STING-associated vasculopathy with onset in infancy (SAVI) is an autoinflammatory disease caused by mutations in TMEM173 gene encoding STING (stimulator of interferon genes). It typically presents in infancy and is mainly characterized by interstitial lung disease, skin rash, and systemic inflammation. This report presents the case of adult-onset SAVI:A 28-year-old male patient was admitted with recurrent episode of cough, expectoration, chest tightness with shortness of breath and erythematous rashes on the extremities, chest, and back.His CT revealed bilateral diffuse fine reticular opacities and irregular reticular shadows, with focal areas of honeycombing. Further inquiry into the family history revealed that the patient's mother had been diagnosed with interstitial lung disease (ILD).Thus, a genetic etiology should be highly suspected.Later, whole-exome sequencing identified a heterozygous mutation in the STING1 gene: c.842G>A (p.R281Q), establishing the diagnosis of SAVI. The patient was subsequently referred to a tertiary care hospital for specialized management. During one year of follow-up, the patient underwent lung transplantation in August 2025 and had since received long-term immunosuppressive therapy for rejection prophylaxis. Cough and expectoration improved markedly, although exertional dyspnea persisted; the cutaneous rash had resolved completely.

Invasive meningococcal disease (IMD) remains a major global health concern because of its epidemic potential, unpredictable presentation, and rapid progression. Although IMD classically presents as meningitis, meningococcemia, or both, Neisseria meningitidis can also cause extra-meningeal manifestations. Serogroup W (MenW), particularly the hyperinvasive ST-11 lineage, has increasingly been associated with atypical and invasive clinical phenotypes. We report an 11-year-old previously healthy boy with IMD due to MenW ST-11 who developed the exceptional triad of meningitis, endogenous endophthalmitis, and septic arthritis. An 11-year-old boy residing in a school dormitory presented with fever, rhinorrhea, cough, generalized erythematous rash, and conjunctival redness. Because of altered consciousness and seizures, he was transferred to the pediatric intensive care unit after receiving initial antibiotic therapy. He had not received meningococcal vaccines. On admission, he was lethargic, with anisocoria, marked right conjunctival hyperemia, neck stiffness, and a diffuse non-blanching petechial and purpuric rash. Cerebrospinal fluid (CSF) analysis was consistent with purulent meningitis; Gram stain showed rare Gram-negative diplococci, and CSF PCR identified N. meningitidis serogroup W, ST-11. Ophthalmologic examination confirmed severe endogenous endophthalmitis with hypopyon, and vitreous PCR also detected N. meningitidis. Because of clinical non-response with progressive ocular and neurologic involvement, therapy was escalated to meropenem. On hospital day 7, acute right knee swelling developed, and synovial fluid PCR confirmed MenW. At 6-week follow-up, the patient had normal vision, normal hearing, no neurologic deficits, and no joint sequelae. Meningococcal endophthalmitis is rare and usually associated with poor visual outcomes; only one adult MenW case has been reported previously. This case demonstrates that MenW ST-11 can cause aggressive multisystem IMD in children and underscores the importance of molecular diagnosis, early multidisciplinary care, and MenACWY vaccination.

Atopic dermatitis (AD) is a chronic inflammatory skin disease in which dupilumab, an interleukin-4 receptor alpha antagonist, has become a cornerstone therapy for moderate-to-severe disease. However, persistent facial and neck erythema and related symptoms have been increasingly reported during dupilumab treatment, and the underlying mechanisms remain incompletely understood. Demodex species, common components of the cutaneous microbiota, have been proposed as potential contributing factors. This retrospective case-control study evaluated Demodex infestation in patients with moderate-to-severe AD receiving dupilumab therapy compared with AD patients not receiving systemic immunosuppressive treatment. A total of 61 patients were included: 31 dupilumab-treated patients and 30 controls. Demodex density was assessed using standardized skin surface biopsy, with ≥ 5 mites/cm2 considered positive infestation. Clinical features, laboratory parameters, and treatment characteristics were analyzed. Demodex positivity was significantly more frequent in dupilumab-treated patients than in controls (45.2% vs. 6.7%, p = 0.001). All dupilumab-treated patients had achieved at least a 75% improvement in Eczema Area and Severity Index at the time of assessment. Within the dupilumab group, Demodex-positive patients were older than Demodex-negative patients, while no significant differences were observed regarding sex, eosinophil counts, or total IgE levels. Most Demodex-positive patients reported persistent facial erythema and pruritus, often accompanied by ocular symptoms. Although a causal relationship cannot be established due to the retrospective design, these findings suggest that Demodex infestation may coexist with persistent head-and-neck symptoms in AD patients receiving dupilumab. Evaluation for Demodex infestation may be considered clinically relevant in patients presenting with atypical or treatment-resistant facial involvement during dupilumab therapy.

