Atypical Distribution Of Lesions Research Articles

The global rollout of COVID-19 vaccines has been a significant step in controlling the SARS-CoV-2 pandemic. While the vaccines have proven to be generally safe, adverse reactions, including both local and systemic effects, have been observed. Cutaneous manifestations, though rare, have been reported in some instances. We report the case of a 67-year-old male who developed pruritic erythematous-to-violaceous papules and plaques three days after receiving the second dose of a COVID-19 vaccine. The lesions were found on the right inner thigh, forearms, trunk, and neck. Histopathological examination revealed findings consistent with a lichenoid drug eruption (LDE), a condition typically linked to medications or, in rarer cases, vaccines. Lichenoid drug eruptions are often seen in association with certain medications, and less commonly with Hepatitis B vaccination. However, this case presents an uncommon presentation of LDE following COVID-19 vaccination, with an atypical distribution of lesions, involvement of uncommon sites, and no history of prior drug or vaccine hypersensitivity. This case underscores the importance of recognizing rare or atypical skin manifestations, such as lichenoid drug eruptions, as potential vaccine-related adverse effects. Identifying these conditions allows clinicians to ensure accurate diagnosis and appropriate management.

Background and Aim: Diagnosing scabies, a skin condition caused by mites, can be challenging due to its resemblance to other skin problems. Avoiding misdiagnoses could result in a significant reduction in treatment delays and complications. Our objective was to investigate scabies cases that initially posed diagnostic challenges. Methods: This retrospective study focused on scabies patients who were initially misdiagnosed despite routine clinical examinations and underwent histopathological examinations with different preliminary dermatological diagnoses. Inclusion criteria were in accordance with the 2020 International Alliance for the Control of Scabies Diagnosis Criteria. The study retrospectively compiled clinical, histopathological, and demographic characteristics, providing data on the challenges and delays in diagnosing scabies cases that mimic other dermatological conditions. Results: In a cohort of 27 scabies cases with diagnostic challenges, the majority were females (63%) with a mean age of 64.8±15.9 years. Pre-admission, 66.7% of the patients used systemic antihistamines, 52.4% used immunosuppressants, and 42.9% used topical scabies treatment. Secondary xerosis cutis and contact dermatitis were noted in 11.1% and 7.4% of cases. The most frequently considered differential diagnoses by dermatologists included prurigo subacuta (29.6%), dermatitis herpetiformis (18.5 %), lymphomatoid papulosis (14.8%), and vesicular/bullous pemphigoid (11.1 %). Conclusion: Previous treatments; prolonged infestations leading to severe secondary dermatological problems including prurigo subacuta, contact dermatitis, and xerotic eczema; atypical distribution of lesions; female prurigo; and elderly with prolonged pruritic atypical dermatoses or vesicular/bullous presentations should be kept in mind as clinical scenarios that may contribute to a delay in the diagnosis of scabies.

Posterior reversible encephalopathy syndrome (PRES) is characterized by clinical symptoms that are associated with bilateral and symmetric vasogenic edema in the parietal and occipital lobes. However, this is rarely present with predominant involvement of the brain stem and cerebellum (variant). To evaluate which clinical or magnetic resonance imaging (MRI) findings can help to predict the prognosis of variant and classical type of PRES and whether or not there is difference between two types of PRES. We retrospectively evaluated MRI and clinical findings from 49 patients with PRES. These patients were divided into two groups. In group I, patients had atypical distribution of lesions. In group II, patients had typical distribution of lesions. Follow-up MRI was performed on 26 patients. We assessed the MRI features, clinical data, and the patients' outcomes. The mean blood pressure (BP) was significantly higher in group I (195.52/121.09 mmHg and 156.78/99.53 mmHg for groups I and II, respectively). The other factors assessed were not significantly different between the two groups. Lesions in 24 of 26 patients reversed upon follow-up. Sequelae were observed in 11 patients (group I, 7; group II, 4). However, there were no significant differences between the two groups. Except for those patients who died, seven of the nine patients with sequelae upon follow-up imaging had hemorrhage or irreversibility of lesions. Even though BP influences the involvement of the brain stem, involvement of the brain stem is not influential on the prognosis. It seems that the influential factor to prognosis is the reversibility of lesions and hemorrhage.

A 10-year-old female spayed Dalmatian was evaluated for progressive cervical scoliosis and stiffness. This imaging report describes the imaging and postmortem findings for this patient. A diagnosis of an atypical manifestation of diffuse idiopathic skeletal hyperostosis (DISH) was made based on imaging and additional diagnostics. This report serves to increase awareness of DISH in the veterinary community, as well as to describe a unique presentation of the disease with atypical lesion distribution and severity. In addition, this report contrasts the pathophysiology and imaging characteristics of DISH with spondylosis deformans, which can appear comparable radiographically.

Characteristic high-resolution CT (HRCT) findings of idiopathic pulmonary fibrosis (IPF) include reticulation, architectural distortion, and honeycombing involving mainly the lung periphery and the lower lobes. In 50% of IPF patients, HRCT is nonspecific. This article illustrates the HRCT findings of IPF correlating with the pathology. The spectrum of HRCT manifestations varies from typical findings that allow confident diagnosis to atypical patterns mimicking other diseases, including predominance of ground-glass opacity, consolidation, nodules, and atypical distribution of lesions.

Two annual, random samples of clinically suspect cases of bovine spongiform encephalopathy (BSE) were taken in 1992-93 (year 1, 1500 cases) and 1993-94 (year 2, 1000 cases). From each sample, 100 positive cases were examined in detail to establish the severity of the vacuolation in 17 specific neuroanatomical locations. The resultant 'lesion profiles' were compared with the profile obtained from a similar sample of BSE-affected cattle from early in the epidemic (1987-89); the comparison showed that the distribution and severity of vacuolation in BSE has remained unchanged. The cases not confirmed as BSE on histological examination (172 in year 1 and 162 in year 2) were examined for evidence of any alternative neurohistological diagnosis. As in previous studies, the majority of these cases showed no significant lesions (61.6 and 61.7 per cent). The remainder consisted of bilateral focal spongiosis of unknown significance (26.7 and 21.0 per cent), inflammatory conditions (8.1 and 11.1 per cent) and a small number of cases with tumours, cerebrocortical necrosis or idiopathic brainstem neuronal chromatolysis. No evidence was found of any cases of BSE with an atypical distribution of lesions. These findings support the theory that the BSE epidemic is sustained by a single, stable strain of the BSE agent, and confirm that the existing statutory diagnostic criteria continue to be appropriate.