Multiple Hyperpigmented Macules Research Articles

Morbus Hansen

Morbus Hansen (MH) which is called leprosy or leprosy is an infectious disease that causes health problems throughout the world. Leprosy is spread all over the world, especially in tropical and subtropical areas and attacks all ages with the highest frequency in the age group of 20 to 30 years. Case Presentation : Mr. AB, male, aged 33 years, came complaining of numbness and frequent tingling. Hands and feet began to swell and sore. Some toenails fall off unnoticed. Physical examination found composmentis awareness. The general status of the patient was madarosis in both eyelashes, the eyes looked anemic. Ears found infiltrates in both earlobes. Dermatological status in the facial region and superior extremities showed multiple hyperpigmented macules and patches, well defined, geographic shape, sizes vary. Bacteriological examination with Slit Skin Smear on the earlobes found 1-10 Acid-Fast Bacilli (AFB) / 100 fields of view (+1). Bacteriological Index obtained +1. Conclusion: The patient was diagnosed with MB type leprosy accompanied by Erythema Nodusum Leprosum

Pityriasis Lichenoides et Varioliformis Acuta pada Wanita Dewasa dengan Bakteriuria Asimptomatik: Sebuah Pemicu Lain?

Introduction: Pityriasis Lichenoides et Varioliformis Acute (PLEVA) is a rare and benign inflammatory skin disease. This acute form is distinguished from the milder chronic condition, Pityriasis Lichenoides Chronica (PLC). The etiology of PLEVA itself remains unclear, although it has been associated with infection as a trigger.Case: Here, we present the case of a 34-year-old woman who presented with abrupt, generalized, pruritic skin eruptions for two months.Case Discussion: The eruptions started as red scaly papules and vesicles and resolved as hyperpigmentations. She denied having any previous dermatological diseases, routine medications, or vaccinations. On examination, she showed generalized multiple hyperpigmented macules, scaly papules, and vesicles over the trunk, extremities, and face, with erosions and crusts in several areas. Eosinophilia and asymptomatic bacteria were found in her urinalysis. A skin biopsy showed diffuse lymphocytic infiltration in the dermal/epidermal junction and perivascular region, with parakeratosis and lymphocyte exocytosis. While the pathogenesis of PLEVA itself remains unclear, a triggering factor of inflammatory reaction, such as infection, may contribute to the development of the disease.Conclusion: Asymptomatic bacteriuria is associated with inflammatory responses, and thus, it can be one of many possibilities. More studies are needed to confirm this association with PLEVA. Due to the lack of a clear pathogenesis and the benign nature of the disease, this rare entity may present difficulties in diagnosis and therapy

Teen with hyperpigmented skin lesions

A 15-year-old boy presented to the Pediatric Clinic with a 2-month history of dark spots on his neck and upper back. They were neither itchy nor painful. Examination revealed multiple hyperpigmented macules with slight scale.What's your diagnosis?

A 17-year-old male presenting with multiple hyperpigmented macules over right side of chest in zosteriform pattern

Lichen planus pigmentosus (LPP) is a variant of lichen planus. It is characterized by small black, brown macules, on sun exposed areas like face, neck, upper extremities and trunk. Lesions are insidious in onset with gradually progressive course. Few variants have been reported like LPP inversus, localized LPP, linear LPP, zosteriform LPP and LPP of oral mucosa etc. Here, we present a case of zosteriform LPP in a young adolescent male, which is a rare presentation.

Abstract 17116: Recurrent Atrial Myxomas As A Presenting Feature Of Carney Complex

Case Presentation: A 24-year-old man with a history of adrenal insufficiency on hydrocortisone presented to the hospital after losing consciousness in a swimming pool and was found to have an acute MCA stroke. PMHx was significant for left atrial myxoma status post resection 3 years ago, known L frontal brain, L adrenal, and testicular masses status post-resection. His father had a history of resected left atrial mass. Cardiology was consulted for a L atrial mass on the bedside echocardiogram upon initial emergency evaluation, during which the patient was placed on mechanical ventilation with stable vitals. The cardiovascular exam revealed a midsternal scar but was otherwise normal. Pulses were 2+ bilaterally on the upper and lower extremities. The skin was noted to have multiple hyperpigmented macules resembling cafe-au lait spots. The patient underwent mechanical thrombectomy with thrombolysis for his large MCA occlusion. His postoperative course was complicated by a worsening neuro exam in the setting of mid-line shift for which he had undergone decompressive hemicraniectomy. His adrenal insufficiency was managed by endocrinology. A TTE was significant for a L atrial mass measuring 4.8 cm attached to the interatrial septum with a stalk. A CT scan identified 2 discrete hypodensities of 8 mm and 3.8 cm which were thought to be the cardioembolic source for the stroke. An abdominal CT revealed a recurrent L adrenal neoplasm with absent R adrenal gland post resection of neoplasm. Conservative cardiac management was elected in the setting of a worsening neuroprognosis with follow-up post neurologic insult. Discussion: Considering the constellation of neoplastic and cutaneous findings, this was diagnosed as a case of Carney complex. This case identifies recurrent myxoma as a unique feature of Carney complex, ruling out other differentials such as neurofibromatosis and MEN syndrome. It highlights the importance of screening to prevent embolic stroke from recurrent myxomas.

