Incidence of Dermatitis Herpetiformis in Sweden 2005 to 2018: A Nationwide Retrospective Cohort Study.

Dermatitis herpetiformis has been investigated in the past; however, only a limited number of studies have reported its incidence based on validated nationwide population-based registries. To address this gap, the aims of this study are to estimate the incidence of dermatitis herpetiformis in Sweden and to validate the National Patient Register (NPR) for diagnosis of dermatitis herpetiformis. A population-based open cohort study was conducted, including all patients diagnosed with dermatitis herpetiformis (International Classification of Diseases 10th revision; ICD-10 code L13.0) in Sweden from 2005 to 2018 (n = 1,724), identified from the NPR. The diagnosis of dermatitis herpetiformis in the NPR was validated using medical records, histopathological and immunopathological data, yielding a positive predictive value (PPV) of 62.5%. The mean annual incidence of dermatitis herpetiformis was 0.93/100,000 (95% confidence interval 0.79-1.08), female to male ratio 1:1, and mean age at diagnosis 60.9 years. In conclusion, this large nationwide cohort study showed a low validity for diagnosis of dermatitis herpetiformis in the NPR, and the adjusted incidence rate of dermatitis herpetiformis in Sweden was estimated to be 0.93/100,000, which is lower than that in previous Swedish studies.

Increased Risk of Squamous Cell Carcinoma of the Skin and Lymphoma Among 5,739 Patients with Bullous Pemphigoid: A Swedish Nationwide Cohort Study.

Evidence about the association of bullous pemphigoid and the risk of cancer is conflicting. Patients diagnosed with bullous pemphigoid (n = 5,739) between 2005 and 2016 were matched with a control cohort from the general population (n = 17,168) to estimate their overall and specific risk of cancer. The risk of squamous cell cancer of the skin (cSCC) was increased in patients with bullous pemphigoid (hazard ratio (HR) 1.3; 95% confidence interval (CI) 1.1-1.6). The risk of lymphoma within one year after bullous pemphigoid diagnosis was also increased (HR 3.1; 95% CI 1.3-7.6). While overall cancer risk prior to diagnosis of bullous pemphigoid was similar in cases and controls (prevalence odds ratio (POR) 1.0; 95% CI 0.9-1.0), the risk of male genital cancer within one year prior to diagnosis of bullous pemphigoid was lower in cases (POR 0.4; 95% CI 0.2-0.8). Clinicians must be aware of the increased risk of cSCC and lym-phoma in patients with bullous pemphigoid.

Necrotizing fasciitis of the finger.

A 62 year old woman with a medical history of hypertension presented to her local general practice with moderate pain in the right ring finger which worsened over a few hours after onset. Her condition progressed swiftly into sepsis and required hospital admission in the intensive care unit. Over the course of 24 h the patient was diagnosed with necrotizing fasciitis in the finger but unfortunately despite treatment with antimicrobials and surgical debridement the patient's finger could not be saved and she had amputation of her finger.

Non-small-cell Carcinoma Localised within the Pulmonary Artery Misdiagnosed as Pulmonary Thromboembolism.

In this case report we describe a 69-year-old male ex-smoker with non-small-cell carcinoma localised within the pulmonary artery, misdiagnosed as pulmonary thromboembolism. This case indicates that non-small-cell carcinoma can be localised within the pulmonary artery. Furthermore, it emphasises the importance of performing a positron emission tomography scan and diagnostic intraluminal biopsy in unexplained lesions in the pulmonary artery to reach the proper diagnosis at the early stages of the disease. The patient is currently undergoing concurrent chemotherapy and radiation therapy. LEARNING POINTS: Tumours within the pulmonary arteries are a rare finding and rarely reported, and are often misdiagnosed as pulmonary thromboembolism.If the diagnosis is unclear a positron emission tomography (PET-CT) scan and intravascular biopsy should be considered at early stages of the presentation.In general, surgery would be the treatment of choice for pulmonary artery tumours but this is not optimal and treatment options remain controversial.