Abstract We report a unique case of ascending cutaneous lymphangitis in a 72‐year‐old immunocompromised man from which a newly described N ocardia species was isolated by 16 S ribosomal gene sequencing. Treatment with trimethoprim‐sulfamethoxazole resulted in successful resolution of symptoms. To the best of our knowledge, this is the first case report of N. veterana implicated in causing ascending cutaneous lymphangitis.
ABSTRACT Background Body‐focused repetitive behaviors (BFRBs) are recurrent, habitual behaviors, such as skin picking, hair pulling, and other compulsions, that can result in distressing cutaneous manifestations of varying severity. Many patients with BFRBs present primarily to dermatologists and a significant proportion subsequently resist engaging with psychological or psychiatric healthcare professionals. Habit reversal therapy (HRT) is one of the most effective evidence‐based management strategies for BFRBs and it can be facilitated by a range of healthcare professionals including general practitioners, dermatologists, and nurses, as well as psychologists. Few dermatologists are comfortable offering HRT, making it a severely underutilized technique in the management of various skin conditions associated with BFRBs. Objectives This article aims to highlight strategies that dermatologists can learn to offer to positively influence the patient experience. A practical approach to implementing simplified HRT for patients with BFRBs will be demonstrated through two case studies.
Acquired idiopathic generalised anhidrosis (AIGA) is a rare disorder that is characterised by sudden onset generalised absence of sweating without any dermatological, neurological or sweat gland abnormalities. AIGA predominately affects young males, mostly involving patients of Asian descent. There have been approximately 100 reported cases worldwide, most of which were reported in Japan. In Singapore, it is rarely seen with one case series on 15 cases of AIGA reported in a 2014 study. Here, we present a case of AIGA who responded well to conservative management with sweating activity.
Journal Article Pyoderma gangrenosum‐like ulcer caused by Helicobacter cinaedi in a patient with x‐linked agammaglobulinaemia Get access J. Dua, J. Dua Departments of Immunology,*Dermatology, †Microbiology, and ‡Histopathology, Barts and the London NHS Trust, London, UK Dr Janet Dua, c/o Dr Hilary Longhurst, 2nd Floor, Pathology and Pharmacy Building, The Royal London Hospital, 80 Newark Street, London E1 2ES, UK E‐mail: janetdua3000@yahoo.co.uk Search for other works by this author on: Oxford Academic Google Scholar E. Elliot, E. Elliot Departments of Immunology,*Dermatology, †Microbiology, and ‡Histopathology, Barts and the London NHS Trust, London, UK Search for other works by this author on: Oxford Academic Google Scholar P. Bright, P. Bright Departments of Immunology,*Dermatology, †Microbiology, and ‡Histopathology, Barts and the London NHS Trust, London, UK Search for other works by this author on: Oxford Academic Google Scholar S. Grigoriadou, S. Grigoriadou Departments of Immunology,*Dermatology, †Microbiology, and ‡Histopathology, Barts and the London NHS Trust, London, UK Search for other works by this author on: Oxford Academic Google Scholar R. Bull, R. Bull Departments of Immunology,*Dermatology, †Microbiology, and ‡Histopathology, Barts and the London NHS Trust, London, UK Search for other works by this author on: Oxford Academic Google Scholar M. Millar, M. Millar Departments of Immunology,*Dermatology, †Microbiology, and ‡Histopathology, Barts and the London NHS Trust, London, UK Search for other works by this author on: Oxford Academic Google Scholar N. Wijesuriya, N. Wijesuriya Departments of Immunology,*Dermatology, †Microbiology, and ‡Histopathology, Barts and the London NHS Trust, London, UK Search for other works by this author on: Oxford Academic Google Scholar H. J. Longhurst H. J. Longhurst Departments of Immunology,*Dermatology, †Microbiology, and ‡Histopathology, Barts and the London NHS Trust, London, UK Search for other works by this author on: Oxford Academic Google Scholar Clinical and Experimental Dermatology, Volume 37, Issue 6, 1 August 2012, Pages 642–645, https://doi.org/10.1111/j.1365-2230.2011.04293.x Published: 01 August 2012
Abstract Eccrine nevi are rare lesions characterized by a sharply demarcated area of localized hyperhidrosis. We present an 11‐year‐old girl with an eccrine nevus on her right lower forearm. To the best of our knowledge, this is the first case successfully controlled with topical glycopyrrolate wipes.