Background: Yuvana Pidika is a commonly described Kṣudra Roga in Ayurveda, occurring predominantly during youth due to vitiation of Kapha and Pitta doṣa along with Rakta dusti. Clinically, it closely correlates with Acne Vulgaris in modern medicine, which is a chronic inflammatory disorder of the pilosebaceous unit. Case description: A 20-year-old male patient presented with multiple pimples distributed over the face associated with redness for the past two years. The condition was recurrent and persistent in nature. Based on clinical presentation and Ayurvedic diagnostic parameters, the case was diagnosed as Yuvana Pidika. Results: Considering the involvement of ūrdhva jatrugata doṣha and predominance of Kapha-Pitta, Nasya karma was selected as the principal therapeutic intervention, followed by Samana Cikitsa and topical lepa. The combined therapeutic approach resulted in a marked reduction in inflammatory lesions, facial erythema, and recurrence of pimples without any adverse effects. Conclusion: This case study suggests that Ayurvedic management with Nasya followed by internal and external therapies is effective and safe in the management of Yuvana Pidika, offering a holistic approach to Acne Vulgaris. Large-scale studies are required to validate this approach.

Cyclin-dependent kinase (CDK)4/6 inhibitors (CDK4/6i) have been shown to improve the outcome of patients with hormone receptor-positive (HR+) human epidermal growth factor receptor 2-negative (HER2-) advanced/metastatic breast cancer (a/mBC). This study aimed to demonstrate the safety and effectiveness of CDK4/6i in HR+/HER2- a/mBC patients, in a single-center study in Cyprus and to confirm whether these are in line with data derived from randomized clinical trials and other real-world data studies. This retrospective study included 269 patients treated with endocrine therapy (ΕΤ) combined with palbociclib or ribociclib or abemaciclib as first-, second- or third-line treatment at the Bank of Cyprus Oncology Center (2018-2021). Seventy patients from the retrospective study who continued to receive treatment with CDK4/6i-containing regimens, were enrolled in the prospective study (follow-up period: 2021-2024) whereby patients were monitored in real time. Statistical evaluation was performed for differences in progression-free survival (PFS), overall survival (OS), adverse events (AEs)/toxicity, and prognostic factors for effectiveness. The majority of patients received CDK4/6i in the first-line setting (68%, n = 182/269), whilst 25% and 7.8% of patients received CDK4/6i as second and third line of treatment, respectively. The median progression-free survival (mPFS) was 31, 25 and 19 months, with median overall survival (mOS) of 60, 54 and 44 months for palbociclib, ribociclib and abemaciclib, respectively. Neutropenia was the most commonly reported AE, followed by diarrhea, alanine aminotransferase (ALT)/aspartate aminotransferase (AST) increase, pneumonia, thrombocytopenia, erythematous rash and prolonged QT interval. Following subgroup analyses, age > 65 years, higher BC grade, de novo metastatic cancer at initial diagnosis, presence of lymph node/liver or brain metastasis and the larger number of metastatic sites at time of CDK4/6i treatment and the later-line use of CDK4/6i, were associated with a significantly shorter mPFS/mOS. The combination of CDK4/6i with ET is the gold standard treatment in HR+/HER2- a/mBC. Our study results confirm the effectiveness and tolerability of CDK4/6i in clinical routine practice with prognostic factors aligning with those identified in previous studies. This is the first real-world data (RWD) describing the effectiveness and toxicity of three CDK4/6i in the Cypriot patients.

