Unusual Skin Lesions Research Articles

Lymphocytic Variant of Triple-Negative Breast Cancer Carcinoma Erysipeloides: A Rare Case of Carcinoma Erysipeloides Following TNBC Mastectomy

Background: Carcinoma erysipeloides (CE) is a rare but significant cutaneous manifestation of metastatic breast cancer, often misdiagnosed due to its rarity and nonspecific presentation. This is particularly true in patients with triple-negative breast cancer (TNBC), where the disease may progress undetected by conventional imaging modalities. This manuscript aims to elucidate the challenges and implications of diagnosing CE in breast cancer survivors, emphasizing the insufficiency of PET scans in detecting such cutaneous metastases and the potential for mismanagement due to diagnostic oversight. Case Presentation: We present a detailed case study of a 43-year-old female with a history of metastatic TNBC, who developed suspicious skin lesions post-treatment. Despite initial negative PET scan results, further investigations revealed CE through histopathological examination of skin biopsies. The case highlights the critical need for biopsy in the presence of new skin lesions in breast cancer survivors, irrespective of imaging results. It also underscores the possibility of lymphatic spread of CE, which could lead to life-threatening complications if not properly managed. Conclusion: The diagnosis of carcinoma erysipeloides must be considered in patients with breast cancer presenting with unusual skin lesions. Increased vigilance and dermatological assessment should be integral to the post-cancer follow-up regimen. The findings advocate for revising current treatment protocols and guidelines to better manage and potentially prevent the complications associated with this diagnosis. Enhanced surveillance for dermatological changes and a more aggressive approach to the biopsy of new skin lesions in cancer patients are recommended to improve outcomes and prevent the misdiagnosis of CE.

Eosinophilic Cellulitis (Well’s Syndrome) and Eosinophilic Granulomatosis with Polyangiitis (Churgg-strauss Syndrome); Different Clinical Entities, or a Single Spectrum of Disease? A Case Study, Discussion and Literature Review

This case study represents an unusual presentation female in her seventies who presented with a chronic eosinophilic rash without systemic involvement on a background of psoriatic arthritis (pSA) and Sjogren’s Syndrome (sSS). Biopsy of the lesions identified flame figures. The differentials for such lesions are wide, however this case discusses three of the most likely differentials including Eiosinophilic Cellulitis (Well’s Syndrome), Eosionophilic Granlomatosis with Polyangiitis (Churgg Strauss Syndrome) and Granulomatous Dermatitis (GD). A common aberrant eiosinophilic response is dicussed and a review of the literature identifies the possibility that these diagnoses represent a single spectrum of disease, rather than separate clinical entities. Whilst the provoking incident was not able to be established in this case, the possibility of covid-19 vaccination contributing to the development of lesions is discussed. This case highlights the importance of conducting skin biopsies of unusual lesions that do not follow an expected clinical course and that skin biopsies might need to be performed opportunistically by emergency departments especially in rural areas where dermatology services are lacking. A lack of knowledge of various complex systemic diseases that present with unusual skin lesions often results in missed diagnosis and delayed patient care. Education of primary care physicians and healthcare professionals working in emergency departments is required to ensure timely biopsy and appropriate serology with screening for underlying systemic diseases including malignancy is required to prevent missed diagnosis and delayed care.

Knowledge, attitudes and practices of people with albinism about photoprotection and skin cancers prevention in Togo

