Cutaneous collagenous vasculopathy (CCV) is clinically characterized by symmetrical, progressive telangiectasias and an absence of systemic involvement. Histopathology is distinct and helps in differentiation from other vascular conditions that result in cutaneous telangiectasias. We present a case of biopsy-proven CCV that had localized clearance following biopsy and was successfully treated with pulsed dye laser. A healthy 36-year-old male presented with a 10-year history of progressive, blanching telangiectasias of the legs, thighs, and forearms. A punch biopsy of a representative patch on the patient’s right thigh demonstrated telangiectasias with thickened PAS-positive vessel walls and a sparse perivascular lymphoid infiltrate, features consistent with a diagnosis of CCV. While there was localized clearance at the biopsy site and adjacent skin, the patient opted for treatment with PDL for his lesions elsewhere. After testing various PDL settings, greatest cosmetic improvement and minimal PIH was achieved with a spot size of 7 mm, pulse duration of 3 milliseconds (ms) and a fluence of 8 J/cm2. Continued resolution of CCV was noted at 24 months. We present this case to underscore the potential efficacy of PDL in the treatment of CCV.
polyarteritis nodosa, and deep mycoses. Serum lipase is a sensitive marker, and ghost cells are pathognomonic for PP. 1,3 Both hyperlipasemia and hyperamylasemia are seen in PP with acinar cell carcinoma and panniculitis, while hyperlipasemia and normoamylasemia are present in PP with PanNET. 3 Osteoarticular manifestations include mainly polyarthritis involving the ankles, knees, and wrists and occasionally polyserositis and intramedullary fat necrosis. 1,2,5 Intramedullary/ intraosseous fat necrosis presents as multifocal low-signal intensity lesions on T1-weighted imaging (T1WI) and high-signal intensity lesions on T2WI. 5 PanNETs originate from hormone-producing cells of the pancreas and are predominantly nonfunctioning. Surgical resection is reasonable for nonfunctional PanNET > 2 cm. 4 The survival period is fewer than 4 months in five PP cases with occult PanNET. 3 In our case, PanNET diagnosis may have been delayed for at least 6 months owing to inconspicuous abdominal symptoms.Hepatic metastasis developed 3-6 months postoperatively despite disappearance of hyperlipasemia, eruption, and arthralgia. Therefore, panniculitis with or without arthritis may foreshadow pancreatic neoplasms and require further pancreatic examinations regardless of abdominal symptoms.
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