Sepsis-like symptoms from parechovirus A type 5 in a neonate: First Japanese case and literature review.

BackgroundErythematotelangiectatic rosacea is characterized by central facial erythema and telangiectasia, accompanied by sensations of burning and stinging. Erythematotelangiectatic rosacea can be addressed through various treatments. We aimed to observe and evaluate the clinical effectiveness of a short pulse narrow-spectrum Intense pulsed light (IPL) with wavelength of 530–750nm and 555–950nm for the treatment of erythematotelangiectatic rosacea.MethodsWe retrospectively collected patient information on erythematotelangiectatic rosacea and evaluated the clinical outcome.Results63 cases of erythematotelangiectatic rosacea were included. All patients received different sessions narrow spectrum IPL treatment with 555–950 nm and 530–750 nm filter combinations. The treatment efficacy rate was 57/63 (90.47%), all patients showed significant post-treatment Erythema Assessment Scale (EAS) levels reduction (p<0.05), and patients who received more treatment sessions tended to obtain greater EAS score reductions. A significant reduction (p<0.05) in the facial red areas was shown by VISIA images after treatment. 59 (93.7%) demonstrated improvement according to GAIS (Global Aesthetic Improvement Scale) scores. There were no significant skin adverse reactions were observed during treatment. All patients expressed satisfaction with the treatment.ConclusionThe narrow-spectrum IPL with 555–950nm and 530–750nm wavelengths filter combinations for the treatment of erythematotelangiectatic rosacea has the advantages of a high erythema improvement rate and low adverse reaction.

In the treatment of hormone receptor-positive (HR+), HER2-negative (HER2-) metastatic breast cancer (MBC), the current guidelines recommend endocrine therapy combined with cyclin-dependent kinase 4/6 (CDK4/6) inhibitors as the preferred first-line treatment to preserve quality of life. Ribociclib is a CDK4/6 inhibitor that has been used in combination with aromatase inhibitors or fulvestrant in patients with HR+, HER2- metastatic breast cancer. Various adverse drug reactions associated with ribociclib have been reported, including cutaneous reactions, hepatotoxicity, and hematologic toxicity. In this study, we aimed to evaluate the clinical manifestations and risk factors of dermatologic toxicities in patients with metastatic breast cancer treated with ribociclib. This retrospective study included patients with metastatic/recurrent breast cancer who were prescribed ribociclib from April 2021 to December 2024 at a single institution. We retrospectively reviewed the medical records of these patients to identify the frequency of cutaneous adverse events, the time of onset, and the clinical characteristics of skin reactions. Logistic regression analysis was performed on several clinical factors, including body surface area (BSA) and concomitant medications, to identify risk factors associated with the occurrence of cutaneous adverse events. A total of 110 patients with MBC were enrolled during the study period. The median age was 53 years (range, 28-82); all 110 patients (100.0%) were female; the median BSA was 1.56 m2 (range, 1.29-2.07); and 32 patients (29.1%) were premenopausal. Ribociclib plus letrozole was administered in 48 patients (43.6%) and ribociclib plus fulvestrant in 29 patients (26.4%). An additional 33 patients (30.0%) received ribociclib plus letrozole with a gonadotropin-releasing hormone (GnRH) agonist. Cutaneous adverse events occurred in 29 patients (26.4%), and the median time to onset was 84 days (range, 3-498). The cutaneous adverse event patterns included pruritus, erythematous macular rash, eczematous rash/contact dermatitis, vitiligo, urticarial reactions, polymorphous light eruption, toxic epidermal necrolysis (TEN), and desquamation. Grade 1 or 2 cutaneous adverse events occurred in 93.1% of patients; Grade 3 toxicity occurred in one patient; and Grade 4 toxicity, namely toxic epidermal necrolysis (TEN), was reported in one patient. Dose reduction was required in three patients (10.3%), and permanent discontinuation of ribociclib occurred in one patient. Clinical improvement was achieved in the majority of patients (86.2%) with cutaneous adverse events following supportive care. Logistic regression analysis revealed that age, Eastern Cooperative Oncology Group (ECOG) performance status, body surface area (BSA), treatment regimen, and use of cholesterol-lowering medications were not independently associated with the development of cutaneous adverse events. CDK4/6 inhibitors represent one of the most important treatment options for HR+/HER2- metastatic breast cancer. Regardless of their clinical efficacy, cutaneous adverse events remain a common source of patient discomfort. Therefore, careful clinical attention and appropriate supportive care are essential to improve patients' quality of life.