Objective: The aim of this study was to evaluate the knowledge, attitudes, and practices of people with albinism (PWAs) related to photoprotection and prevention of skin cancers in Togo. Materials and Method: A qualitative, cross-sectional study was conducted over a period of three months in the year 2020 among PWAs over eighteen years of age residing in Lomé, Togo. Results: A total of 78 PWAs were interviewed. Their mean age was 23.38 ± 15.11 years (extremes: 18 and 63 years), and their sex ratio (M/F) was 0.81. In terms of knowledge, all PWAs declared that photoprotection was essential to prevent skin cancers. Interview data revealed the following strengths: wearing a wide-brimmed hat (n = 77; 98.7%) and using sunscreen cream (n = 75; 96.2%) were the main means/measures of prevention. In terms of attitudes, only 27 PWAs (34.6%) said that a dermatology consultation would be their first reaction to an unusual skin lesion. The main prevention means/measures in their possession were wide-brimmed hats (91.3%), sunscreen creams (85.9%), dark clothes (76.9%), and tinted glasses (70.5%). Regarding the practices, sunscreen creams were used by 88.5% of PWAs (n = 69). About two-thirds (64.1%) of respondents used tinted glasses to protect themselves from the sun. Finally, less than a quarter of the respondents (17.9%) consulted a dermatologist for a skin lesion in the last twelve months. Conclusion: The results of this study indicated that PWAs in Togo have fairly good knowledge about photoprotection and prevention of skin cancers. Attitudes and practices were generally positive but some behaviors such as dermatological follow-up still require improvement. Key words: Albinism, Sun protection, Skin cancers, Togo

Atypical Mpox in a Nigerian Tertiary Health Facility.

We describe diverse clinical characteristics and course of confirmed mpox cases managed in a Nigerian tertiary health facility. Clinical and epidemiologic data were analyzed, highlighting the unusual presentations of polymerase chain reaction (PCR)-confirmed mpox cases observed during the 2022 outbreak. Out of 17 suspected cases, 13 (76.4%) were PCR confirmed for mpox. The mean ± SD age for the participants was 28.62 ± 10.29 years (range, 2-55), of which 9 (64.3%) were male. Of the 13 PCR-confirmed cases, 5 (38.5%) had varicella zoster virus coinfection, 2 (15.4%) had HIV coinfection, and 1 (7.7%) had diabetes mellitus comorbidity. All patients experienced rash, with 6 (46.2%) having significant genital lesions and 1 (7.7%) having a severe perianal lesion. A lack of prodromal symptoms was reported in 3 (23.1%), and a prolonged prodrome (>1 week) occurred in 5 (38.5%). Skin lesions were polymorphic in 6 (46.2%), and solitary skin lesions occurred in 3 (23.1%), which persisted for >120 days in 7.7%. Clinical recognition, diagnosis, and prevention remain a concern in resource-limited settings. Our findings highlight the need to further evaluate unusual skin lesions and to include mpox screening for genital skin lesions that are presumed to be sexually transmitted infections. Revision of clinical case definition and enhanced surveillance are key to early recognition and prevention of spread.

Tumour Recurrence in peristomal skin: a case report

Peristomal skin recurrences of colorectal cancer after excision of the primary are rare. Clinically, it presents as a subcutaneous mass throughout the abdominal wall and progressively extends on the abdomen as a skin granuloma. Two colorectal cancer patients (an 83-year-old man, previously treated with left hemicolectomy and right exteriorisation for an obstructive tumour of the descending colon, Stage IV mucinous, poorly differentiated adenocarcinoma, and a 60-year-old man who finished the Hartmann's operation and small bowel resection for a perforated and locally advanced cancer of the descending colon) presented tumour recurrences in their peristomal skin. In both patients, the initial presentation was a tiny mucocutaneous skin granuloma. Subsequently, it became a large-sized, atypical, fungated tumour growth, which was complicated with persistent bleeding. A skin biopsy demonstrated an infiltration of adenocarcinoma throughout the dermis and was diagnosed as a local recurrence accompanied by peristomal skin metastasis. Although abdominal skin metastasis of colorectal cancer is rare, it is often a sign of intraabdominal recurrence. Therefore, any unusual skin lesions around the incision scar or stoma should be early biopsied to rule out local metastasis. Stoma nurse specialists play a crucial role in conducting stoma examinations, which involve both stoma and abdominal assessments. Point of care using ultrasound; clinical photos; telehealth; and patient empowerment could be advanced to facilitate early identification of stomal complications for timely investigation and treatment.