Porphyria cutanea tarda induced by alcohol abuse: A case report

Porphyrias are group of inherited and acquired disorders resulting from enzyme deficiency in the metabolic pathway of haem biosynthesis. Among all types of porphyria, the most common type is porphyria cutanea tarda in adults, occurring due to deficiency of enzyme uroporphyrinogen decarboxylase in the metabolic pathway ofm heme biosynthesis. A 35‑year old man presented in opd with chief complaints of recurrent episodes of vesicles, blisters, erosions, raw areas on dorsum of hand and face for 2 years. Local examination revealed multiple erosions with adherent crusting, atrophic plaques of healed lesions over the face and multiple hyperpigmented macules with scaring, erosion and raw areas present overe dorsum of the hands. Laboratory findings showed abnormal liver profile and elevated zinc protoporphyrin and coprophyrin levels. Urine revealed coral pink fluorescence under woods lamp. Histology of the skin showed epidermal spongiosis, subepidermal blister with minimal inflammatory cell infilterate in the dermis. Treatment given were sun screen lotions, hydroxy-chloroquine, avoidance of triggering factors and alcohol discontinuation. Patient showed marked improvement in skin lesions. Keywords: Porphyria, Gunther?s disease, Uroporphyrinogen III synthase deficiency.

Generalized Dowling Degos disease: A rare genetic disorder

Dowling Degos disease (DDD) is an uncommon, autosomal dominant genodermatosis characterized by acquired, flexural hyperpigmentation. Clinico-histopathological correlation is diagnostic showing multiple hyperpigmented macules clinically and marked, heavily pigmented, slender and elongated rete ridges on histology. This entity needs to be differentiated from other reticulate hyperpigmentary disorders. Due to rarity of this condition, we report a case of generalized Dowling Degos disease in an adolescent female. Keywords: Dowling Degos disease, Genodermatosis, Hyperpigmentation.

Immune Thrombocytopenia causing Abnormal Uterine Bleeding in an Adolescent Girl having Co-Existent Type-1 Neurofibromatosis- Is it an Association or Coincidence?

Immune Thrombocytopenia (ITP) is an autoimmune disorder characterised by a low circulating platelet count. ITP is caused by destruction of antibody-sensitised platelets in the reticuloendothelial system. Majority of the patients with ITP remain asymptomatic or develop only purpura, petechiae or epistaxis (83%) but few, very rarely, may present with abnormal uterine bleeding. On the other hand, Neurofibromatosis is an autosomal dominant disorder which can present with either precocious puberty or delayed puberty. This case report highlights a case of a 14-year-old female who presented with heavy menstrual bleeding as a presenting symptom of ITP and was co-incidentally also diagnosed as Neurofibromatosis type 1 (NF-1) during work-up of ITP for multiple hyperpigmented macules (Café-au-lait spots) noticed on her neck, forearm and back and the presence of Lisch nodules in iris. She was managed with steroids, oral contraceptive pills, iron and multivitamin tablets.

Reticulate Acropigmentation of Kitamura: A Dermoscopic Perspective.

Reticulate Acropigmentation of Kitamura: A Dermoscopic Perspective.

Penile Edema and Lichenoid Plaques on Scrotum: An Unusual Presentation of Secondary Syphilis.