Rosacea is characterized by facial erythema that can be resistant to improvement. This research evaluated the efficacy and tolerability of a topical anti-inflammatory moisturizer containing oat and aloe as compared to 0.75% metronidazole cream over 12 weeks. This double-blinded, randomized, controlled trial enrolled 60 adults with mild-to-severe rosacea, randomized to either the study anti-inflammatory moisturizer or 0.75% metronidazole cream daily for 12 weeks. Participants were evaluated at baseline and Weeks 4, 8, and 12. Efficacy was measured by investigator global assessment (IGA) of erythema and inflammatory lesion counts. Tolerability was assessed by the investigator and subjects. Both study products demonstrated similar IGA scores at Week 4. By Week 8, the study oat and aloe anti-inflammatory moisturizer demonstrated significantly greater reduction in both erythema IGA (50% vs. 22%, p = 0.001) and lesion counts (74% vs. 6%, p = 0.015). At the conclusion of the 12-week study, the anti-inflammatory moisturizer produced a reduction in IGA erythema of 54% vs. 23% (p < 0.001) and a reduction in inflammatory lesion counts of 74% vs. 17% (p = 0.044). No tolerability issues were noted. The oat and aloe anti-inflammatory moisturizer was superior and outperformed 0.75% metronidazole cream in both erythema and lesion reduction in rosacea subjects after 8 and 12 weeks of treatment.

Kumkumadi Taila is a classical Ayurvedic facial oil traditionally used in primary care as a routine preventive skincare product to enhance the complexion; however, clinical instrument-based data and detailed chemical profiling remain scarce. In this single-arm 15-day exploratory study, 30 healthy adults with Fitzpatrick skin types III-IV applied Kumkumadi Taila once daily to the face using a standardized massage and wash-off procedure, while biophysical skin parameters and safety were monitored at baseline, Day 7, and Day 15 with an integrated DermaLab Combo® device. Facial melanin index, erythema index, hydration, and elasticity showed statistically significant changes over time, whereas transepidermal water loss and skin thickness did not. This indicates short-term cosmetic improvement without detectable disruption of barrier integrity. Parallel UPLC-MS/MS QTOF analysis of the oil identified multiple bioactive phytochemicals, including safranal, berberine, palmatine, liquiritin, nuciferine, rubiadine, retinol, sesamin, and aliuretic acid, which are consistent with antioxidant, anti-inflammatory, and pigmentation-modulating actions reported in the literature. No adverse events were reported during the study. The results were statistically significant (p < 0.05), indicating that the data deviates from a normal distribution and is skewed. Overall, Melanin and Erythema Index decreased significantly, indicating improved pigmentation and reduced redness. Skin elasticity declined over time, while skin hydration fluctuated. TEWL and skin thickness remained stable throughout the study. In this exploratory proof-of-concept assessment, short-term application of Kumkumadi Taila was associated with changes in selected facial skin biophysical parameters over 15 days. The study supports its potential as a safe and accessible primary care intervention in the form of a routine preventive skincare product, and its findings highlight the relevance of traditional Ayurvedic topical formulations in routine skin care. The study also demonstrates a practical framework for evaluating non-invasive skin metrics and phytochemicals, serving as a proof of concept.

