Sedef Şahin

Screening for latent tuberculosis infection in psoriasis and psoriatic arthritis patients in a tuberculosis-endemic country: a comparison of the QuantiFERON®-TB Gold In-Tube test and tuberculin skin test.

Since the introduction of biologic therapies for tuberculosis (TB), screening for latent TB infection has increased in importance, especially in countries in which TB is endemic. The aim of this study was to evaluate the effect of psoriasis on tuberculin skin test (TST) results and to compare two TB screening tests, the TST and QuantiFERON®‐TB Gold In‐Tube (QFT–GIT) test, in psoriasis and psoriatic arthritis (PA) patients living in a TB‐endemic country (Turkey). This prospective study included 61 psoriasis and 40 PA patients, and 58 healthy controls. Demographic data, medical history, human immunodeficiency virus (HIV) status, level of education, smoking status, exposure to TB, personal and family histories of TB, and bacillus Calmette–Guérin (BCG) vaccination status were recorded for all participants. The TST and QFT–GIT were performed in all participants. The mean ± standard deviation TST indurations in the patient and control groups were 12.6 ± 6.4 mm and 10.2 ± 6.5 mm, respectively (P = 0.051). The TST positivity rate was higher in patients than in controls (86.1% vs. 37.9%; P < 0.001), whereas QFT–GIT positivity did not differ significantly (patients: 20.8%; controls: 17.2%; P = 0.737). False positive results can lead to unnecessary prophylactic TB treatment; therefore, the cut‐off point for TST positivity in psoriasis and PA patients should be re‐evaluated, or other tests, such as the QFT–GIT, should be used.

Long-term follow-up of early mycosis fungoides patients treated with narrowband ultraviolet B phototherapy

Background: Narrowband ultraviolet B (UVB) provides complete response (CR) in 54–91% of early mycosis fungoides (MF) patients. Data concerning relapse rate and relapse-free interval after discontinuation of therapy need clarification. The purpose of this study was to evaluate the relapse rate and the relapse-free intervals of early MF patients after achieving complete response with narrowband UVB phototherapy. Methods: Retrospective evaluation of data, which belong to early MF patients treated with narrowband UVB phototherapy between May 2000 and July 2010, and followed-up until May 2012 in a single institution, for the occurrence of relapse and the time to relapse. Results: Of 31 patients, who were followed-up for a mean of 56.5 ± 30.2 months (median 55 months, range 20–120 months), relapse was observed in 11 (35.5%) patients, within a mean of 28.8 ± 18.2 months (median 33 months, range 4–59 months), whereas 20 (64.5%) patients stayed relapse-free for a mean of 54.2 ± 28.8 months (median 55.5 months, range 20–119 months). Patients received maintenance phototherapy with a median duration of 12 months (range 1–30 months) after achieving complete response. Conclusion: Results indicate that narrowband UVB phototherapy may induce low relapse rates and long relapse-free intervals for early MF.

Tumor-stage mycosis fungoides of the vulva successfully treated with local low-dose radiotherapy

Mycosis fungoides (MF) is the most common type of primary cutaneous T‐cell lymphoma. According to the proposed guidelines for MF, skin‐directed therapies are the treatment of choice for patients with limited stage disease. We present a case of early‐stage MF, who progressed to tumor‐stage MF during the postpartum period, showing a solitary ulcerated tumor on the vulva, which was successfully treated with local response‐based, low‐dose radiotherapy.

Pigmented purpuric dermatosis-like sarcoidosis

Sarcoidosis is a chronic multisystem granulomatous disease of unknown origin. Recently, a purpuric variant of cutaneous sarcoidosis resembling pigmented purpuric dermatosis (PPD) has been documented. Herein, we describe another unusual case with clinical features mimicking PPD, characterized by brownish macules and flat‐topped papules with a slightly purpuric component on the legs and dorsum of the feet and histopathological features consistent with sarcoidosis. We designated this unusual clinical presentation as “PPD‐like sarcoidosis”.

Lesson of the month 1: Sudden onset postural livedo reticularis, cyanotic toes and multiorgan failure

Cholesterol embolisation syndrome (CES) is a rare but serious disease with high mortality caused by the formation of an embolus made up of cholesterol crystals from atherosclerotic plaques. Its clinical presentation is usually initially insidious and it often remains unrecognised because of its non-specific clinical presentation, which can cause delays in treatment and high mortality. The most common physical symptoms are cutaneous. We present a lethal case of CES to increase the awareness about this serious condition.