Rosai-Dorfman Disease-Like Reaction to Tattoo.

A 47-year-old white man presented with a 14-month history of an asymptomatic 2-cm, slow-growing nodular lesion on his left shin that arose in the background of a black tattoo. An excisional biopsy followed by histological examination revealed a prominent lymphohistiocytic infiltrate, with many large, foamy histiocytic cells containing intact inflammatory cells within their cytoplasm, findings consistent with emperipolesis, a feature typical of Rosai-Dorfman disease (RDD). By immunohistochemistry, S-100 (a marker that is positive in almost all cases of RDD) was negative, arguing against the diagnosis of RDD. In addition, prominent black tattoo pigment was seen in many areas, expanding the differential diagnosis to include an unusual reactive lymphohistiocytic response to the tattoo mimicking RDD. Histologically, RDD shows many plasma cells, neutrophils, lymphocytes, and histiocytes with abundant foamy cytoplasm that contains intact lymphocytes and other cells, a phenomenon described as emperipolesis. A wide variety of cutaneous reactions to tattoos have been described, including tenderness, burning pain, inflammation, and pruritus. However, histologic features suggestive of RDD as a reaction to tattoo pigment have not been previously described and should therefore also be considered as a potential rare reaction pattern to tattoos.

Use of a Natural Porcine Extracellular Matrix With Negative Pressure Wound Therapy Hastens the Healing Rate in Stage 4 Pressure Ulcers.

INTRODUCTION: Chronic wounds are physically debilitating and painful and are responsible for the addition of more than $25 billion annually in health care costs in the United States. Extracellular matrix (ECM) replacements have been demonstrated to aid in wound healing by providing an optimal environment to facilitate the healing process. OBJECTIVE: This study examines the healing rates of stage 4 pressure ulcers using combination of a commercially available porcine-based wound matrix dressing alongside negative pressure wound therapy (NPWT) versus using NPWT alone. MATERIALS AND METHODS: Patients were randomized to receive either the matrix plus NPWT (study) or NPWT alone (control) for stage 4 sacral pressure ulcer treatment. Wounds were photographed and measured weekly. The experimental group had their ECM dressings changed every other week and their NPWT changed twice weekly. RESULTS: A total of 16 patients, 8 study and 8 control, completed this study. After the 12-week study period, the average control patient healing rate was 45.79% as compared with the 89.98% healing rate in the study group. The difference in healing rate between control and study patients was optimal by 12 weeks. CONCLUSIONS: These studies suggest that ECM dressings may be a promising adjunctive treatment option for stage 4 pressure ulcers.