Introduction: Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome represents an uncommon yet potentially fatal clinical condition. Drug-induced hypersensitivity reaction is characterised by fever, rash, haematological abnormalities and multi-organ involvement particularly the liver. Carbamazepine is a well-known trigger. Aim: The study presents a rare but serious adverse drug reaction, carbamazepine-induced DRESS syndrome with hepatic involvement. Case Presentation: A 29-year-old male with a seizure disorder on long term carbamazepine therapy presented with high grade fever, generalized erythematous rash, abdominal pain and jaundice. Laboratory findings showed leukocytosis, eosinophilia, elevated liver enzymes and hyperbilirubinemia. Methodology: Clinical evaluation, laboratory monitoring and causality assessment using the Naranjo scale (score 7) were performed. Carbamazepine was discontinued and replaced with levetiracetam along with supportive therapy. Discussion: Temporal association, clinical features and improvement after drug withdrawal confirmed carbamazepine induced DRESS with hepatic involvement. Conclusion: The study concludes that early recognition and discontinuation of the offending drug are crucial to prevent serious complications and ensure a favourable recovery.

ABSTRACT Brentuximab vedotin (BV) is an effective treatment for CD30‐positive lymphomas, including mycosis fungoides (MF). However, its use can be associated with various cutaneous adverse effects, including rashes. This case describes a 60‐year‐old male with stage IIB MF who developed a drug‐induced erythematous rash after three infusions of BV. Remarkably, the rash spared pre‐existing MF lesions, which remained demarcated and flattened. Histopathological evaluation confirmed a drug‐induced lichenoid reaction in the affected skin, while the MF lesions exhibited residual disease with CD30‐positive atypical T‐cells. Systemic corticosteroids led to resolution of the rash, and BV therapy was temporarily paused. The patient achieved complete remission of MF with only residual hyperpigmentation at the 10‐month follow‐up. This case highlights a unique interaction between BV and the neoplastic skin environment, warranting further investigation into the underlying mechanisms.

Background: Accurate erythema assessment is essential in dermatologic evaluation, yet detecting erythema in diverse skin tones remains challenging. Traditional visual assessment methods, including the Fitzpatrick Skin Type Classification Scale, have limitations in darker skin tones, where erythema may be underestimated or present differently. Objective colorimetric tools, such as the SkinPhotoTyper and SkinColorCatch from Delfin Technologies Ltd, Kuopio, Finland, provide quantitative measurements of erythema and pigmentation; however, their performance across diverse skin tones remains underexplored.Methods: A cross-sectional study was conducted among 44 patients with rashes attending an outpatient dermatology clinic. Erythema index (EI), melanin index (MI), Individual Typology Angle (ITA), and CIELAB (Commission Internationale de l’Éclairage L*a*b*) values were measured at unaffected (baseline) and affected (rash) sites using calibrated colorimetric devices. Paired t-tests compared baseline and rash measurements, Pearson correlations evaluated relationships among colorimetric parameters, and one-way ANOVA examined differences across Fitzpatrick phototypes, ITA categories, rash locations, and rash types.Results: As anticipated, erythema was elevated in rash sites compared to baseline, and higher melanin correlated with lower ITA and lightness. Unexpectedly, baseline erythema did not correlate with rash erythema, and darker ITA categories demonstrated higher erythema levels, suggesting that localized inflammation may not be accurately reflected by baseline skin tone or visual assessment alone.Conclusion: This study supports the use of colorimetric tools across skin tones and highlights their potential in clinical assessment. Future research should focus on larger, longitudinal studies to evaluate changes in erythema and pigmentation during treatment. Such work could improve diagnostic accuracy, personalize treatment, and promote equity in dermatologic care, particularly by improving disease severity assessment, treatment decisions, and monitoring in conditions where erythema is less visually apparent.

