Luís Soares-Almeida

Bullous hemorrhagic dermatosis induced by enoxaparin

Abstract The bullous hemorrhagic dermatosis induced by enoxaparin is a rare adverse reaction, which may be under-reported given its favorable evolution. We report a 71-year-old man who developed hemorrhagic bullae at sites distant from subcutaneous enoxaparin injections. It is important that clinicians be aware of the different adverse reactions of these widely used drugs.

Autoimmune thyroiditis presenting as interstitial granulomatous dermatitis

A 54-year-old female presented with recurrent, widespread, erythematous, painful plaques, over a 3-month period. Skin biopsy was compatible with interstitial granulomatous dermatitis. Additional investigation revealed hypothyroidism and positive anti-thyroid antibodies. Normalization of thyroid function and high-potency topical corticosteroids provided only transitory improvement of the dermatosis. Interstitial granulomatous dermatitis is a histologic inflammatory reaction, with variable cutaneous expression. It has been reported in association with several drugs, lymphoproliferative diseases and autoimmune disorders, such as rheumatoid arthritis, systemic lupus erythematosus and vasculitis, but association with autoimmune thyroiditis is rare. Optimal therapy for this condition is yet to be established, but topical corticosteroids have been a mainstay of treatment. In most cases, this disease is characterized by flares and remissions.

Pachydermodactyly in a 16-Year-Old Adolescent Boy

Pachydermodactyly is a superficial benign fibromatosis of unknown etiology; it is rare, more frequent in adolescent males, and characterized by painless swelling of the proximal interphalangeal joints(PIP) of the hands. Histologic examination of the skin shows epidermal hyperplasia and increased number of dermal fibroblasts and collagen fibers.We report the case of a 16-year-old adolescent boy who presented swelling of the lateral and dorsal regions of all the metacarpophalangeal and PIP joints of the left hand and PIP and metacarpophalangeal joints of the second and fifth fingers of the right hand, with 3 years of evolution and no arthritis or functional impairment. Results of complementary diagnostic examinations were normal, with the exception of hand ultra sound that showed skin thickening, without synovial proliferation or joint effusion. Skin biopsy confirmed pachydermodactyly. The patient under went aesthetic surgery with good outcome, without recurrence.This rare condition should be distinguished from idiopathic juvenile arthritis and other entities such as knuckle pads syndrome.

Multifocal primary cutaneous extranodal NK/T lymphoma nasal type

Nasal type extranodal NK/T-cell lymphoma is a distinct entity according to the World Health Organization classification. Although 60% to 90% of patients with this disease present with a destructive mass in the midline facial tissues, it may also primarily or secondarily involve extranasal sites, like the skin. We report the case of a 77-year-old patient that came to our department with erythematous plaques of the right leg and eczematous lesions of the trunk. These lesions were biopsied and the patient was diagnosed with extranodal NK/T-cell lymphoma, nasal type. He was treated with multi-agent systemic chemotherapy but died 5 months after diagnosis. This case highlights the rarity and variability of cutaneous features of this disease and its aggressive course and poor prognosis.

Porokeratosis and malignant melanoma: A causal or incidental association?

Indian Dermatology Online Journal November-December 2015 Volume 6 Issue 6 451 10. Smoller BR, Bortz J. Immunophenotypic analysis suggests that granuloma faciale is a gamma‐interferon‐mediated process. J Cutan Pathol 1993;20:442‐6. 11. Teixeira DA, Estrozi B, Ianhez M. Granuloma faciale: A rare disease from a dermoscopy perspective. An Bras Dermatol 2013;88(Suppl 1):97‐100. 12. Gupta L, Naik H, Kumar NM, Kar HK. Granuloma faciale with extrafacial involvement and response to tacrolimus. J Cutan Aesthet Surg 2012;5:150‐2. 13. Ludwig E, Allam JP, Bieber T, Novak N. New treatment modalities for granuloma faciale. Br J Dermatol 2003;149:634‐7.

Cutaneous Alternariosis Caused by Alternaria infectoria: Three Cases in Kidney Transplant Patients

The genus Alternaria has more than 80 species. Alternaria alternata and Alternaria infectoria are the most frequent species associated with infections in humans. Their clinical importance lies in the growing number of cases reported in immunocompromised patients. Herein, we report three cases of kidney-transplanted patients with different clinical presentations of cutaneous alternariosis and we discuss the treatment options.

Subungual ectopic hair studied by scanning electron microscopy.

remains rare, it first justifies a 3–6-month monitoring before initiating a potential treatment. There is actually no treatment guideline. Treatments commonly used include dermocorticosteroids, intralesional corticosteroid injections or surgery in case of non-confluent isolated lesions with frequent recurrence. Other treatments have been reported in isolated cases, including pulsed dye laser, intralesional bleomycin, imiquimod and interferon alfa-2b. In our patient, the indication of phototherapy was based on the previous summer remissions and it led to lesion disappearance. ALHE is a dermatosis whose clinical and progressive polymorphism with the possibility of spontaneous regression is a source of misdiagnosis. Clinical and outcome data of a larger number of patients are required to determine ALHE aetiopathogenesis and define a therapeutic consensus.

Herpes simplex virus and cytomegalovirus co-infection presenting as exuberant genital ulcer in a woman infected with human immunodeficiency virus

In patients infected with human immunodeficiency virus (HIV), genital herpes can result in severe and atypical clinical presentations, and can become resistant to aciclovir treatment. Rarely, these manifestations may represent concurrent herpes simplex virus (HSV) with other agents. We report a 41‐year‐old black woman with HIV who presented with extensive and painful ulceration of the genitalia. Histological examination of a biopsy sample was suggestive of herpetic infection, and intravenous aciclovir was started, but produced only partial improvement. PCR was performed on the biopsy sample, and both HSV and cytomegalovirus (CMV) DNA was detected. Oral valganciclovir was started with therapeutic success. CMV infection is common in patients infected with HIV, but its presence in mucocutaneous lesions is rarely reported. This case exemplifies the difficulties of diagnosis of genital ulcers in patients infected with HIV. The presence of exuberant and persistent HSV genital ulcers in patients with HIV should also raise suspicions of the presence of co‐infection with other organisms such as CMV.

Progressive disseminated histoplasmosis as a presentation of AIDS in a patient from the Congo: the role of skin biopsy.

Progressive disseminated histoplasmosis is frequently fatal in HIV patients, and the standard diagnostic techniques can cause treatment delay. Skin biopsy can help in the differential diagnosis, allowing also an earlier treatment initiation.

Agminated Clear Cell Tumor: An Impostor of PEComa and Distinctive Dermal Clear Cell Mesenchymal Neoplasm

Cutaneous clear cell tumors are a heterogeneous group of cutaneous neoplasms, which may show a wide range of histogenesis. We report the clinicopathological features of an agminated clear cell tumor, arising in a 67-year-old man, otherwise asymptomatic, with distinct histopathological and immunohistochemical features, which did not fit into any existing diagnostic categories. The patient presented with several skin-colored papules at the lateral and posterior aspects of the neck, which on histopathological examination showed circumscribed lobular aggregates of clear cells within the dermis. The immunohistochemical marker panel performed showed diffuse expression of vimentin, NKI-C3, and CD64 while revealing marked negativity for factor XIIIa, CD10, CD13, CD14, CD34, CD68, CD163, lysozyme, HMB45, Renal Cell Carcinoma antigen, calponin, h-caldesmon, Anti-alpha smooth muscle actin antibody [1 A4], S100, and pancytokeratin, leading the authors to postulate a monocytic origin.