P212 Fatal invasive aspergillosis in a child with Chronic Granulomatous disease; a case report

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PMIn this article, we have reported a case of invasive aspergillosis in an 8-year-old boy with chronic granulomatous disease, who presented with pleural effusion and pneumonia, cerebral venous sinus thrombosis, and unusual skin lesions (Fig. 1) caused by Aspergillus fumigatus (Fig. 2). The patient received recombinant human interferon-γ subcutaneously (1-2 doses in even days) and antimicrobial prophylaxis, including itraconazole (100 mg/d), cotrimoxazole (5 mg trimethoprim/kg body weight/d), and ofloxacin (3 times a week, 200 mg), during hospitalization. It is noteworthy that treatment was immediately started according to the direct examination results. Due to the MRI findings suggestive of brain abscesses and brain edema, empirical amphotericin and voriconazole were started. The in vitro antifungal susceptibility tests (AFST) of A. fumigatus utilized the microbroth dilution method of the Clinical and Laboratory Standards Institute (CLSI) M38-A2 protocol for five antifungal agents including; voriconazole, itraconazole, fluconazole, caspofungin, and amphotericin B, that the minimum inhibitory concentrations (MIC) of antifungal agents were 0.25, 1, 16, 0.125, and 4 mg/L, respectively. Voriconazole and caspofungin were shown to be the most potent antifungal drugs against this A. fumigatus strain. On the other hand, the IDSA protocols recommend voriconazole as the initial therapy of invasive aspergillosis in most patients. So, in response to the results of antifungal susceptibility testing, treatment was switched to voriconazole at the dose of 100 mg twice a day (taken every 12 h), and interferon-γ subcutaneously (1-3 doses in even days) was introduced. Unfortunately, the patient passed away due to cerebral venous sinus thrombosis (CVST), and intracerebral hemorrhage (ICH) following increased intracranial pressure (ICP) after 1 month. In conclusion, we have reported a case in which a patient who came with pleural effusion and pneumonia in the chest x-ray, CVST, and unusual skin lesion caused by A. fumigatus expired after one month. Our report suggests the importance of early diagnosis in children presenting with invasive fungal infections particularly, those involving the central nervous system.

Meningothelial Hamartoma of the Scalp: Clinicopathologic Review of an Unusual Tumor Mimicking a Vascular Neoplasm With Review of Literature

An unusual benign skin lesion is reported in a 19-year-old man with no significant medical history. The lesion had been present since he was an infant and had been slowly enlarging over the past 15 years. The lesion caused pain and discomfort, and the patient underwent an excisional biopsy. Histologic examination showed a subcutaneous lesion with ill-defined borders and peripheral areas of infiltration between adnexal structures. The lesion was composed of small round to ovoid cells embedded in a collagenous stroma with prominent cystic pseudovascular appearing channels causing a pseudopapillary or lymphangitic appearance that mimicked a vascular neoplasm. Immunohistochemistry performed showed positive staining for EMA, progesterone receptor, D2-40, and vimentin within the lesional cells. The tumor cells were negative for cytokeratin AE1/AE3, CD34, CD31, HHV-8, STAT6, SMA, Desmin, S-100, Melan A, and HMB45. A next-generation sequencing study using a hybrid capture-based panel examining 50 commonly mutated genes in human neoplasia was performed and showed no molecular alterations suggesting a nonneoplastic nature. Based on the clinical presentation, histologic features, and results of ancillary studies, the case was diagnosed as a hamartoma of the scalp with meningothelial-like elements. Reported cases of this lesion have behaved in a benign manner; however, as the histologic differential includes low-grade malignant vascular neoplasms such as angiosarcoma, it is important to recognize the salient features of this lesion.

