Fluid-filled Lesions Research Articles

Evaluation of the In-Vitro Effects of Albendazole, Mebendazole, and Praziquantel Nanocapsules against Protoscolices of Hydatid Cyst.

Cystic echinococcosis still remains a serious health and economic problem worldwide. The etiologic agent is Echinococcus granulosus sensu lato, giving origin to a fluid-filled cystic lesion. Therapy faces several challenges. Nanodrugs have shown promise as chemotherapeutics against hydatid cysts. The present study evaluated a highly safe lipid nano-polymeric capsule for its superior efficacy and ability to overcome drug resistance. Nanocapsule drugs were formulated into six groups: Albendazole, mebendazole, praziquantel, albendazole + mebendazole, albendazole + praziquantel, and praziquantel + mebendazole. The protoscolicidal effects of these six groups were assessed at 10, 60, and 120 min in three concentrations (1, 0.5, and 0.25 mg/mL). Drug formulations were evaluated via zeta potential, droplet size, solubility, particle size analyzer (PSA), and scanning electron microscopy. According to the PSA results, the mean size of the albendazole nanocapsules was 193.01 nm, mebendazole was 170.40 nm, and praziquantel was 180.44 nm. Albendazole + mebendazole showed the greatest protoscolicidal activity at a concentration of 1 mg/mL after 120 min. In contrast, each drug's 0.25 mg/mL single-dose times showed the least protoscolicidal activity after 120 min. With the right application of nanotechnology, it is possible to produce safe and effective drugs, such as the polymeric combination of albendazole and mebendazole, which has promising implications.

Recurrent catamenial hemoptysis: diagnostic challenges and management strategies—a case report

Catamenial hemoptysis (CH) is a rare, known disease for which diagnosis is crucial and treatment is indefinite. In this case report, CH was identified 2 years ago while taking medical history of the patient. It has disclosed hemoptysis at night with breathlessness that was concurrent with her menses every month for the past 6 months. A series of radiological tests followed by a bronchoscopic examination during menses confirmed the diagnosis. A complex fluid-filled cystic lesion with few air foci in the right lower lobe superior segment with ground glass opacity was seen by a CT scan test. Subsequent bronchoscopy examination showed an active bleeding site at the right lower lobe superior segment. The bronchial wash tests were negative for microbial infections as well as for malignancies. Bronchial artery embolization (BAE) was done and it ceased the hemoptysis. However, it recurred after 2 years of the BAE procedure. The symptoms and amount of hemoptysis were milder; hence, repeated BAE was not required. Earlier, the patient refused hormonal therapy (HT) owing to its side effects, but this time, she accepted HT. After 2 months of HT, hemoptysis gradually ceased. If complications arise in the future, then surgical treatment along with HT (combination therapy) would be the course of treatment. The diagnosis of CH is challenging, and treatment procedures vary from patient to patient; hence, they are customised. Hormones regulate the CH recurrence even though the symptoms have ceased after treatment. Therefore, regular follow-up and close vigilance are crucial requirements.

Large Epididymal Cyst: A Tale of Three Testes

Background: An epididymal cyst is a benign cystic structure that develops from the epididymis, typically due to a blockage in the epididymis, resulting in fluid accumulation. These cysts are generally harmless and noncancerous. Case Presentation: We examine the case of a 30-year-old male referred by the Psychiatry department for an assessment of the inguinal scrotal region, due to his belief that he had three testicles. Physical examination revealed an extratesticular, fluctuant, and cystic swelling easily palpable and distinct from the body of the left testis. Ultrasound findings showed a 2.3 x 1.7 cm fluid-filled lesion at the head of the epididymis. Intervention: Following a psychiatric evaluation, the patient underwent surgical excision of the cyst. Conclusion: The histopathological examination of the surgically removed cyst confirmed the diagnosis of an epididymal cyst, underscoring the importance of considering such benign conditions in differential diagnoses of scrotal abnormalities.

