Cutaneous leishmaniasis typically presents as a painless papule progressing to an ulcer or plaque. In this case study of the ear, the disease manifested as a small painful bump progressing into redness and swelling about the ear with purulent drainage. After multiple oral/intravenous antipseudomonal, antistaphylococcal, and antifungal treatments, there was no improvement. The skin progressed to an erythematous plaque and hemorrhagic ulcer; punch biopsy and speciation revealed Leishmaniasis guyanensis. The patient was switched to a seven-dose course of intravenous L-amphotericin B (visceral leishmaniasis protocol). Within 21 days, pain and edema resolved and the ulcers healed. Three-month follow-up demonstrated no recurrence. Further studies are needed to evaluate the use of L-amphotericin B in Leishmaniasis guyanensis.
The 3-point stitch and the modified suspension suture techniques are easy and simple methods that can be incorporated into reconstruction after MMS for defects of variable depth covering any multisubunit perialar region to prevent or correct INV collapse.
Adenopathy and extensive skin patch overlying a plasmacytoma is a very rare syndrome featuring a red-to-brown, violaceous skin patch along with a plasmacytoma. Only 11 case reports exist in the literature. Skin biopsies from the cutaneous patch overlying the plasmacytoma exhibit a dermal vascular hyperplasia with increased surrounding dermal mucin. Radiation therapy is used to treat and cure the plasmacytoma.
A case of rhabdomyolysis associated with a therapeutic dose of bupropion sustained release is presented. Other features of the use of bupropion are also discussed.
ANSWERClinical Course. Based on the histological findings, the tumor was classified as an adenomyoepithelial tumor and the patient was referred to Mohs surgery for complete resection with nail plate excision to ensure negative margins and prevent recurrence. Excision of the remaining lesion with a 2 mm margin of normal tissue was completed down to the level of the periosteum. A review of horizontal frozen sections intraoperatively showed no residual tumor at the margins examined, and the surgical defect was closed in a linear fashion along the periungual fold (Fig. 3A). At follow-up, there was no regrowth of the tumor at 7 months postoperatively (Fig. 3B). FIGURE 3. A, B, Closure immediately after excision (A) and good healing without recurrence 7 months postoperatively (B).
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