Mac Machan

Necrotizing infundibular crystalline folliculitis manifesting as a perforating mucinosis: a case report.

: Necrotizing infundibular crystalline folliculitis (NICF) is a rare entity manifesting as waxy folliculocentric papules comprised of filamentous birefringent crystalline deposits. We report a case of NICF in an 85-year-old man, presenting as gritty, cream-colored, and erythematous papules across the midline back. Biopsy demonstrated a pale plug comprised of copious mucin. The diagnostic crystals were initially overlooked because of softening of the paraffin block with 10% ammonia solution, which dissolved the crystals in the initial sections. X-ray microanalysis confirmed the organic nature of the crystals. This is the first report of NICF from North America. Our case highlights the presence of mucin in some cases of NICF and serves as a cautionary tale on the pitfalls of postprocessing artifacts in the histology laboratory.

How accurate are the suggested diagnoses on biopsy requisitions for inflammatory skin disease? A retrospective study of 348 cases.

Abstract:Clinical information is often critical to the histopathologic interpretation of cutaneous biopsies for inflammatory skin diseases. This information is often conveyed to the dermatopathologist as list of possible diagnoses. We reviewed 348 cases of biopsied inflammatory skin disease and measured the correlation between the original clinical differential diagnoses on the pathology requisition and the patients final diagnosis. The final diagnosis was included among the suggested diagnoses in 270 of 348 (78%) cases reviewed. In 191 of 270 (71%) correctly diagnosed cases, the final diagnosis was listed first among those included in the differential diagnoses. The total number of suggested diagnoses did not correlate with overall diagnostic accuracy. The most commonly neglected diagnoses were eczematous dermatitis, psoriasis, lichen planus, and granuloma annulare. We conclude that the differential diagnosis submitted with pathology specimens for inflammatory skin disease includes the final diagnosis in a majority of cases. The first listed diagnosis has the highest positive predictive value. Submitting longer differential diagnosis lists did not improve diagnostic accuracy.

Diffuse Hyperkeratosis in a Deaf and Blind 48-Year-Old Woman—Quiz Case

An 83-year-old man with a history of diabetes and chronic obstructive pulmonary disorder (COPD) (taking prednisone, 5 mg/d) was admitted to our facility with a monthlong history of persistent right arm swelling, erythema, and pain. He had multiple prior admissions for this issue and was treated with oral and intravenous antibiotics for a suspected “cellulitis.” His skin symptoms worsened despite treatment, and he developed an extensive superimposed pustular eruption with sinus tracts involving the entire forearm and a portion of the upper arm (Figure 1). Workup included ultrasonography, which showed no fluid collection, and magnetic resonance imaging, which showed soft-tissue swelling without evidence of any underlying myositis or osteomyelitis. A Tzanck smear failed to show multinucleated giant cells. Punch biopsy specimens for culture and histopathologic analysis were obtained (Figure 2 and Figure 3). What is your diagnosis?

Pegfilgrastim‐induced Sweet's syndrome: a case report

A 43-year-old Caucasian woman presented with a 7-day history of a painful cutaneous eruption of the trunk and extremities and intermittent fever. Past medical history included hepatitis C, polysubstance abuse, a nonspecific lymphadenopathy, bipolar disorder, and schizoaffective disorder. Her medications were quetiapine and aripiprazole. The patient had recently started pegfilgrastim (Neulasta, Amgen, Inc., Thousand Oaks, CA, USA) for presumed ziprasidone-associated neutropenia. Laboratory testing demonstrated a white blood cell count of 5.5 9 10/ll (67.7% neutrophils, 26.5% lymphocytes, 1.6% eosinophils, 4.2% monocytes); hemoglobin, 11.8 g/dl; platelets, 177,000/ll; alanine aminotransferase, 38 U/l; and aspartate aminotransferase, 20 U/l. Urine toxicology was positive for opiates and cocaine. Physical examination revealed tender, edematous hemorrhagic papules and plaques, some with central crusting and erosion, diffusely involving the face, neck, trunk, and upper and lower extremities (Fig. 1). No lymphadenopathy was detected. A punch biopsy demonstrated diffuse neutrophilic dermatitis with papillary edema and signs of vasculitis, including hemorrhage, leukocytoclasia, collagen necrosis, and periand intravascular deposition of fibrin in postcapillary venules (Fig. 2). Grocott methenamine silver and Giemsa preparations did not reveal infectious bacteria or fungi. A diagnosis of pegfilgrastim-induced Sweet’s syndrome (SS) was made. The patient was treated with cessation of pegfilgrastim and intravenous methylprednisolone. She experienced marked improvement within 48 hours.

Increased Prevalence of Sleep Disorders and Medical Comorbidities in Psoriatic Arthritis Patients Compared with Patients with and without Psoriasis

Background The relationship between sleep quality and medical comorbidities of psoriasis and psoriatic arthritis is poorly understood. Objective To evaluate the association of sleep disturbance and medical comorbidities in patients with psoriasis and psoriatic arthritis compared with healthy volunteers. Methods This cross-sectional study compared patients with psoriasis, patients with psoriatic arthritis, and control participants. The Pittsburgh Sleep Quality Inventory (PSQI) and the Global Fatigue Scale were used to measure sleep disturbance and fatigue. Results The psoriatic arthritis, psoriasis, and control groups had elevated mean PSQI scores indicating poor sleep quality; the psoriatic arthritis group had the statistically highest mean score. Psoriatic arthritis patients had higher mean body mass index and a higher prevalence of diabetes, restless leg syndrome, and insomnia. Conclusions Poor sleep quality and medical comorbidities were prevalent in patients with psoriasis and psoriatic arthritis but are highest in patients with psoriatic arthritis. The link between sleep disorder, psoriatic disease, and medical comorbidities deserves more study.