Postpartum sepsis-like illness and rash associated with Hansen’s disease

Abstract Objectives Hansen’s disease (HD) often manifests during pregnancy and the postpartum. Patients with HD may experience reactions that mimic other conditions making diagnosis challenging. Case presentation We present a case of a patient from Chuuk, a state of the Federated States of Micronesia with a sepsis-like illness and worsening painful rash immediately postpartum. Antepartum, the patient noted a pruritic rash on her legs. Four hours after delivery, the patient became febrile and later developed systemic inflammatory response syndrome (SIRS). The rash rapidly spread to other areas of her body and became painful and edematous. Eight weeks after delivery, a skin biopsy revealed tuberculoid granulomatous dermatitis consistent with HD. Conclusions HD and its associated reactions are easily misdiagnosed. Performing a skin biopsy of unusual skin lesions or common skin lesions with severe illness in a pregnant patient can expedite diagnosis of rare conditions such as HD. Early initiation of treatment for HD and its reactions are critical to prevent serious nerve damage and permanent disability.

Meningothelial Hamartoma of the Scalp: Clinicopathologic Review of an Unusual Tumor Mimicking a Vascular Neoplasm with Review of Literature

Abstract Introduction/Objective Benign meningothelial hamartoma of the scalp is a rare entity with only scattered case reports existing in the literature. The hamartomatous process is believed to occur secondary to ectopic displacement during embryogenesis with the migration of meningothelial cell precursors to the incorrect location or secondary to an obliterated meningocele. This tumor may be easily missed and may be misdiagnosed as lipoma or sometimes as cutaneous angiosarcoma due to the several histologic features that mimic the histology of a vascular neoplasm. Methods/Case Report We report an unusual benign skin lesion occurring in a 19-year-old man with no significant past medical history. The lesion had been present since he was an infant and had been slowly enlarging over the past 15 years. The lesion caused pain and discomfort and the patient underwent an excisional biopsy of the lesion. Histologic examination showed a subcutaneous lesion with ill-defined borders and peripheral areas of infiltration between adnexal structures. Immunohistochemistry performed on the tumor cells showed that they were positive for EMA, progesterone receptor, D2-40, and vimentin. A next-generation sequencing study using a hybrid capture-based panel examining 50 commonly mutated genes in human neoplasia was performed and showed no molecular alterations supporting the benign or non-neoplastic nature of the lesion. Along with this case, we review 20 cases of meningothelial hamartomas from 13 papers and summarize them in the table. Results (if a Case Study enter NA) N/A Conclusion To our knowledge, this is the first reported case of one of these lesions with associated molecular genetic testing. The molecular study carried out, in this case, did not disclose any genetic variants commonly associated with human neoplasia supporting the notion that this lesion does not represent the neoplastic process but rather a hamartomatous process. Meningothelial hamartoma is an exceedingly rare, benign lesion that may be confused with a low-grade vascular neoplasm due to its rare nature and unusual histologic features.

Incontinentia pigmenti: a rare case of neurocutaneous disorder in the newborn

Incontinentia pigmenti (IP) is a rare X linked dominant genetic multisystem neurocutaneous disorder that may affect many organs including the skin, bone, eyes and the central nervous system. Central nervous system manifestations are seen in 30%-40% of cases with seizures and mental retardation. Seizures as the presenting sign of IP in neonates are rarely reported. We report a case of a female newborn with IP who had pleomorphic skin rashes and erythematous vesicles over upper and lower extremities since 5th day of life which were followed by seizures on day 22nd of life. With this case report, we would like to emphasize the need for inclusion of IP in the differential diagnosis of neonatal seizures and to confirm diagnosis of all such unusual skin lesions histologically.

Prostate adenocarcinoma and cutaneous metastases

Prostate cancer is the second most frequently diagnosed cancer in men and the fifth leading cause of mortality worldwide. Men of African descent with prostate adenocarcinoma tend to present late with advanced, aggressive and often metastatic disease. Cutaneous metastases are extremely rare, with the incidence reported to be as low as 0.36%. We report a case of prostate adenocarcinoma with cutaneous metastases. A 69-year-old African male known to the urology unit, with metastatic adenocarcinoma of the prostate, presented with a two-week history of pale-to-purple large nodular lesions on the skin of his left hemiscrotum and smaller nodules on the penile shaft. Punch biopsies of the scrotal nodules revealed metastatic prostate adenocarcinoma. Bilateral orchidectomy and excision of the cutaneous lesions were performed. Although cutaneous metastases are rare, more so in patients with adenocarcinoma of the prostate, any skin lesions in patients with a known primary malignancy should raise a suspicion of metastasis. All physicians should therefore have a low threshold for the biopsy of any unusual skin lesion in patients with known prostate cancer. Level of evidence: 5.