Sir, A previously healthy 35-year-old male presented with complaints of swelling of penis with inability to retract foreskin and dark-colored lesions on scrotum for 20 days. There was a history of unprotected sexual exposure with a female commercial sex worker 3 months back. One month later, he developed a solitary, painless ulcer on the penis. The patient opted for over-the-counter topical and systemic antibiotics following which the ulcer healed in the next 4–5 weeks. However, 2 weeks later, he developed swelling of the penis with inability to retract the foreskin, dark-colored asymptomatic lesions on scrotum and dark-colored scaly rash on palms and soles. There was no history of any urethral discharge, burning micturition or any constitutional symptoms. On examination, the patient had edema of the prepuce with secondary phimosis [Figure 1a]. There were multiple, violaceous, scaly plaques on scrotum [Figure 1b]. Palms [Figure 2a] and soles [Figure 2b] had multiple hyperpigmented macules with few keratotic papules. The mucosae, scalp and nails were unremarkable. He had multiple, discrete, non-tender, shotty lymph nodes (1–2 cm in diameter) in both inguinal regions. The hematological and biochemical investigations were normal. The venereal disease research laboratory (VDRL) test was reactive in a titer of 1:128 and Treponema pallidum hemagglutination assay (TPHA) was positive. ELISA (enzyme-linked immunosorbent assay) for HIV was negative. Our patient denied consent for skin biopsy. In the setting of corroborative history, examination and reactive serological tests, a final diagnosis of secondary syphilis was made. The patient was treated with a single dose of benzathine penicillin 2.4 million units (1.2 million units given in each buttock) after sensitivity testing. He was counseled about safe sexual practices and was asked to get his wife evaluated too.Figure 1: (a) Edema of the prepuce with secondary phimosis; (b) violaceous, scaly plaques on the scrotumFigure 2: (a) Hyperpigmented macules on both palms; (b) hyperpigmented, keratotic papules on both solesWhen the patient was reviewed 6 weeks later, the penile edema and the scrotal lesions had resolved and a healed atrophic scar was appreciable on the undersurface of the prepuce [Figure 3]. A repeat VDRL titer 3 months post treatment was 1:32, indicating adequate response to the treatment.Figure 3: Healed atrophic scar on the undersurface of the prepuce (solid black arrow)Discussion Secondary syphilis is often called “the great mimicker” because of its protean clinical presentations.[1] Skin rash is seen in more than 80%–95% of cases with over 95% of the eruptions being macular, maculo-papular or papular lesions. Rare variants include nodular, pustular, lichenoid and erythema multiforme like lesions. Penile edema is usually a feature of syphilitic balanitis seen in primary syphilis. Our patient had unusual lichenoid lesion on scrotum associated with penile edema resulting in secondary phimosis. He did not have any systemic involvement or generalized rash on body. Only because he had typical lesions on palms and soles did we consider the possibility that the scrotal lesions and penile edema were possible manifestations of secondary syphilis, which was later confirmed by serological tests. Lichenoid lesions on scrotum as a manifestation of secondary syphilis was previously reported by Narang et al. in two cases who also had generalized lymphadenopathy, fever and malaise.[2] Also, scrotal eczema-like presentation in syphilis has been rarely mentioned in literature.[3] Therefore, one must keep a high index of suspicion of syphilis in a patient presenting with a temporal history of high risk sexual behavior and cutaneous manifestations that can easily be confused with common dermatoses like lichen planus, psoriasis, tinea, eczema, etc. Penile edema is usually seen as a manifestation of syphilitic or Follmann's balanitis[4] in the primary stage and usually resolves with the resolution of the chancre. In our patient, the penile edema may have been a manifestation of chancre redux which went unnoticed due to secondary phimosis or could have been a rare manifestation of secondary syphilis itself as has been described by Korta et al.[5] To conclude, clinical presentations of secondary syphilis are protean and might be misleading. It is important that a high index of suspicion is maintained when evaluating lesions in patients at epidemiologic risk for syphilis and any suspicion should be dealt accordingly with appropriate investigations. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest. Acknowledgements We are thankful to the family of our patient for their support and cooperation.

Oral pigmentations in Laugier-Hunziker syndrome: a case report and review of diagnostic criteria

ABSTRACT Laugier-Hunziker syndrome (LHS) is a rare mucocutaneous disorder, of unknown etiology, characterized by multiple hyperpigmented macules, dispersed mostly on the oral mucosa, occasionally associated with longitudinal ridging of the nails. The diagnosis requires exclusion of other conditions, such as Addison's disease and Peutz-Jeghers syndrome. We report a case of a 34-year-old male patient, presenting with hyperpigmented macules on the lips, buccal mucosa and palate, as well as mild dark striations on toenails. After careful clinical and laboratorial investigations, the diagnosis of LHS was established. Given the lack of aesthetic complaints and symptoms, no treatment was necessary.

Idiopathic Eruptive Macular Pigmentation - Uncommon Presentation of an Uncommon Condition.

Idiopathic eruptive macular pigmentation (IEMP) is an asymptomatic condition with dark brown, nonconfluent lesions chiefly occurring in children and adolescents. The usual sites involved are face, trunk, extremities, and the lesions resolve over few months to years. We report an unusual presentation of this uncommon condition. A 22-year-old male presented with multiple dark-colored asymptomatic lesions on the scalp and forehead for the past 3 years. There was no history of preceding symptoms, drug, or applications, past or family history of such lesions. Examination revealed multiple hyperpigmented macules and barely elevated nonscaly plaques with a velvety feel akin to acanthosis nigricans (AN). Dermoscopy was similar to AN. Blood sugar, thyroid, and lipid profiles were normal. Histology showed “pigmented papillomatosis” concluding the final diagnosis of IEMP. Confluence of lesions is a rarely described phenomenon, with the scalp being a hitherto unreported site. The velvety feel of lesions, the dermoscopic, and histopathological findings further substantiate the hypothesis of this entity being an eruptive variant of AN.

