Histopathology of bilateral lower extremity inflammatory lymphedema in military basic trainees: A leukocytoclastic vasculitis of the deep vascular plexus.

Bilateral lower extremity inflammatory lymphedema (BLEIL) is a recently described condition that presents with exquisite tenderness, erythema and edema of the lower leg, ankle and dorsal foot resembling an acute cellulitis. It was first reported in healthy, young adult military basic trainees with a normal body mass index during the first 72 hours of arrival to basic training. It occurs while standing at attention for many hours, and shows rapid resolution with elevation and rest. We report an additional case of BLEIL and describe the histopathology of this case and 2 of the previously reported cases. All 3 biopsies showed a deep perivascular infiltrate of neutrophils with karyorrhectic debris and prominent red blood cell extravasation. One of the 3 cases was positive for complement by direct immunofluorescence. We postulate this condition represents a deep leukocytoclastic vascultis with secondary reactive lymphedematous changes.

Understanding Medical Standards for Entrance Into Military Service and Disqualifying Dermatologic Conditions.

The military is a desirable career field for many young adults; however, the Department of Defense (DoD) requires its members to maintain a level of health necessary to meet the physical demands of military duties and be able to deploy to austere environments. The strict standards are designed to protect the health of the individual and maximize mission success. Standards for entrance into the US Armed Forces, called accession standards, are codified in DoD Instruction 6130.03, Volume 1 and include a section dedicated to skin and soft tissue conditions. This document lists medical conditions that do not meet the standard due to current and prior diagnoses and is regularly updated by a board using the best available scientific evidence. Applicants who do not meet the physical and medical standards can be considered for a medical waiver, although not guaranteed. Generally, retention standards differ for those already serving in the military and will not be addressed here. The focus of this article is to inform the general dermatologic community that these standards exist, to discuss specific dermatologic conditions that are disqualifying at the current time, and to provide resources for the dermatologist or primary care physician to access current information.

Pyostomatitis Vegetans With Orofacial and Vulvar Granulomatosis in a Pediatric Patient.

Pyostomatitis vegetans (PSV) is a rare disorder strongly associated with inflammatory bowel disease (IBD), most commonly ulcerative colitis, but has infrequently been found in patients with Crohn disease (CD). We present the case of a 7-year-old girl with PSV and extraintestinal findings suggestive of CD-chelitis granulomatosa, perianal and vulvar edema with biopsies revealing noncaseating granulomas, and anal skin tags-and an elevated calprotectin noted during a cutaneous flare. She did not have clinical or endoscopically identified underlying gastrointestinal involvement for 4 years after symptom onset. Given the paucity of data on managing PSV in a child without gastrointestinal findings of IBD, the literature is reviewed and treatment options discussed.