Leukaemia cutis as a specific skin involvement in chronic myelomonocytic leukaemia and review of the literature: Acknowledgments.

The skin involvement of myeloid leukaemia is conventionally divided into specific malignant lesions and non-specific benign lesions, and these categories are also applicable in chronic myelomonocytic leukaemia (CMML). According to the 2016 World Health Organization (WHO) classification of tumours of haematopoietic and lymphoid tissues, CMML is defined as a myeloid neoplasm with characteristics of myelodysplastic syndrome (MDS) and myeloproliferative neoplasms (MPNs). As a specific cutaneous sign of extramedullary infiltration, leukaemia cutis (LC) is a rare occurrence in patients with CMML, and only approximately 89 cases have been reported in the literature thus far. The clinical features of LC are varied, and LC in CMML exhibits heterogeneous histopathologic features, with manifestations as cutaneous nodules or papules that are composed of blast cells showing either granulocytic or monocytic differentiation. Skin biopsy and further immunohistochemical examination are essential at the time of diagnosis to evaluate pathological type and determine the clinical course. Generally, once diagnosed as LC in CMML, this unusual skin lesion might be an indicator of transformation to acute myeloid leukaemia (AML) and is associated with a poor prognosis. The main treatment is allogeneic stem cell transplantation (ASCT). Therefore, early diagnosis and accurate identification have important therapeutic and prognostic significance in CMML patients with skin infiltration.

Contradictory diagnostic investigation results of an unusual skin lesion in a man with HIV-HBV coinfection – A diagnostic and management conundrum

Contradictory diagnostic investigation results of an unusual skin lesion in a man with HIV-HBV coinfection – A diagnostic and management conundrum

A novel mutation of ABHD5 gene in a Chanarin Dorfman patient with unusual dermatological findings

BackgroundChanarin Dorfman Syndrome (CDS) is a rare autosomal recessive disorder characterized by the multisytemic accumulation of neutral lipids inside the cytoplasmic lipid droplets. This condition is caused by mutations in the abhydrolase domain containing 5 gene (ABHD5). In CDS the skin involvement is the prevalent and always observed clinical feature, consisting of a non-bullous congenital ichthyosiform erythroderma (NCIE). Moreover, a variable involvement of the liver and neuromuscular system can be also observed. In this report, we aimed to perform the clinical and genetic characterization of a patient affected by CDS with atypical dermatological findings, considering this rare inborn error of neutral lipid metabolism.MethodsGenomic DNA samples obtained from patient and his parents were used to perform the sequencing of the ABHD5 exons and their intron/exon boundaries. Bioinformatic analyses were performed to investigate the possible effect of the identified mutation on protein structure.ResultsHere we present the case of a 29-year-old male patient with CDS, who, for long time, has been misdiagnosed as pityriasis rubra pilaris (PRP). He has a history of increasing hyperlipidemia; hepatomegaly associated with hepatosteatosis was also detected. ABHD5 molecular analysis revealed a novel missense mutation, the c.811G > A (p.G271R). Bioinformatic investigations showed that the variant has a deleterious effect on ABHD5 function, probably causing an incorrect folding of the mutant protein.ConclusionsThese results highlihts the importance of genetic testing for ABHD5 in unresolved cases of patients presenting unusual skin lesions, that resemble PRP, associated with a history of hyperlipidemia and nonalcoholic fatty liver.