Urticaria pigmentosa.

A 6-year-old female, presented with multiple dark-colored lesions, which started over the scalp and further progressed to involve the face and trunk since past six months. She gave a history of elevation, redness, and itching on the lesions on application of pressure. There was no associated flushing, vomiting, diarrhoea, or wheeze. The personal and family history was not contributory. On examination, there were multiple hyperpigmented macules over the scalp, forehead, face, and neck in addition to minimally elevated hyperpigmented plaques over the chest and the back [Figure 1a–c]. Gentle rubbing of the lesions elicited urtication and itching within 2 min and it resolved within 15–20 minutes, suggestive of the Darier's sign [Figure 1d].Figure 1: (a) Multiple ill-defined hyperpigmented macules on the forehead, nose, and the upper lip, (b) multiple ill-defined hyperpigmented macules over the scalp, (c) minimally elevated hyperpigmented plaques on the chest, and (d) positive lesional Darier's signA complete blood count, liver and renal functions, urine analysis, and chest roentgenogram were normal. The histopathology of a minimally elevated lesion from the back demonstrated increased melanization of the basal layer with sheets of oval mast cells infiltrating the upper and lower dermis [Figure 2a–c]. The metachromatic granules of the mast cells were visualized using the toulidine blue stain [Figure 2d]. The diagnosis was thus established as urticaria pigmentosa.Figure 2: (a) 4×—Scanner view: Sheets of mast cells seen occupying the upper mid and the lower dermis, (b) 10×—Basal layer hyperpigmentation with oval mast cells seen infiltrating the upper and mid-dermis without any evidence of epidermotropism, (c) 40×—Sheets of oval monomorphic mast cells, (d) Oil immersion-toulidine blue stain demonstrating the metachromatic granules of the mast cellsUrticaria pigmentosa is the most common form of mastocytosis with onset generally below two years of age. The lesions are rose colored, pruritic, urticarial, slightly pigmented macules, papules, or nodules. The nonevanescent urticated lesions persist and gradually become pigmented. The increased number of the functionally normal mast cells in the dermis degranulate in response to stroking with the release of histamine, which is responsible for the local itching, erythema, and weal formation or the Darier's sign.[1] The lesions usually disappear within a few years, usually before puberty, although in a few cases the lesions may persist into adult life. Although systemic involvement is possible, malignant transformation is exceedingly rare. The multiplicity of lesions on the scalp is an uncommon finding in the case discussed.[2] Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Neurofibromatosis with chronic myeloid leukemia in an elderly male: An unusual association

Neurofibromatosis is a genetic disorder of neural crest-derived cells that predominantly affect growth and development of neural tissues. We report a case of 64-year-old patient, had several soft tissue cutaneous nodules (neurofibroma) on the body including the face, head, and neck, extremities and multiple hyperpigmented macules on trunk and back (Café-au-lait pigmentation), who was accidentally diagnosed as chronic myeloid leukemia, on routine investigation for surgical management. He did not

Multiple hyperpigmented macules on the torso of a dark-skinned man

Multiple hyperpigmented macules on the torso of a dark-skinned man

Aneurysmal Rupture of the Internal Carotid Artery in a Presumed Neurofibromatosis Type I Patient

Carotid artery aneurysms are uncommon but have the potential of catastrophic clinical events. The aneurysms, as we know, lead to severe neurologic symptoms like embolization and even sudden death from rupture. Aneurysms of the carotid artery result from injury or may be a long term sequel of spontaneous dissection. It could be also caused by congenital arterial anomalies such as Neurofibromatosis type I (NF-I). NF-I, so-called von Recklinghausen disease, is an autosomal dominant disorder affecting one per 3,5004000 live births. NF-I is developed by mutations in, or deletions of, the NF-I gene that is located on 17q11.2. This gene controls neurofibromin, a GTPaseactivating protein that is thought to have a possible tumor-suppressor function by maintaining the ras proto-oncogene in an inactive form. Over 250 mutations in the NF-I gene have been identified. The inheritance is autosomal dominant type with 50% of the cases representing new mutations. Clinical features of NF-I include multiple hyperpigmented macules (so-called cafe′au lait spots), various benign and malignant tumors including neurofibroma, iris hamartomas (so-called Lisch nodules), and freckling in the axillary or inguinal regions (so-called Crowe’s sign), and abnormalities of blood vessels. Vascular abnormalities, mostly in the form of aneurysms or stenoses, affect mediumand large-sized vessels and are presented in NF-I. The renal artery is the most frequently involved one, but abdominal aortic coarctation, internal carotid artery aneurysms, and

An 11-year-old Girl With Multiple Hyperpigmented Macules

An 11-year-old Girl With Multiple Hyperpigmented Macules