Robin P. Gehris

Phototoxic dermatoses in pediatric BMT patients receiving voriconazole

We investigated the incidence of phototoxic skin reactions in pediatric BMT recipients treated with voriconazole. Nine out of 40 patients (22.5%), all Caucasian, developed skin lesions in sun‐exposed distributions. Dermatologic findings included sunburn‐like erythema, pseudo‐porphyria, linear papulovesicular lesions, severe erosive cheilitis, dermatoheliosis and lentigines. Patients were treated with sun avoidance, high‐potency sunscreens, and topical steroids with significant improvement in all cases. Prolonged voriconazole use requires close monitoring for chronic skin toxicities. Long‐term risks including the risk of skin cancer need to be investigated. Pediatr Blood Cancer 2014;61:1325–1328.

Blue Foot: An Unusual Complication of Tattoo and Successful Treatment with a QS-Nd:YAG Laser

There are various tattoo complications detailed in medical literature, but the unwanted visible spread of tattoo pigment outside of tattoo margins has not yet been described. Furthermore, successful treatment for this complication has not previously been reported. Although ‘‘tattoo blow-out’’ has been described as a type of tattoo complication in the ‘‘Body Modification Ezine’’ (BME), an online encyclopedia maintained by volunteer authors, there are no medical references or reports that discuss this phenomenon. The BME details ‘‘tattoo blow-out’’ as a ‘‘blurry halo’’ surrounding the main tattoo and attributes it to capillary spread of ink injected too deeply. While our case grossly fits the BME description, there is a lack of scientific evidence that supports any one proposed mechanism of pigment spread. Additionally, there are scientific reports of lymphatic spread of tattoo pigments that migrate into lymph nodes and mimic metastatic melanoma. To more precisely target therapy for our patient, we felt that it was important to histopathologically distinguish among capillary, lymphatic, or other mechanisms of pigment spread.

Facial necrosis after endovascular Onyx‑18 embolization for epistaxis

Background: Evolution in techniques and equipment has expanded the role, effectiveness, and safety of endovascular transarterial embolization for the treatment of severe epistaxis. Risks from this treatment approach include major ischemic complications. To date, there have been only a few reports of soft tissue necrosis following endovascular embolization for severe epistaxis; none involve the use of Onyx-18. Case Description: We report the case of a 52-year-old woman who presented with epistaxis that was refractory to medical and surgical management, which lead to endovascular intervention and embolization with Onyx-18. The patient subsequently developed nasal ala and facial necrosis as a result of the procedure. Conclusion: We report the use of Onyx-18 for the endovascular embolization of a patient with severe epistaxis and subsequent complications. In cases of severe epistaxis that warrant intervention in the form of embolization, ischemic complications are rare; however, ischemic complications may be unavoidable and should factor into the discussion regarding procedural risks.

Bullous Sweet's Syndrome After Granulocyte Colony-Stimulating Factor Therapy in a Child with Congenital Neutropenia

We present the case of a 20‐month‐old boy with congenital neutropenia for which he was being treated with granulocyte colony‐stimulating factor (G‐CSF) who developed bullous Sweets syndrome. Because of the challenging and extensive differential diagnosis of an acute bullous eruption in an immunocompromised child, we highlight the importance of a prompt and precise diagnosis before initiation of any systemic therapy in children with Sweets syndrome.

Group A streptococcal panniculitis.

Infectious panniculitis caused by group A beta‐hemolytic streptococcus is rare, especially in immunocompetent patients. Its clinical presentation is usually nonspecific, but skin biopsy may provide information on the source. We describe the case of a previously healthy 2‐year‐old girl who presented with fever, tachycardia, and diffuse erythematous skin nodule; biopsy revealed a deep lobular neutrophilic panniculitis with gram‐positive bacteria.

Exophytic nodule on the helix.

A 13-year-old boy presented for surgical removal of a “cyst” on his left ear, which had been present since birth. He reported that it had initially resembled a small red bump but had grown over the last 10 years and occasionally discharged a thick, white material. The patient carried a diagnosis of attention-deficit hyperactivity disorder and depression, but had no history of developmental or growth delay and had normal renal function. Physical examination revealed a 1-cm nontender, exophytic, firm nodule on the left helix (Fig. 1). An excision was performed. Histologic sections were stained with hematoxylin and eosin and are shown in Figs. 2 and 3.

Cutaneous Small/Medium CD4+ Pleomorphic T-Cell Lymphoma-Like Nodule in a Patient With Erythema Chronicum Migrans.

CD4+ small/medium pleomorphic T-cell lymphoma is a relatively rare subtype of cutaneous lymphoproliferative disorder with an indolent clinical behavior. The place of this condition among lymphomas is debatable. The authors describe a rare case of the direct association of CD4 small/medium pleomorphic T-cell lymphoma-like solitary nodule with Borrelia burgdorferi infection in a 5-year-old boy, discuss the reactive nature of this condition, and emphasize the importance of clinicopathological correlation.

Sinus pericranii: A case report

A healthy 6-week-old white male presented with an intermittently enlarging reddish-blue plaque on the midline forehead and frontal scalp. Neuroimaging revealed an abnormal vascular communication between the extracranial and intracranial venous systems. This rare condition is termed sinus pericranii. The authors provide a review of sinus pericranii and describe its imaging findings, embryologic derivation, differential diagnosis, and clinical management.

Neonate Presenting with a Midline Supraumbilical Raphe

A newborn female (2.07 kg, 45.5 cm), who was born at 32 weeks gestation via an uncomplicated vaginal delivery, presented at birth with hypoglycemia and a midline sternal defect. Physical examination revealed an 8-cm supraumbilical linear defect (Fig. 1) with surrounding welldemarcated patchy areas of hypopigmentation on the central chest, chin, and lower lip and focal deeply erythematous macules on the nasal columella and left malar cheek. The neonate received phototherapy for hyperbilirubinemia and empiric antibiotics for presumed sepsis due to the exposed tissue from the sternal defect; however, her blood cultures remained negative. Thoracic ultrasonography showed no evidence of ectopia cordis. An echocardiogram revealed a patent foramen ovale with a small patent ductus arteriosus without other defects, and an EKG showed normal sinus rhythm. Over several days of life, she progressively developed prominent and widespread plaque-like facial hemangiomas along the jawline and bilateral malar cheeks, as well as on the left temporal scalp, periocular, and nasal regions (Figs. 2 and 3).