A 61 year old man presented to the emergency department with sudden onset breathlessness associated with cough productive of purulent sputum. He had been diagnosed with squamous cell carcinoma of the bronchus one month earlier. His staging was T4N2M1. Two weeks earlier he had developed a pathological clavicular fracture and was due to start radiotherapy. On admission he had no haemoptysis or chest pain. However, his blood pressure was 80/40 mm Hg, pulse rate was 140-160 beats/min, and respiratory rate was 18 breaths/min.
On examination he had swelling and plethora of the face and neck. Crepitations were heard in the right mid zone of his lung field. Heart sounds were normal. His jugular venous pressure was non-pulsatile and was raised to the level of his ear lobes. His breathlessness and facial swelling were exacerbated by lying flat and coughing.
Electrocardiography showed sinus tachycardia. Arterial blood gas on room air showed a partial pressure of oxygen of 7 kPa, and a partial pressure of carbon dioxide of 4.2 kPa.
Chest radiography was performed (fig 1⇓).
Fig 1 Chest radiograph on admission
An echocardiogram showed no pericardial effusion but moderate left ventricular function and no right ventricular dysfunction. Figure 2⇓ is a picture of the patient at admission.
Fig 2 Patient on admission
### 1 What is the most likely diagnosis?
#### Short answer
Obstruction of the superior vena cava.
#### Long answer
This patient has obstruction of the superior vena cava. His chest is plethoric, and on closer inspection he has some distended thoracic veins (fig 3⇓).
Fig 3 Patient’s chest showing plethora and distended thoracic veins
His chest radiograph on admission shows a widened mediastinum and a right hilar …
A 17 year old previously well black British born student was at college when he became feverish. He noticed a faint itchy rash over his arms and legs and was brought to the emergency department. He developed facial swelling and difficulty in swallowing and was admitted under the ear, nose, and throat team for suspected epiglottitis. On examination he had a faint maculopapular rash over his limbs, with submandibular lymphadenopathy and mild pharyngitis. Joint tenderness without effusions was elicited in both knees and elbows. No heart murmurs were heard. He had no family history of hereditary conditions and no history of allergy, foreign travel, or sexual relations. He had rising inflammatory markers, with a white cell count of 69×109/L (4-11), neutrophils 65×109/L (1.8-7.5), C reactive protein 163 mg/L (0-5), erythrocyte sedimentation rate 138 mm/h (3-15).
Liver function tests were deranged (alanine transaminase 577 U/L (10-40), alkaline phosphatase 117 U/L (40-129), bilirubin 50 µmol/L (1-17)). Ferritin was 50 000 µg/L (10-160). Blood cultures, malaria screen, antistreptolysin O antibody titre, hepatitis serology, cytomegalovirus, HIV, rheumatoid factor, antinuclear antibodies, and double stranded DNA were negative. Computed tomography of his neck, chest, and abdomen showed minimal reactive lymphadenopathy and 2 cm hepatomegaly. An echocardiogram was normal.
Despite four weeks of empirical antibiotic treatment he continued to have spiking fevers of more than 40°C. His rash faded away but the arthralgia was persistent.
### 1 What are the differential diagnoses of fever of unknown origin?
#### Short answer
The differential diagnosis of fever of unknown origin includes infections (such as tuberculosis), cancers (such as non-Hodgkin’s lymphoma), collagen vascular conditions (such as systemic lupus erythematosus), drugs, and other causes.
#### Long answer
Fever of unknown origin is defined as a core body temperature …
Gastrointestinal stromal tumours (GISTs) are mesenchymal tumours arising in the gastrointestinal tract. Early detection, before metastasis occurs, is important as complete surgical excision achieves cure. Approximately 85% of GISTs are associated with mutations in the KIT gene, and although the majority of GISTs are sporadic, familial GISTs have been identified. Several families with multiple GIST tumours have also been described with various cutaneous findings including hyperpigmentation, multiple lentigines, vitiligo and urticaria pigmentosa. We discuss a 6‐year‐old boy who presented with an unusual pattern of hyperpigmentation in association with a family history of GIST. A causative KIT mutation was identified in DNA from the pigmented skin and from the resected GIST, and the patient was referred to the Paediatric Gastroenterology department for GIST screening. The term 'GIST cutaneous hyperpigmentation disease' has been suggested previously for the association of familial GIST with cutaneous hyperpigmentation caused by a germline KIT mutation.
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