Frederick L. Glavin

Pediatric basal cell carcinoma: case reports and literature review

Basal cell carcinoma (BCC) is a rare disease in the pediatric population that usually presents in children with predisposing genetic conditions. It is often diagnosed on final pathology of an excisional biopsy, and the treatment may be delayed in younger populations because of a physicians low index of suspicion. Increased knowledge of BCC by pediatric caregivers would expedite definitive therapy for childhood BCC as well as any necessary evaluation by subspecialists for predisposing syndromes. We report 3 cases of BCC in pediatric patients and review the literature concerning BCC in children.

Progressive nodular histiocytosis: a case report with literature review, and discussion of differential diagnosis and classification.

Histiocytoses are a heterogeneous group of disorders which are difficult to categorize because of overlapping clinical and microscopic features, and incompletely understood mechanisms of cellular origin and triggers of proliferation. Progressive nodular histiocytosis (PNH) is a rare non‐Langerhans cell histiocytic (NLH) disorder. We present the case of a 34‐year‐old woman with PNH, who has involvement of the back, head and neck, face, and uniquely, extensive involvement of the posterior pharynx and larynx, which has shown progressive worsening and deformity over a 7‐year course. Clinically it is best classified as PNH, although it microscopically closely resembles juvenile and adult xanthogranulomatosis. This study reinforces the concept that the NLH is a closely related group of disorders, possibly representing a spectrum of a single underlying process.

Majocchi's granuloma after antithymocyte globulin therapy in a liver transplant patient.

A. Gega, G. Ketsela, F.L. Glavin, C. Soldevilla‐Pico, D. Schain. Majocchis granuloma after antithymocyte globulin therapy in a liver transplant patient.
Transpl Infect Dis 2010: 12: 143–145. All rights reserved

Malignant Cylindroma of the Scalp Arising in a Setting of Multiple Cylindromatosis: A Case Report

An unusual case of malignant cylindroma of the scalp arising in a 79-year-old white female with multiple cylindromatosis is presented. The tumor apparently arose from a cylindroma and had features of spiradenoma. Multiple cylindromatosis is an uncommon hereditary autosomal dominant disease, which is characterized by multiple skin adnexal tumors like cylindromas and trichoepitheliomas and occasional spiradenomas. Cylindroma is an uncommon benign tumor, which originates from skin appendages and is most commonly found on the scalp and face with a strong predilection for middle-aged and elderly females. Although cylindromas are usually benign neoplasms, carcinoma arising in such neoplasms is rare with only sporadic reports in literature. Her family history was negative for a similar disease. The patient’s main concern was painful lesions over her right ear that interfered with wearing of her glasses. The clinical, histological immunohistochemical features, and treatment are presented along with a review of the literature.

Laryngeal Involvement in Progressive Nodular Histiocytosis: A Case Report

Progressive nodular histiocytosis (PNH) belongs to an exceedingly rare family of benign proliferative skin disorders known as non-Langerhans cell histiocytoses (NLCHs). Since initial description as progressive nodular histiocytoma by Taunton et al 1 in 1978, there have been only a handful of case reports describing this rare entity. In the past, there has been a great deal of confusion in classifying the various histiocytoses owing to the rarity in which they were encountered as well as to the tremendous overlap, both clinically and histologically, observed between these diseases. 2 The lesions encountered in this family of diseases are generally benign; however, in the case reported herein, the involvement of the larynx led to partial airway obstruction, a clinical occurrence previously undescribed (to our knowledge).

Severe Neonatal Purpura Fulminans Caused by Staphylococcus aureus.

An 8-day-old term male patient presented to an outside hospital for vomiting and lethargy for 1 day. He was noted to be lethargic, poorly perfused and had erythematous ecchymotic lesions on the lower back. He was endotracheally intubated, aggressively fluid resuscitated, started on inotropic and antibiotic therapy (ampicillin, cefotaxime). Over the next 48 hours, there was deterioration in his clinical condition. He developed worsening respiratory failure and refractory shock. His skin lesions rapidly increased, extending to the upper back, pelvis, and abdominal wall. In addition, he developed severe ischemia of fingers and toes and had evidence of disseminated intravascular coagulation (DIC). Antibiotic coverage was expanded to include vancomycin, gentamicin and acyclovir. Endotracheal cultures grew methicillin-resistant Staphylococcus aureus (MRSA), blood/urine cultures/viral respiratory polymerase chain reaction panel were negative. After 48 hours, the patient was transferred to our institution. On arrival he was noted to have severe anasarca and poor perfusion. His skin examination revealed hemorrhagic bullae with ecchymoses and erythema on back/buttocks (Figure 1) and digital ischemia of multiple fingers/toes. Laboratory investigations revealed arterial pH 7.17, arterial lactate 5.3 mmol/L, white cell count 1400/mm, hemoglobin 11 g/dL, platelet count 10 000/mm, creatinine 0.6 mg/dL, alanine transaminase 86 U/L, international normalized ratio 1.5, and fibrinogen 270 mg/dL. Renal replacement therapy was initiated for severe anasarca. Over the next 48 hours, there was progression of septic shock with rising serum lactate levels and worsening of DIC, renal and hepatic failure. His echocardiogram demonstrated good cardiac function. He was initiated on venoarterial extracorporeal membrane oxygenation (ECMO) on day 3 of admission for refractory septic shock and worsening hyperlactemia (peak lactate = 16 mmol/L). His tissue perfusion and organ dysfunction improved subsequently and he was weaned from ECMO after 7 days. However, his skin lesions progressed and he developed full thickness necrosis of the skin over the whole back and buttocks (Figure 2). Culture of the skin lesion grew MRSA, blood and urine cultures were negative. Molecular characteristics of MRSA were not studied. Patient had low adenovirus serum titers (1904 copies/mL). Infectious disease experts opined that the load was too low to cause clinically significant disease. However, he was treated empirically with cidofovir (2 doses) and immunoglobulin. Repeat titers were negative and cidofovir was discontinued. Other infectious diseases work-up, including 660693 CPJXXX10.1177/0009922816660693Clinical PediatricsNicolas et al brief-report2016

Peyronellaea gardeniae fungus infection presenting as posttraumatic hemorrhagic bullae and desquamation

Peyronellaea gardeniae is a rare fungus, first described in 1966 by Chandra and Tandon,1 which was never previously identified as a source of infection in humans. We report a case of a 72-year-old white man with multiple medical comorbidities who presented with extensive hemorrhagic bullae on his left upper extremity secondary to infection with Peyronellaea gardeniae.

Crusted pink papule in a 20-year-old

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