A 57-year-old woman presented with periorbital ecchymoses, laxity in skin folds,
polyneuropathy and bilateral carpal tunnel syndrome. A skin biopsy of the axillary
lesion demonstrated fragmentation of elastic fibers, but with a negative von Kossa
stain, consistent with cutis laxa. The diagnosis of primary systemic amyloidosis was
made by the presence of amyloid material in the eyelid using histopathological
techniques, besides this, the patient was also diagnosed with purpura,
polyneuropathy, bilateral carpal tunnel syndrome and monoclonal gammopathy. She was
diagnosed as suffering from multiple myeloma based on the finding of 40% plasma cells
in the bone marrow, component M in the urine and anemia. The patient developed
blisters with a clear content, confirmed as mucinosis by the histopathological exam.
The final diagnoses were: primary systemic amyloidosis, acquired cutis laxa and
mucinosis, all related to multiple myeloma.
Improvement of laboratory diagnosis of onychomychosis is important so that adequate treatment can be safely implemented. To evaluate and compare the performance of mycological and histopathological examinations in onychomycoses caused by dermatophyte and non-dermatophyte moulds. Patients with lateral/distal subungual onychomycosis in at least one hallux were enrolled in the protocol and assessed via mycological and histopathological tests. The isolation of filamentous fungi was considered the gold standard. Test performance was evaluated through sensitivity, specificity and positive and negative predictive values. A total of 212 patients were enrolled in the study. Direct microscopy (DM) was positive in 57.5% patients, and cultures in 34.4%. Among these patients, 23.3% were positive for dermatophytes, with Trichophyton rubrum the most frequently isolated, and 86.3% were positive for non-dermatophytes, with Neoscytalidium dimidiatum predominance. Histopathology was positive in 41.0% samples. Direct microscopy showed better sensitivity for non-dermatophyte moulds (P=.000) and nail clipping was more specific for dermatophyte (P=.018). Histopathology of the distal nail plate is a valuable complementary tool for the diagnosis of onychomycosis caused by dermatophytes and direct microscopy is especially useful for non-dermatophyte molds.
The acral melanoma is the most prevalent type of melanoma in the non-Caucasian
population, and dermoscopy is a useful tool for earlier diagnosis and differentiation
from benign lesions. The dermoscopic pattern often associated with melanoma on the
volar skin is the parallel ridge, with 99% specificity according to the literature.
However, this pattern can also occur in several benign acral lesions, so it is
important to make a good interpretation of this pattern, along with the clinical
history and evolution.
Telangiectasia macularis eruptiva perstans is a rare form of cutaneous mastocytosis,
characterized by the presence of erythematous or yellowish-brown macules with
telangiectasias, preferably located on the trunk and upper limbs. We have described a
case of telangiectasia macularis eruptiva perstans focusing on the dermoscopic
characteristics of this disease.
Lichen sclerosus is a chronic inflammatory mucocutaneous disorder of unknown etiology
that most commonly affects the female genitalia. Cutaneous involvement with
nonhaemorrhagic bullous is very unusual. We describe a case of bullous lichen
sclerosus.
Muir-Torre syndrome is a rare genodermatosis characterized by the occurrence of at
least one sebaceous tumor associated with visceral neoplasia, but with no
predisposing factors. The sebaceous neoplasm may appear before, during or after the
diagnosis of colorectal cancer. As it is regarded as a subtype of nonpolyposis
hereditary colorectal cancer, it is important to evaluate the patient's first-degree
relatives. The clinical course of the neoplasm is usually more indolent and the
syndrome has a good prognosis. We report the case of a patient who, after a ten-year
diagnosis of colorectal cancer, presented with multiple sebaceous neoplasms.
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