Photoaged skin is primarily induced by prolonged exposure to ultraviolet radiation, leading to increased pigmentation, reduced elasticity, and pronounced wrinkles. There has been an increasing recognition of the influence of nutrition on skin health, with dietary elements emerging as a viable alternative approach to preventing photoaging. This study explores how oral supplementation impacts photoaged skin, hydration, and elasticity. This study evaluates the effects of an antioxidant-rich synbiotic supplement on facial elasticity, hydration, and photoaging markers, such as erythema and pigmentation. In this 8-week study, 36 participants from the Sacramento region were randomized to receive either the antioxidant-rich synbiotic supplement or a placebo. Participants had 3 visits: baseline, week 4, and week 8. Noninvasive facial measurements, including hydration, elasticity, erythema, and pigmentation, were obtained. Facial photography and analysis were performed. Tolerability was assessed. At week 8, the treatment group showed a significant reduction in wrinkle severity (-5.28%, p < 0.01), whereas the placebo group did not. Cheek elasticity increased significantly at week 4 (22.0%, p < 0.01) and week 8 (13.8%, p < 0.05), along with firmness at week 8 (12.2%, p < 0.01). The placebo group showed no significant changes in these parameters. Additionally, the viscoelasticity of the cheek increased at week 4 (30.2%, p < 0.01) in the treatment group, with no change in the placebo group. The antioxidant-rich synbiotic supplement improved wrinkle severity, skin facial elasticity, and skin firmness, enhancing several parameters of photoaging.

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare but potentially fatal hypersensitivity reaction characterised by rash, fever, eosinophilia and multiorgan involvement. Although antiepileptics are common triggers, antitubercular therapy (ATT) is increasingly recognised as a cause in tuberculosis-endemic regions. Pulmonary involvement is uncommon and can mimic disease progression or superadded infection, creating diagnostic confusion. We report a diabetic woman in her late 40s with pulmonary tuberculosis who developed a diffuse erythematous rash, fever, eosinophilia, hepatic and renal dysfunction following ATT initiation. Histopathology and Registry of Severe Cutaneous Adverse Reactions scoring supported DRESS syndrome. Sequential drug rechallenges identified pyrazinamide as the culprit. She subsequently developed new pulmonary infiltrates, which resolved after drug withdrawal and systemic corticosteroids. Extensive infectious workup was negative. This case highlights the need to consider DRESS in patients on ATT presenting with rash and systemic involvement. Early recognition, prompt withdrawal of the offending drug and judicious steroid therapy are crucial to improve outcomes.

Botulinum toxin type A (BoNT-A) injections have a well-known cosmetic outcome and safety profile in a variety of medical conditions. Recent studies have shown promising results for possible use in treating erythematotelangiectatic rosacea (ETR). This systematic review aimed to evaluate the efficacy and safety of BoNT-A injections in patients with ETR. A systematic search was conducted across multiple databases to identify relevant studies. Eligible articles were randomized controlled trials (RCTs) that investigated BoNT-A injections in adults diagnosed with ETR.Studies involving other rosacea subtypes, lacking a comparative group, or combining BoNT-A with other interventions without isolating its effects were excluded. Three RCTs met the inclusion criteria. Both parallel-group and split-face analyses demonstrated that BoNT-A injections significantly reduced facial erythema and flushing, resulting in improved patient satisfaction. Across all studies, BoNT-A was well-tolerated, with adverse events being mild, transient, and self-limited. However, the evidence remains limited by the small sample sizes, suboptimal study designs, and short follow-up durations. BoNT-A injections show promising efficacy and safety in the treatment of ETR. However, larger, well-designed randomized trials with longer follow-up durations are required to confirm its therapeutic role and establish standardized treatment protocols.

We report the case of a 52-year-old male patient with pulmonary tuberculosis who, 72 hours after initiating antituberculosis therapy, developed a severe drug-induced toxicoderma. The clinical presentation was characterized by intense pruritus, erythematous rash, eczema, and diffuse skin desquamation with a positive Nikolsky sign. Given the suspicion of a severe adverse reaction, the antituberculosis regimen was immediately discontinued, and management with fluid support and topical corticosteroids was initiated. Skin biopsy revealed a perivascular lymphoplasmacytic infiltrate, lymphocytic exocytosis, and neutrophilic aggregates, findings consistent with a reactive inflammatory process induced by drugs. The discussion focuses on the immunological complexity of the case, which exhibited overlapping clinical and histological features between type IVc (cytotoxic) and type IVd (neutrophilic) hypersensitivity reactions, suggesting a combined form within the spectrum of toxic epidermal necrolysis (TEN) and acute generalized exanthematous pustulosis (AGEP). In addition to cutaneous involvement, the patient developed a mixed pattern of liver injury that resolved following drug withdrawal. After complete remission of the lesions was achieved, a stepwise and monitored reintroduction of the regimen was carried out, which was well tolerated. This case underscores that early diagnosis and prompt discontinuation of the causative agent are the most critical prognostic factors in preventing fatal outcomes in drug-induced toxicodermas associated with first-line antituberculosis medications.

