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Slide Seminar 09 - Inflammatory Diseases of the Skin
Monday, September 18, 2006 14:00 - 17:30
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Moderator:
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Dr. Lorenzo Cerroni
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Disclosure:
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In accordance with ACCME guidelines regarding disclosure, the USCAP policy requires that faculty members who have a significant financial or other relationship with a commercial company, entity, or service (which will be discussed in this Slide Seminar) must disclose this to attendees. The Academy also requires that speakers disclose any products that are not labeled for the use under discussion. Faculty members for this Slide Seminar have indicated they have no disclosures to make.
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Clinical histories are displayed below.
Click on the case numbers to display the text and references for each case.
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- Interface Dermatitis
Submitted by: Timothy McCalmont, M.D.
Case 1: 68-year-old female with recurrent eruption 2-3 years, with recent flare of scattered tender to painful, bilateral and asymmetrical discrete, smooth tumid papules and patches (to several cm.) on torso, limbs, and fingers. She is on several medications; CBC normal, ESR-38 (one month ago); 5 mm punch at center of tender 1 1/2 cm disc right inner knee.
Case 1 - Slide 1
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Case 2: 56-year-old male with 2 week pruritic, semi-annular eruption on trunk.
Case 2 - Slide 1
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Case 3: 82-year-old female with 2 cm red nodule. "Consider SCC, BCC, or trauma"
Case 3 - Slide 1
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- Acute Generalized Exanthematous Pustulosis Secondary to Vancomycin Therapy
Submitted by: James W. Patterson, M.D.
A 21 year-old African-American woman who was 32 weeks pregnant developed methicillin-resistant Staphylococcus aureus infection. She presented with the sudden onset of a pinpoint pustular eruption. A biopsy was obtained from the skin of the right lumbar region.
Case 4 - Slide 1
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- Elastic Tissue Changes Consistent with Elastosis Perforans Serpiginosa Due to Penicillamine Therapy
Submitted by: James W. Patterson, M.D.
A 56 year-old man presented with slightly thickened macular, erythematous lesions of the neck and shoulder. Two microscopic sections are submitted: one stained with hematoxylin and eosin and the other with the Verhoeff-van Gieson method.
Case 5 - Slide 1
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Case 5 - Slide 2
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- Eosinophilic Panniculitis Secondary to Intravenously Administered Antibiotic Therapy
Submitted by: James W. Patterson, M.D.
A 68 year-old woman presented with a firm, ecchymotic, indurated subcutaneous plaque of the right medial forearm. She had recently received a diagnosis of cellulitis.
Case 6 - Slide 1
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- Linear IgA Bullous Dermatosis Due to Vancomycin Therapy
Submitted by: James W. Patterson, M.D.
A 73 year-old woman noted the recent onset of tense blisters on the arms and back. She had a recent medical history of meningitis.
Case 7 - Slide 1
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- Vesicular Skin Diseases
Submitted by: Kenneth S. Resnik, M.D.
Case 8: This 50-year-old female presented herself to her dermatologist bearing an annular plaque with focal vesiculation on her posterior left thigh which was clinically considered to represent either erythema chronicum migrans or linear IgA dermatosis.
Case 8 - Slide 1
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Case 9: This 61-year-old female developed an indurated vesiculo-bullous plaque on the dorsum of her hand shortly after returning from a vacation in the Arizona desert. Clinical considerations for this lesion included allergic contact dermatitis, coccidiomycosis, herpes and bullous impetigo. At the time the punch-biopsy was received, tissue culture turned out to be positive for herpes simplex virus, bacterial culture excluded bullous impetigo, and deep fungal culture was pending.
Case 9 - Slide 1
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Case 10: An 18-year-old male presented himself to his dermatologist with a medical history of gluten-sensitive enteropathy and lesions on his knees, buttocks and elbows. A punch-biopsy was received with a clinical differential diagnosis of dermatitis herpetiformis versus folliculitis.
Case 10 - Slide 1
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- Necrobiotic Xanthogranuloma with Paraproteinemia
Submitted by: Carlo Tomasini, M.D.
61-year-old healthy woman with a 2 year-history of slowly enlarging, red-yellowish nodules on the lower extremities.
Case 11 - Slide 1
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- Inflammatory Morphea Profunda
Submitted by: Carlo Tomasini, M.D.
56-year-old woman with multiple brownish plaques on the lower limbs.
Case 12 - Slide 1
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- Herpetic Panniculitis
Submitted by: Carlo Tomasini, M.D.
65-year-old renal transplant woman with an ulcerated mass on the pubis dating from 3 months.
Case 13 - Slide 1
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- Exclusive Involvement of Folliculosebaceous Units by Herpes: A Reflection of Early Herpes Zoster
Submitted by: Noreen Walsh, M.D.
A 43-year-old woman attended her family physician because of recent onset of 'painful, red, indurated lumps' on one side of her scalp and forehead. The clinical differential diagnosis included vasculitis and an allergic reaction. A punch biopsy of one of the lesions was taken.
Case 14 - Slide 1
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- Histiocytoid Sweet's Syndrome
Submitted by: Noreen Walsh, M.D.
A 53 year old woman attended her dermatologist because of recent onset of a papulovesicular eruption. This had begun during a vacation in Cuba and mainly involved the upper chest and back. The clinical differential diagnosis included polymorphous light eruption, a drug-induced photoallergic eruption and Sweet's syndrome. A punch biopsy of a representative lesion was taken.
Case 15 - Slide 1
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- Necrobiotic Xanthogranuloma
Submitted by: Noreen Walsh, M.D.
A 57 year old man attended a dermatologist because of longstanding annular cutaneous plaques involving the trunk and extremities. Some of the plaques were markedly indurated and had a yellowish hue. The patient was also under the care of an ophtalmologist because of scleritis. The initial clinical impression was of granuloma annulare. Successive sets of punch biopsies were taken from involved skin.
Case 16 - Slide 1
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Case 16 - Slide 2
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- Non-infectious Granulomas
Submitted by: Roger H. Weenig, M.D.
Case 17: A 79-year-old female presents with a 2 month history of progressive pink - red papules and plaques on the trunk, face, and extremities. Several of the papules and plaques are ulcerated. The patients past medical history is positive for 2 primary lung adenocarcinomas treated surgically 5 and 7 years ago respectively, and a history of breast cancer treated with mastectomy. The patient also carried a diagnosis of sero-negative rheumatoid arthritis.
Case 17 - Slide 1
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Case 18: A 28-year-old female, physical trainer / professional "dancer" presents with a two-month history of indurated, slightly erythematous plaques on her thighs in association with fevers, chills, night sweats and joint aches. The day prior to the onset of symptoms, the patient was doing a leg workout which was of moderate intensity. The next morning she noted some tenderness, redness and thickening of the skin overlying her anterior hip region.
Case 18 - Slide 1
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Case 19: A 56-year-old male presents for evaluation of a suspected drug eruption due to itraconazole. The patient had been taking itraconazole for 4 months for presumed pulmonary histoplasmosis, diagnosed by serologic study, a positive M-band histoplasmosis-immunodiffusion assay, and ung biopsy findings of fibrocaseous granulomatous inflammation. The patient also noted recent development of induration in areas of previous scaring on distal extremities. Physical exam revealed diffuse pink papules distributed on the trunk and extremities. Involving the scalp, several 3 - 4 cm, well-circumscribed annular brown plaques were note. Several scars on the distal extremities showed induration and a brownish coloration. The submitted biopsy is from a right forearm scar.
Case 19 - Slide 1
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