Pyoderma gangrenosum is a rare neutrophilic dermatosis characterized by painful, rapidly progressing necrotic ulcers. Although PG has been reported in association with various autoimmune diseases, its coexistence with rheumatoid arthritis (RA) mimicking vasculitis is uncommon. We present a case report of a 75-year-old female with a longstanding history of RA who developed ulcerative skin lesions that initially presented as vasculitis. She presented with new-onset painful, ulcerative skin lesion on the lower extremity, accompanied by malaise. Physical examination revealed asymmetric, deep necrotic ulcers with undermined borders. Laboratory investigations showed elevated acute phase reactants and negative rheumatoid factor. Skin biopsy demonstrated neutrophilic infiltration, confirming the diagnosis of PG. Further investigations, including imaging studies and vasculitis-specific laboratory tests, were negative, ruling out vasculitis. The patient was managed with systemic corticosteroids and immunosuppressive therapy, resulting in significant improvement of skin lesions. This case highlights the importance of considering PG as a potential differential diagnosis in patients with RA presenting with ulcerative skin lesions resembling vasculitis.
Chronic lymphocytic leukemia (CLL) is one of the most prevalent B-cell cancers for people over the age of 65. CLL is commonly comorbid with trisomy 12, as reported in up to 20% of cases. In our case, trisomy 12 was incidentally found on this patient. Its pathophysiology is quite unclear but has played a role in the side effect profile of CLL. Trisomy 12 with CLL has been shown to have increased risk for side effects like thrombocytopenia, Richter transformation and hematological cancers. The goal of this case presentation is to discuss a case of CLL with cutaneous manifestations and to look at the role that trisomy 12 can play.
The goal in this case report is to discuss one presentation of the microbiology of the Candida species in an intra-abdominal abscess which is under reported. In general, the Candida species fungi is a common yeast found human beings as part of the microbiology. Common sites of candidiasis are often the oral cavity or the genitalia. Candida species have been found to have a mutualistic relationship with different species with the body [5]. When overproduction of Candida species occurs, it can cause pathological infections in patients. While it is common to see patients with Candida species in their gut micro biome, it is not well documented to have intra-abdominal abscesses that grow Candida species. Typically, bacterial causes are first on the differential for clinicians. This case presentation looks to discuss some of presenting factors seen in intra-abdominal candidiasis (IAC) and what leads to it being under diagnosed.
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