Bullous pemphigoid as a paraneoplastic manifestation of metastatic adenocarcinoma of the lung

A 73-year-old male smoker presented with complaints of fever and multiple clear fluid-filled lesions for 3 months. He was initially being treated for primary bullous pemphigoid but lesions recurred. On a chest X-ray, he was found to have a right hilar mass, and contrast-enhanced computed tomography of the chest revealed a right lung mass lesion with cervical, hilar, and mediastinal lymphadenopathy. A bronchoscopy was done, and bronchoalveolar lavage cytology was suggestive of lung adenocarcinoma. An excision biopsy of the left supraclavicular lymph node showed features consistent with adenocarcinoma lung. Hence, he was diagnosed with metastatic adenocarcinoma of the lung with bullous pemphigoid as a paraneoplastic manifestation. He was subsequently treated with chemotherapy, and his skin lesions resolved.

Case Report: A successful treatment approach of rituximab and azathioprine for pemphigus vulgaris

Pemphigus Vulgaris is an uncommon autoimmune skin disorder that is characterized by persistent and blistering lesions. In approximately 50% of patients, mucous membrane erosions are the initial symptom. The primary presenting symptom is often oral mucosal erosions. Affected individuals frequently experience flaccid blisters and erosions on healthy skin and mucous membranes, and other areas of the body may also be affected. This condition is the result of autoantibodies that target desmosomal antigens. We are presenting a case of a 28-year-old male who presented to the hospital with fluid-filled lesions on his forehead and in his oral cavity. A skin biopsy was performed, and he was diagnosed with pemphigus vulgaris. Initially, he was started on a combination of steroids and azathioprine, but he did not respond to this treatment regimen. However, he was successfully treated with injection rituximab. Rituximab has been found to be an effective treatment approach towards pemphigus vulgaris. It can help prevent further complications and reduce the severity of the disease. By targeting the autoantibodies that cause the disorder, rituximab can help control the patient's symptoms and improve their quality of life. It is important to note that early diagnosis and treatment can play a critical role in the management of pemphigus vulgaris.

Athena: Specialty Certificate Examination case for generaldermatology.

This Athena concerns a 45-year-old man who presented with a 1-year history of recurrent tense fluid-filled lesions over his forearms, hands, feet and face associated with scarring and pigmentary changes. He had a history of regular alcohol intake (> 3 units daily). Lesion biopsy revealed a thick granular deposition of IgG along the basement membrane with thick homogeneous positivity of papillary dermal vessels for various immunoreactants (IgG, IgA, C3, IgM).

Development of autoimmune pemphigus vulgaris following Chadox1 nCov-19 coronavirus vaccine (recombinant)

Pemphigus vulgaris is a rare IgG-mediated autoimmune disease that affects the skin and mucous membranes, causing painful blistering. Pemphigus vulgaris has been reported to be triggered or exacerbated by various factors, including genetic vulnerability, certain drugs, and malignant diseases. We present a case of a patient who was admitted to the dermatology ward with complaints of multiple fluid-filled lesions, initially over the chest, containing clear fluid-filled, ruptured within 1 to 2 hours to leave behind painful raw areas, predominantly over the trunk, scalp, face, upper limbs in the past 2 weeks, and single raw erosions inside the oral cavity after receiving the second dose of Chadox1 nCov-19 coronavirus vaccine (Covishield™), and also mentioned he had developed similar symptoms after the 1st dose of COVID vaccine. We chose to report this case because of the unusual presentation of a rare COVID vaccine adverse drug reaction seen in India.

A giant chylolymphatic cyst of the retroperitoneum: a case report

Abstract Chylolymphatic cysts are an extremely rare variant of mesenteric cysts and account for 7.3% of all abdominal cysts. They can develop anywhere along the mesentery of the gastrointestinal tract and present in a wide range of symptoms. A 46-year-old male presented with mild abdominal pain and intermittent claudication in his right leg for the last 2 months and a history of a retroperitoneal resection of a simple abdominal cyst 5 years ago. Abdominal ultrasound and computerized tomography showed a fluid-filled cystic lesion measuring 17 × 11 × 10 cm in the right retroperitoneum. The cyst was surgically excised, and the histopathological examination was consistent with the chylolymphatic cyst. On a 1-year follow-up, the patient is recovered with no recurrence observed. Our report presents a case of a giant retroperitoneal chylolymphatic cyst with uncommon presenting symptoms and a rare etiology.

