Ana Filipa Pedrosa

Sweet’s syndrome triggered by pneumococcal vaccination

Abstract Sweet’s syndrome is the most frequent category among the neutrophilic dermatosis and is diagnosed by clearly defined criteria. Vaccines are included as potential triggers of this syndrome. Nevertheless, there are few reports unveiling such association. Herein, we describe the case of a patient who developed Sweet’s syndrome after pneumococcal vaccination. To our knowledge, this is the second case of Sweet’s syndrome triggered by pneumococcal vaccine reported, and the first one specifically with the 13-valent conjugate vaccine.

Spitz/Reed nevi: a review of clinical-dermatoscopic and histological correlation

Background: Spitz/Reed nevi are melanocytic lesions that may mimic melanoma at clinical, dermatoscopic and histopathological levels. Management strategies of these lesions remain controversial. Objectives: We aim a correlation among clinical-dermatoscopic and histological features of a series of Spitz/Reed nevi diagnosed during 7 years at the Department of Dermatology. Methods: Clinical, dermatoscopic and histological features of Spitz/Reed nevi diagnosed at our tertiary hospital from 2008 to 2014 were reviewed in order to seek correlation. Results: All described dermatoscopic patterns for Spitz/Reed nevi were found among the 47 enrolled patients; starburst and atypical/multicomponent patterns prevailed (57.4%). Reticular pattern predominated among children younger than 12 years, whereas homogeneous pattern was more frequent in patients older than 12 years, although these differences were not statistically significant (P=0.785). Among histological atypical lesions, all dermatoscopic patterns were represented, but the atypical/multicomponent predominated (56.3%). Two out of 11 dermatoscopically atypical lesions did not show histopathological counterpart. Conclusions: The excision of Spitz/Reed nevi in adults is supported, given the inability to accurately predict those with histopathological atypia, based on clinical and dermatoscopic features, which may raise concern about malignancy.

Primary Langerhans cell histiocytosis of the vulva: acitretin as a glucocorticoid-sparing agent

Serra Kayac etin, MD Ankara Numune Education and Research Hospital Pathology Clinic Ankara Turkey E-mail: seraycakmak@gmail.com References 1 Speeckaert MM, Speeckaert R, Lambert J, et al. Acute generalized exanthematous pustulosis: an overview of the clinical, immunological and diagnostic concepts. Eur J Dermatol 2010; 20: 425–433. 2 Guevara-Gutierrez E, Uribe-Jimenez E, Diaz-Canchola M, et al. Acute generalized exanthematous pustulosis: report of 12 cases and literature review. Int J Dermatol 2009; 48: 253–258. 3 Mayo-Pamp ın E, Fl orez A, Feal C, et al. Acute generalized exanthematous pustulosis due to pseudoephedrine with positive patch test. Acta Derm Venereol 2006; 86: 542– 543. 4 Treudler R, Grunewald S, Gebhardt C, et al. Prolonged course of acute generalized exanthematous pustulosis with liver involvement due to sensitization to amoxicillin and paracetamol. Acta Derm Venereol 2009; 89: 314–315. 5 Sim HS, Seol JE, Chun JS, et al. Acute localized exanthematous pustulosis on the face. Ann Dermatol 2001; 23: S368–S370. 6 Betto P, Germi L, Bonoldi E, et al. Acute localized exanthematous pustulosis (ALEP) caused by amoxicillinclavulanic acid. Int J Dermatol 2008; 47: 295–296.