Unusual recurrent skin lesions: Bazin's disease

A 46 year old Iraqi Kurd female patient was presented with recurrent round erythematous skin lesions on her upper and lower extremities mainly calves, lower abdomen, and buttock for 3 years. Routine laboratory investigations were unremarkable; however, based on strongly positive tuberculin skin test, positive interferon gamma release assay, histo-pathological findings and a response to anti-TB treatment, she was diagnosed with Erythem Induratum of Bazin (EIB). The patient was treated successfully with combination anti-TB drugs. The skin lesions disappeared after 2 months of the treatment. There was no recurrence of the lesions over a 6 month follow up period.

Multiple Unusual Ulcerated Skin Lesions in a Crohn's Disease Patient

Multiple Unusual Ulcerated Skin Lesions in a Crohn's Disease Patient

Diabetes mellitus and congenital proximal femur hypoplasia: is there a link or association

We present a case of congenital short femur with scleredema Diabeticorum (SD) in a patient with diabetic neuropathy with unusual skin lesion distribution. Gait symptoms progressively worsened. The atypical distribution of the skin lesions is quite unusual. This case express rare complications of diabetes mellitus, the maternal diabetes which had disrupted in part the development of skeletal system of the offspring who in turn developed a rare dermatologic complications i.e. scleredema Diabeticorum (SD).This case will leave inedible memory for every diabetologist not to miss the skeletal and dermatologic manifestations of DM. The combination of this congenital proximal femoral hypoplasia with complicating diabetes make the question if there is a link with similar genetic predilection or just an association.

Pathological and phylogenetic characterization of Amphibiothecum sp. infection in an isolated amphibian (Lissotriton helveticus) population on the island of Rum (Scotland).

Outbreaks of cutaneous infectious disease in amphibians are increasingly being attributed to an overlooked group of fungal-like pathogens, the Dermocystids. During the last 10 years on the Isle of Rum, Scotland, palmate newts (Lissotriton helveticus) have been reportedly afflicted by unusual skin lesions. Here we present pathological and molecular findings confirming that the pathogen associated with these lesions is a novel organism of the order Dermocystida, and represents the first formally reported, and potentially lethal, case of amphibian Dermocystid infection in the UK. Whilst the gross pathology and the parasite cyst morphology were synonymous to those described in a study from infected L. helveticus in France, we observed a more extreme clinical outcome on Rum involving severe subcutaneous oedema. Phylogenetic topologies supported synonymy between Dermocystid sequences from Rum and France and as well as their distinction from Amphibiocystidium spp. Phylogenetic analysis also suggested that the amphibian-infecting Dermocystids are not monophyletic. We conclude that the L. helveticus-infecting pathogen represents a single, novel species; Amphibiothecum meredithae.

Cryptococcose cutanée mimant un carcinome basocellulaire et révélant une atteinte systémique sur immunodéficience acquise

Cryptococcosis is a rare and a serious opportunistic infection that occurs primarily on the field of immunodeficiency. We report a case of disseminated cryptococcosis in acquired immunodeficiency syndrome revealed by unusual skin lesions. A 52-year-old patient consulted for two crusty ulcerative lesions situated on the left supraorbital and on the nasal tip that appeared 6 months ago. He also reported respiratory symptoms present since one year, with dry cough and dyspnea, chronic headache and vomiting with no alteration in visual acuity. The mycological study of the skin biopsy on both lesions isolated Cryptococcus neoformans as well as in the sputum and cerebrospinal fluid. Serology of human immunodeficiency virus infection was positive. Treatment with fluconazole, local care and antiretroviral triple therapy was implemented. Skin lesions during cryptococcosis are rare and observed in 2-10% of cases. Cutaneous symptoms were the reason for consultation in our patient. This is a rare form of cutaneous cryptococcosis leading to the discovery of both pulmonary and central nervous system locations, and to diagnosis of HIV infection.

An unusual skin lesion caused by Lasiodiplodia theobromae

We describe a case of subcutaneous infection as a result of traumatic implantation caused by the fungus Lasiodiplodia theobromae. It was isolated in multiple swabs from the foot of an active healthy male. The fungus was identified by traditional mycology culture methods though this was slow with much time required for sporulation on only one of the agars used. Identification was confirmed by DNA sequencing. The patient was successfully treated with Voriconizole.