Bullous diabeticorum

Bullous Diabeticorum is a skin condition that occurs rarely in diabetic patients. It is a specific type of skin lesions characterized by non-inflammatory blisters that heals spontaneously. It is usually found in long standing diabetic patients with poor glycemic control, although the relationship between BD and blood glucose level in diabetic patients remains unclear. It frequently goes undiagnosed because it resembles other vesicobullous illnesses. Few published articles reported such cases. This case report describes a rare case of Saudi female patient presented to the clinic with a well demarcated erythematic fluid-filled lesion. Based on medical history and clinical examination diagnosis of diabetic bullae was made. We present this case to shed light on the rare occurrence of Bullous Diabeticorum in diabetic patients, to highlight the role of interprofessional team in its management and to improve the patients’ outcome.

Late-onset peritoneal inclusion cysts (PIC) in adolescents undergoing major gastrointestinal surgery

Peritoneal inclusion cysts (PICs) are reactive, fluid-filled lesions of the peritoneal serosa that are usually present in reproductive-age women with a history of prior pelvic or abdominal surgery. In this report we presented 5 cases of females with short bowel presented with ovarian inclusion cysts during adolescence, long after abdominal surgery performed during their infancy or early childhood. Only one case was managed conservatively. Two cases had repeated episodes of pain and in two cases the cysts become infected (leading to septic shock in one) requiring long term of Intravenous antibiotic and supportive treatment. The presence of a PIC should be included in the differential diagnosis of abdominal pain in teenagers having undergone intestinal transplant or extensive intestinal resection resulting in short bowel.

Loculated Pneumothorax in COVID-19 Patient – A Case Report

Aim: Loculated pneumothorax and multilocular cystic lung lesions are rare complications of acute respiratory distress syndrome in patients with COVID-19 infection. In this case report we wanted to emphasize that not only mechanically ventilated patients are at increased risk of pneumothorax and cystic lung lesions. Those lesions can also be found in non-ventilated patients. Case report: We present a case report of a 52-year-old man who was hospitalized because of COVID-19 pneumonia. MSCT pulmonary angiography revealed ground glass opacities, multilocular cystic lesions and loculated pneumothorax. On followup computerized tomography examination in an outpatient hospital two months later, there was a significant regression of the lung parenchymal ground glass opacities, as well as the regression of the cystic lesions with residual fluid-filled lesion in the oblique interlobar fissure. Conclusion: Only few case reports have been published on this specific lung pathology in COVID-19 disease. Increased incidence of complications such as pneumothorax in COVID-19 pneumonia is common, but physicians should also be aware of the possibility of other lung pathologies such as loculated pneumothorax and multilocular cystic lesions which can present not only in mechanically ventilated patients.

Spectrum of Skin Dermatoses among Patients of Substance Use Disorder: A Hospital-based Study

Introduction: Various substances of abuse are known to cause specific cutaneous manifestations. Cutaneous manifestations are associated with the use of cocaine, methamphetamine, heroin, marijuana, alcohol, anabolic steroids, and general signs of drug abuse, including the stigmata of injection drug use, infectious complications, and vascular complications. However, the literature on the same is very limited from the Indian subcontinent. The purpose of the study is to find out various dermatoses in patients of substance use disorder.Materials and Methods: In the present study, 46 Diagnosed cases of substance use disorder as per the Diagnostic and statistical manual of mental disorder-5 (DSM-5)1 and confirmed by a qualified psychiatrist, were taken. The cutaneous examination was performed accordingly. Laboratory investigations were done as per need.Results: Mean age was 42.21 ± 16.64. The majority of the patients were illiterate (41.3%) and 26.1% were either graduate or postgraduate and 21.7% were high school pass and 6.5%were in middle school and the minority had primary school education (4.3%). The majority of the patients had complaints of raised lesions (56.5%) and followed by redness (23.9%), pain (19.6%), burning (13%) and oozing (13%) discomfort and flaking of skin (10.9%), rash (8.7%), light spots (6.5%) and fluid-filled lesions (4.3%).Conclusion: Few substances were associated with specific dermatoses. However, there is very little data, so this study will add upon the minuscule literature on this topic.

