subcutaneous Sweet's syndrome in chronic lymphocytic leukemia: A case report.

Sweet's syndrome is a neutrophilic dermatosis characterised by sudden onset of fever, neutrophilia, erythematous skin rashes and neutrophilic infiltration of the dermis. Subcutaneous Sweet's syndrome, or Sweet's panniculitis, is an uncommon variant of the classic syndrome, with hypodermal neutrophilic infiltration. The association of Sweet's syndrome with various malignancies has been reported. The most common underlying hematological malignancies are of myeloid origin; however, there have been several reports of the classic Sweet's syndrome in patients with a lymphoproliferative disorder, although the association of subcutaneous Sweet's syndrome with lymphoproliferative disorders has not been well-documented thus far. Herein, we present the case of a 48-year-old man with a 2-year history of chronic lymphocytic leukemia who developed fever and skin rashes, without any evidence of a relapse. The clinical and pathological investigation resulted in the diagnosis of subcutaneous Sweet's syndrome. The patient exhibited no significant response to conventional therapeutic measures; however, following two subsequent doses of rituximab, his general condition and skin rash improved. The follow-up skin biopsy demonstrated dermal neutrophilic infiltrations in conjunction with prior mixed lobular and septal panniculitis, suggesting evolution of subcutaneous Sweet's syndrome to its classic form. To the best of our knowledge, this is one of the first reports of rituximab as a novel biological treatment for Sweet's syndrome. However, further randomized trials are required to evaluate the efficacy and safety of such biological therapies for Sweet's syndrome.

Sporadic colonic polyposis and adenocarcinoma associated with lymphoblastic and large B-cell lymphoma in a young male patient: A case report.

We herein report a case of colonic polyposis, colorectal carcinoma and large B-cell lymphoma in a 22-year-old male patient with a previous history of childhood lymphoblastic lymphoma. Eight years after lymphoblastic lymphoma, which presented as mediastinal mass and superior vena cava syndrome, the patient complained of abdominal pain, lower gastrointestinal bleeding and an abdominal mass. The surgical exploration revealed numerous mucosal polyps throughout the large intestine, and multifocal masses in the ascending and transverse colon and the rectosigmoid region. A retroperitoneal mass was also found. The pathological examination revealed >100 tubular adenomatous polyps and a multifocal, well-differentiated adenocarcinoma, with lymph node involvement and pericolic invasion. Interestingly, the immunohistochemical studies confirmed the malignant undifferentiated retroperitoneal mass as large B-cell lymphoma. Over a period of ~10 years, the patient had suffered from three different malignancies. To the best of our knowledge, such a combination of sporadic adenomatous colonic polyposis, colorectal carcinoma and two extra-intestinal non-Hodgkin lymphomas has not been reported to date. It should be considered that each malignancy increases the risk for other neoplastic diseases and a close follow-up is crucial for early detection of second malignancies and neoplastic syndromes.