Warren R. Heymann

Epstein–Barr virus: Dermatologic associations and implications: Part I. Mucocutaneous manifestations of Epstein–Barr virus and nonmalignant disorders

Epstein-Barr virus (EBV) is a ubiquitous virus that has been implicated in a wide range of human diseases, many of which have mucocutaneous manifestations. As a member of the herpesviridae family, EBV causes lifelong infection by establishing latency in B lymphocytes. An intact immune response is critical in preventing progression of EBV disease, and the clinical manifestations of infection are dependent on the intricate relationship between virus and host immune system. This review provides a comprehensive overview of the epidemiology, pathophysiology, and diagnostic testing in EBV infection. In part I of this continuing medical education article, the mucocutaneous manifestations of EBV infection are reviewed with an emphasis on pathophysiology and management.

Identification of a gain-of-function STAT3 mutation (p.Y640F) in lymphocytic variant hypereosinophilic syndrome

To the editor: Hypereosinophilic syndrome (HES) is a heterogeneous group of disorders characterized by (1) persistent peripheral eosinophilia, (2) target organ pathology mediated by infiltrating eosinophils, and (3) the absence of known infectious or allergic causes of hypereosinophilia.[1][1],[2][

Clinicopathologic challenge: acral lymphomatoid papulosis

History A 51-year-old otherwise healthy female presented with recurrent red, painful papules and pustules on her palms for two months’ duration. One of the pustules had drained prior to examination. These lesions were previously treated with cephalexin, valacyclovir, and mupirocin without any improvement. We prescribed topical difluorosone diacetate 0.05%, and the lesions ultimately resolved within the next month. She reported a similar eruption one year prior, which was distributed on the left flank, breasts, eyelids, and legs. After two months, these lesions

Papulovesicular Eruption in a Pregnant Woman With Darier Disease

A primigravida woman in her 30s at 35 weeks’ gestation and with a history of Darier disease was admitted with an acute, painful eruption on her face and neck. She reported no history of pregnancy-related complications. Physical examination revealed confluent erythema with keratotic papulovesicles distributed on the face and neck (Figure, A). Honeycolored crusts were present on the left ear and preauricular area. The chest and inframammary area displayed occasional red, crusted papules. Laboratory tests revealed an elevated white blood cell count of 17.18 × 10 μL (reference range, 4.50-11.00 × 10 μL). A shave biopsy specimen and tissue culture were obtained from the center of an umbilicated papule on the neck (Figure, B and C). Clinical image A

A Cyst Misinterpreted on Airport Scan as Security Threat

Discussion | Many airports use a full-body backscatter x-ray scanning device that creates a body image able to detect weapons and contraband hidden in clothing and skin. The radiation doses emitted during these scans are extremely small, equivalent to that received during 3 to 9 minutes of normal daily living.1 In larger airports millimeter-wave scanners, using radio frequencies instead of x-rays to detect concealed objects, are replacing backscatter devices. If a possible threat is detected, a yellow box appears at the suspected anatomical site on a mannequin-like image. Further security measures may then include a physical pat down. Newer scans may be completed in less than 2 seconds, substantially expediting the screening process.2 Naraynsingh et al3 reported the case of a 68-year-old man with an asymptomatic, easily reducible, left inguinoscrotal hernia who had a similar experience at a US airport. He was humiliated by the interrogation and examination of his genital region and opted to have an inguinal herniorrhaphy. The authors’ prediction that other disorders such as lipomas or cysts could provoke a similar scenario proved prescient.3 For as long as x-ray scanners are in use, it is essential that both screeners and passengers be knowledgeable about disorders that may be misconstrued as terroristic threats, thereby avoiding potential humiliation, embarrassment, and perhaps unnecessary surgery.