Erica Kelly

Pancreatic Panniculitis Associated with Allograft Pancreatitis and Rejection in a Simultaneous Pancreas–Kidney Transplant Recipient

Pancreatic panniculitis is an uncommon condition that can occur in association with pancreatic disease. We present a case of pancreatic panniculitis in a female pancreas–kidney transplant recipient 5 months post‐transplant. The patient was on standard immunosuppressive medications and had acute rejection of her renal allograft. The diagnosis of allograft pancreatitis and rejection presenting with pancreatic panniculitis was supported clinically, histopathologically and by laboratory and imaging data. This is the fourth case of pancreatic panniculitis occurring in a transplant recipient and the first in a simultaneous pancreas–kidney transplant recipient. It is also the first case associated with allograft rejection. Clinicians should be aware that pancreatic panniculitis may be a manifestation of underlying allograft pancreatic disease.

Fox-Fordyce disease in daughter and father.

On examination, discrete 2to 3-mm perifollicular papules localized to the bilateral axillae ( fig. 1 ) and the pubic area were noted. The color of the papules ranged from flesh-colored to slightly hypopigmented. Additionally, her left axilla showed areas of superficial erosion, erythema and overlying honey-colored crust ( fig. 2 ). Of particular interest, the patient’s father was also examined in our office because of a similar eruption in both axillae, which was asymptomatic. A diagnosis of Fox-Fordyce disease with superficial impetigo was made clinically, and the patient was treated with oral antibiotics and bacitracin ointment. The impetigo improved, but the apocrine miliaria persisted. Since the lesions were asymptomatic, she desired no further treatment.

Cosmetic Dermatology Training in Residency: Results of a Survey from the Residents' Perspective

BACKGROUND Dermatologists are expected to be experts in the evaluation and treatment of their patients cosmetic concerns. It has been reported that some dermatology residents do not feel adequately trained in this field. OBJECTIVE To assess how dermatology residents are being trained in cosmetic dermatology. METHODS A survey was e‐mailed to 473 third‐year dermatology residents. RESULTS One hundred eighteen surveys were returned (24.9%), representing 45% of programs. Most residents have assigned reading (70.7%) and lectures (81.4%) in cosmetic dermatology. To learn technical skills, 79.7% participate in formal training sessions, and 73% have an apprenticeship model. Most residents have the opportunity to perform botulinum toxin injections, laser surgery, fillers, chemical peels, and sclerotherapy. More than 58% of programs have an encouraging or somewhat encouraging attitude toward teaching cosmetics, whereas 22% were somewhat discouraging or discouraging. Most residents (75.4%) plan to incorporate cosmetics into their practice. Residents do not feel less prepared (94.9%) or less interested (97.4%) in medical dermatology as a result of their cosmetic training. CONCLUSIONS Residents are being trained in cosmetic dermatology through a variety of methods. Residency programs should periodically assess and adapt their curricula to ensure adequate training in this field.

Disseminated Acanthamoeba infection with sporotrichoid nodules.

On physical examination the patient was afebrile and in no apparent distress. Multiple 1–2-cm subcutaneous nodules in a sporotricoid pattern were observed covering the extremities; some ulcerated (Fig. 1). A 0.3-cm punch biopsy of one of the nodules revealed a diffused granulomatous inflammation with numerous foamy cells resembling macrophages. No fungi or acid fast bacilli were observed on special stains. Three days later, the patient developed myoclonus and was admitted to the hospital for antibiotic therapy. The patient progressed to multiorgan failure and expired 11 days after admission. Autopsy revealed multiple Acanthamoeba trophozoites and cysts in the patient’s brain, lung, and skin. The original biopsy was reviewed, and a trichrome stain showed that numerous cells, originally interpreted as macrophages, were in fact amoebic trophozoites (Fig. 2).