Azithromycin, a macrolide antibiotic, an azalide derivative of erythromycin, is a Schedule H drug that can be procured from pharmacies in India only with a prescription. Despite the strict regulations, it is commonly available as an over-the-counter (OTC) medication in most pharmacies in India. A 33-year-old male had complaints of fever and sore throat, for which he self-administered tablet Azithromycin 500 mg once daily for three days. Two days after the last dose, he noticed the development of an itchy, erythematous rash. He was diagnosed with acute generalised exanthematous pustulosis (AGEP). Azithromycin was discontinued immediately, and he was treated in the ICU with corticosteroids and antihistamines. Acute Generalised Exanthematous Pustulosis (AGEP) is a rare and self-limiting Severe Cutaneous Adverse Reaction (SCAR) induced by medications. It presents with the rapid appearance of numerous non follicular, sterile pustules on a widespread erythematous base, often accompanied by fever and neutrophilic leukocytosis.This case highlights the potential for azithromycin, a commonly used and generally well-tolerated antibiotic, to induce rare but significant cutaneous reactions such as AGEP. Clinicians should remain vigilant when prescribing antibiotics, especially in patients who present with new-onset rashes during or after therapy.

The article describes a clinical case of adult Still's disease in a 34-year-old female patient. The disease was characterized by persistent fever, arthralgia, lymphadenopathy, hepatosplenomegaly, erythematous skin rashes, pharyngitis, and persistent leukocytosis. After a complex differential diagnosis with acute appendicitis, sepsis, psoriasis, acute respiratory viral infections, intestinal infections, lymphoproliferative and autoimmune systemic diseases, the final clinical diagnosis was "adult Still's disease." Treatment was prescribed with dexamethasone, pentoxifylline, acetylsalicylic acid, and omeprazole. The patient's condition improved with the resolution of fever, the disappearance of erythematous rashes, and the alleviation of arthralgia. The normalization of the main indicators of the general blood test and C-reactive protein was observed. This scientific article highlights the relevance of the problem of the complexity of early diagnosis of adult Still's disease in order to prevent its negative consequences.

Chikungunya fever is an emerging arboviral disease of international significance. While fever and arthralgia are its key symptoms, the wide range of cutaneous manifestations remains dispersed throughout the literature. This review consolidates available data on dermatological manifestations of Chikungunya. A systematic review and meta-analysis were conducted as per PRISMA guidelines with PROSPERO ID-CRD42024612162. Eligible studies documenting cutaneous symptoms in suspected or confirmed Chikungunya cases were searched and included through database search in PubMed, Embase, Scopus, and Web of Science up to 13th May 2025. Two reviewers independently conducted two-stage screening and data extraction. Meta-analysis was performed using a random-effects model, heterogeneity measured using the I2 statistic. A total of 65 studies covering 42011 Chikungunya cases were included. The pooled prevalence of rash exhibited was 41% (95% CI: 34%-48%) and erythematous maculopapular rash was 29% (95% CI: 21%-37%). Additional pooled prevalence estimates comprised hyperpigmented macules 13% (95% CI: 6%-24%), Centro-facial hyperpigmentation (10% (95% CI: 4%-20%), pruritus (29% (95% CI: 19%-40%), vesiculobullous lesions (8% 95% (95% CI: 2%-18%). Heterogeneity was substantial (I2 > 95%) with publication bias evident for hyperpigmented and vesiculobullous lesions. Overall certainty of evidence was low to very low. Cutaneous manifestations are common and clinically diverse in Chikungunya infection. Erythematous maculopapular rash, hyperpigmentation, and pruritus predominate. The high heterogeneity and potential reporting bias indicate a need for standardized dermatological documentation and higher-quality studies to strengthen clinical characterization and outbreak surveillance.