Cat‐scratch disease during anti‐tumor necrosis factor‐alpha therapy: case report and review of the literature

References 1 Nagore E, Insa A, Sanmartín O. Antineoplastic therapy-induced palmar plantar erythrodysesthesia (hand-foot) syndrome. Incidence, recognition and management. Am J Clin Dermatol 2000; 1: 225–234. 2 Chew L, Chuen VS. Cutaneous reaction associated with weekly docetaxel administration. J Oncol Pharm Pract 2009; 15: 29–34. 3 Eisenhauer EA, Vermorken JB. The taxoids. Comparative clinical pharmacology and therapeutic potential. Drugs 1998; 55: 5–30. 4 Benghiat H, Al-Niaimi A. Palmar-plantar erythrodysesthesia secondary to docetaxel chemotherapy: a case report. J Med Case Reports 2011; 5: 80. 5 Webster-Gandy JD, How C, Harrold K. Palmar-plantar erythrodysesthesia (PPE): a literature review with commentary on experience in a cancer centre. Eur J Oncol Nurs 2007; 11: 238–246. 6 Eich D, Scharffetter-Kochanek K, Eich HT, et al. Acral erythrodysesthesia syndrome caused by intravenous infusion of docetaxel in breast cancer. Am J Clin Oncol 2002; 25: 599–602. 7 Zimmerman GC, Keeling JH, Lowry M, et al. Prevention of docetaxel-induced erythrodysesthesia with local hypothermia. J Natl Cancer Inst 1994; 86: 557–558. 8 Kara IO, Sahin B, Erkisi M. Palmar-plantar erythrodysesthesia due to docetaxel-capecitabine therapy is treated with vitamin E without dose reduction. Breast 2006; 15: 414–424. 9 Corazza M, Minghetti S, Zauli S, et al. Pegylated liposomal doxorubicin-induced palmar-plantar erythrodysestesia in multiple uncommon sites. Eur J Dermatol 2011; 21: 433–434. 10 Chu CY, Yang CH, Yang CY, et al. Fixed erythrodysaesthesia plaque due to intravenous injection of docetaxel. Br J Dermatol 2000; 142: 808–811. 11 Cruz A, Temu T, Hines-Telang G, Kroumpouzos G. Paclitaxel-induced neutrophilic adverse reaction and acral erythema. Acta Derm Venereol 2011; 91: 86–87.

The Importance of Trichoscopy in Clinical Practice

Trichoscopy corresponds to scalp and hair dermoscopy and has been increasingly used as an aid in the diagnosis, follow-up, and prognosis of hair disorders. Herein, we report selected cases harbouring scalp or hair diseases, in whom trichoscopy proved to be a valuable tool in their management. A review of the recent literature on this hot topic was performed comparing the described patterns with our findings in clinically common conditions, as well as in rare hair shaft abnormalities, where trichoscopy may display pathognomonic features. In our view, trichoscopy represents a valuable link between clinical and histological diagnosis. We detailed some trichoscopic patterns, complemented with our original photographs and our insights into nondescribed patterns.

Necrobiotic xanthogranuloma with giant cell hepatitis, successfully treated with intravenous immunoglobulins

A 44-year-old Caucasian woman with a year history of IgG kappa light-chain monoclonal gammopathy and giant cell hepatitis was referred to our department due to an arm lesion evolving for 2 months. On physical examination, an asymptomatic, erythematous-violaceous indurated plaque on the extensor surface of the left arm (Fig. 1A) and multiple yellowish, nontender, edematous, confluent papules on the periorbital area (Fig. 1B) were observed. The patient complained of recurrent red eye episodes and myalgia. Laboratory tests revealed elevation of transaminases and complement consumption; protein electrophoresis showed a diffuse increase in gamma globulins and a peak of free kappa light-chains; echocardiography was normal. Biopsies of the arm and periorbital lesions showed similar features, namely an infiltrate of histiocytes, including some multinucleated giant and foamy cells, extending into the hypodermis, foci of necrobiosis, cholesterol clefts, and a moderate lymphocytic infiltrate with occasional plasma cells (Fig. 1C–E). The diagnosis of necrobiotic xanthogranuloma (NXG) was established. Liver biopsy revealed hepatocytes with giant cell transformation, microvesicular steatosis, and intralobular necroinflammatory lesions. A bone marrow biopsy excluded a malignancy. Oral prednisolone (1 mg/kg/day) was started and later tapered off and replaced by oral budesonide (9 mg/day), yielding an initial reduction in transaminases values, but followed by another raising (ALT/AST 159/466, normal range <31 U/I). The cutaneous picture worsened increasingly with periorbital necrosis and ulceration (Fig. 2A). As the patient wanted to get pregnant, intravenous immunoglobulins (IVIg), 0.5 g/kg/day (4 consecutive days every 4 weeks) were administered concomitantly with oral budesonide. After three cycles of IVIg, the skin lesions improved remarkably (Fig. 2B) and transaminase values normalized. When 15 cycles of IVIg have been completed, the interval was extended to 6 weeks, maintaining the outcome. An attempt to reduce budesonide to 6 mg/day was followed by elevation of transaminases, leading to a return to the original dose. The serum free kappa light-chains remained Address correspondence and reprint requests to: Ana Filipa Bastos Pedrosa, MD, Department of Dermatology and Venereology, Centro Hospitalar São João EPE, Alameda Prof. Hernani Monteiro, Porto 4200-319, Portugal, or email: anabastospedrosa@gmail.com.