Unusual Presentations of Bullous Pemphigoid in Young Patients: A Case Series

Introduction: Bullous pemphigoid (BP) is the most common subepidermal autoimmune vesiculobullous disorder. It mainly affects the elderly, with a mean age at presentation of 69 to 83 years and an incidence of 7 to 43 per million population in European studies. Bullous pemphigoid (BP) is rarely encountered in young people, with an incidence rate of less than 0.5 cases per million population in individuals less than 50 years. Case Presentation: A 28-year-old male presented with fluid-filled lesions over his right forearm for three days. Also, an 18-year-old male presented with fluid-filled lesions over his face, hands, groin, and legs for two months. In both cases, histopathology and direct immunofluorescence confirmed BP. Conclusions: Though BP is rare in young individuals, it should be considered one of the differentials of vesiculobullous disorders. Herein, we reported two cases of BP in young people at unusual sites.

32301 A cross sectional study on hand manifestations during COVID-19 pandemic

Introduction: Since the outbreak of COVID-19, many new habits became the new normal among us such as social distancing, wearing a mask, and hand hygiene. It is noticed that there is an increase in skin complaints among health care providers and the general population. So, we hereby undertook a study to look for the incidence of skin complaints on hand during the COVID-19 pandemic. Methods: Responses from 454 people were collected which included doctors, nurses, and the general population through an online questionnaire. Results: Out of 454 people, 230 (50.7%) are males, 220 (48.5%) females and 4 (0.9%) preferred not to reveal their sex. 356 (78.4%) were associated with the medical field, and 98 (21.6%) were others. 336 (74%) of them use hand gloves and 118 (26%) of them did not use hand gloves. The average time of wearing a glove is 5 hours a day for 20 days a month. The average use of sanitizers is 15 times a day per person. On average, a person washed their hands 7-8 times a day with soap. Of the 454 people 278 (61.2%) people have hand complaints and 176 (38.8%) people did not have any complaints. The most common complaints are dryness (71.6%) and peeling of the skin (69.3%). Burning (28.4%), itching (20.5%), fluid-filled lesions (2.3%), papules (2.3%) and oozing (2.3%) were among other complaints. 70 (15.4%) people had aggravation of already existing skin complaints. Conclusion: Due to frequent hand hygiene methods, the skin barrier function is disrupted, leading to hand dermatitis. Although hygiene is a crucial preventive measure in this pandemic, maintaining skin integrity is also important.

Dermoscopic Assessment of Lymphangioma Circumscriptum Treated With Topical Sirolimus Ointment: A Case Report

Introduction: Lymphangioma circumscriptum (LC) is characterized by malformation of superficial lymphatics. Dermoscopy reveals brownish-yellow lacunae and white septa. In scrotal LC, gray and red areas are also noted. Treatment of LC is challenging because of its high recurrence. We herein report a case of scrotal LC that was successfully treated with topical sirolimus with dermoscopic assessment of the therapeutic response. Case presentation: A male patient presented with fluid-filled lesions on the scrotum after partial penectomy. Examination revealed multiple skin-colored vesicles containing serous fluid on either side of the scrotum. Dermoscopy showed brownish-yellow lacunae with white septa as specific patterns. A diagnosis of secondary LC was made based on the clinical and dermoscopic features, and the patient was treated with 0.1% topical sirolimus ointment. Discussion: Management of LC includes close follow-up. Sirolimus, by inhibiting cellular proliferation and angiogenesis, helps in the regression of vesicular lesions of LC. Furthermore, dermoscopy supports an accurate evaluation of the therapeutic response. Conclusion: Sirolimus is a promising topical agent in the treatment of LC. Dermoscopy comes handy in the evaluation of treatment response. Any residual lesions could be noted and treated accordingly.