Photoletter to the editor: Congenital atrichia associated with an uncommon mutation of HR gene

Congenital atrichia (CA) is a rare form of irreversible alopecia with an autosomal recessive mode of inheritance, usually associated with a mutation in the human hairless (HR) gene located at chromosome 8. Papular lesions may develop as an additional phenotypic feature. Herein we describe a case of CA supported by trichoscopy, histology and genetic analysis. The patients single brother had also universal alopecia. To our knowledge this is the second report of a specific pathogenic mutation (c.2818C>T) of the HR, which until now had only been identified in a family with CA and papular lesions, emphasizing the difficulty to establish a strict correlation between HR genotyping and the phenotype.

Malassezia infections with systemic involvement: Figures and facts

Malassezia are lipophilic and commensal yeasts capable of inducing skin disease among susceptible hosts. However, severely immunocompromised patients and preterm infants admitted to intensive care units are particularly at risk of developing Malassezia systemic infections. Patients often have central venous catheters which are usually the portal of entry for colonization and infection. In addition to the clinically non‐specific findings, a delay in the laboratorial diagnosis may occur as there is often the need to add lipid supplementation to culture in order to support these organisms’ growth. Herein, we report three unrelated cases of Malassezia bloodstream infection at a university hospital during a 2‐year period, followed by a discussion of the clinical results and comparison with the most recently available published data on epidemiology and risk factors, pathogenesis, diagnosis, susceptibility profile and treatment.

Re-emergence of syphilis in the biological era.

cost Sporothrix detection methods are needed for adoption in endemic areas of Abancay, Peru. Oral itraconazole is considered the first-line drug for treatment of fixed and lymphocutaneous sporotrichosis. In this case, the patient’s lesions responded completely after treatment with KI. Treatment with KI has been reported for use in therapy for children with cutaneous sporotrichosis. Despite the adverse effects associated with this compound (metallic taste, mild gastrointestinal intolerance) and transient altered thyroid profile, it remains a satisfactory therapy for children with cutaneous sporotrichosis, probably because of its wide availability and low cost. In this case, it was not possible to measure the serum levels of thyroid-stimulating hormone, total triiodothyronine, and total thyroxine, to confirm the altered thyroid profile. The awareness of palpebral sporotrichosis, by dermatologists, ophthalmologists, and other providers, will hopefully allow for potential cases to be more quickly recognized.

Neutrophilic dermatosis of the dorsal hands: a restrictive designation for an acral entity

In 2000, Galaria et al. proposed the designation neutrophilic dermatosis of the dorsal hands (NDDH). The authors describe a case of NDDH with predominant involvement of the palmar aspect of the hands in a patient suffering from lung cancer, a possible paraneoplastic manifestation. Therefore, the term NDDH is not accurate because palmar manifestations of this dermatosis are also possible.