Five-Year Outcomes After Decompression and Fusion Versus Decompression Alone in the Treatment of Lumbar Synovial Cysts

Spinal synovial cysts are acquired, fluid-filled lesions of the facet joint that most commonly occur in the lumbar spine. They are thought to arise from degenerative changes and to result from segmental instability. Although the treatment of these lesions has been studied, the long-term implications and effects of the different strategies for surgical intervention (i.e., decompression and fusion vs. decompression alone) have not yet been elucidated or established. Using an all-payer database with 53 million patient records (MARINER-53), patients with a diagnosis of lumbar synovial cysts were identified. Patients who had undergone lumbar fusion versus laminectomy were matched 1:1 using binomial and gaussian logistic regression models to evaluate the need for future lumbar surgery within 5 years after their index procedure. No statistically significant differences were noted between the 5-year rates of subsequent intervention, additional laminectomy, or fusion among patients who had undergone index decompression and fusion (n= 51; 10.5%) versus decompression alone (n= 43; 8.8%; P= 0.39). Furthermore, no significant differences were found in the odds of intervention type after index decompression and fusion versus decompression alone (subsequent laminectomy: odds ratio, 0.59; 95% confidence interval, 0.32-1.09; subsequent fusion: odds ratio, 1.14; 95% confidence interval, 0.64-2.02). Patient-specific factors and surgeon-patient-shared decision-making should be used when planning interventions for these lesions. However, synovial cysts might not require a fusion procedure for presumed instability. Further investigation is required, using randomized and prospective studies, to further evaluate the effective treatment of this entity.

Case of a 30-year-female with systemic lupus erythematosus: a rare clinical image.

Systemic lupus erythematosus is a chronic and autoimmune disease that causes inflammation in connective tissue such as cartilage and the lining of blood vessels in which the immune system attacks its tissues. The aetiology factors are unknown but are linked to environmental, genetic, and hormonal factors; They can affect the joints, skin, brain, lungs, kidneys and blood vessels. We here report the case of a 30-year-female patient, who came to the dermatology ward with the complaints of flat red rash across the cheek and bridge of the nose, fluid-filled lesion all over the body, pain and itching, burning associated with the lesion, pedal oedema, oral ulcer, she was apparently alright four days back when she developed fluid-filled lesion which was sudden in onset and gradually progressive, the lesion occurred after ingestion of drug for fever. Initially, blood, ECG, Chest X-ray investigation done, USG done, which was suggestive of mild hepatosplenomegaly with the dilated portal vein and minimal free fluid in the pouch of Douglas, raised cortical echotexture of kidneys, skin biopsy done, and it shows atrophied epidermis, histopathological features suggestive of erythema multiform. The patient was referred to the dermatology and medicine department for further management.

Novel management of spontaneous onset sclerocorneal cyst in a child

A 2-year-old girl was referred for management of swelling on the nasal side in the right eye. On ophthalmic examination, the right eye showed a subconjunctival cyst extending into the anterior corneal stroma on the nasal side. Ultrasound biomicroscopy of the right eye showed a fluid-filled cystic lesion involving the cornea, with no communication with the anterior chamber. Examination under anesthesia revealed an intrastromal sclerocorneal cyst over the nasal half of cornea, not involving pupillary axis. The cyst was drained, anterior cyst wall excised, scleral lips glued together, and the bare corneoscleral bed covered with amniotic membrane with no recurrence.

Elderly Male: An Immune-Compromise Sufficient Enough to Have Hemorrhagic Varicella.

Elderly Male: An Immune-Compromise Sufficient Enough to Have Hemorrhagic Varicella.

Pemphigus and Beyond

A 23-year-old male diagnosed with pemphigus foliaceous presented with multiple asymptomatic hyperpigmented patches and plaques clinically resembling seborrheic keratoses over multiple sites on the body of 1-year duration. There were no fluid-filled lesions, active erosions, or mucosal involvement. Histopathological examination from the hyperpigmented plaque revealed marked acanthosis with intra-epidermal acantholysis. Enzyme linked immunosorbent assay (ELISA) for antidesmoglein-1 antibodies was positive with a titer of 157 units/ml. Treatment with oral azathioprine, dapsone, and topical halobetasol propionate produced a marked response with complete clearance of the lesions. A thorough workup helped us detect the persistence of disease activity and thus prevent a potential relapse. This case report highlights the unusual presentation of a common immunobullous disorder, Pemphigus acanthomata a rare entity with regard to its morphological, histopathological, and immunological features.