Precursor B-cell lymphoblastic lymphoma (B-LBL) is a rare entity and primary cutaneous B-LBL is an even more uncommon diagnosis that typically affects children. A 4-year-old boy presented with a persistent rash on his left cheek for almost 2 years and was found to have primary cutaneous B-LBL. We report this case to emphasize that B-LBL should be in the differential diagnosis for an otherwise unimpressive persistent lesion in the head and neck region and review all reported pediatric cases of primary cutaneous B-LBL without extracutaneous involvement.
Health disparities encompass a wide range of personal, societal, environmental, and system-based factors that contribute to inequitable health and health outcomes in vulnerable patient populations.These factors interact with the biologic and genetic elements of disease, becoming difficult to isolate when researching disease and outcomes. However, addressing the non-biologic determinants of health that contribute to patient outcomes is integral to practicing effective and equitable medicine.
Background: Cutaneous venous malformation (VM) can be associated with internal
Penile syringomas are benign adnexal tumors that are usually asymptomatic but can be cosmetically distressing. Because of the delicate nature of skin in this region, treatment is difficult, and there are few case reports of procedural destruction of these tumors. We report a case of successful surgical excision using Castroviejo ophthalmic scissors followed by primary closure with fast-absorbing plain gut suture and a cyanoacrylate adhesive application. This procedure was well tolerated and had an impressive cosmetic outcome.
Annular, or ring-like, skin lesions are a distinctive cutaneous morphology. Dermatologic diagnosis is based on morphology and distribution, and therefore the generation of a differential diagnosis based on these criteria can lead to proper identification of an eruption. For many dermatologic conditions, considering a differential that includes infection, immune phenomenon, neoplastic process, physical etiology, and idiopathic process will assure that one thinks broadly and is likely to reveal the best diagnosis. Several of these categories are covered in this review of annular eruptions in children.
M ycobacterium mucogenicum is a nontuberculous mycobacterium (NTM) recently noted as the etiologic agent of infections in various organ systems, including the skin. Infection by NTM is associated with AIDS and has been encountered with increasing frequency in the population without AIDS.1 Found ubiquitously in water and soil, NTM easily colonize the respiratory tract, with cutaneous infections occurring less frequently. 2 Individuals with NTM colonization typically do not develop disease. However, when M mucogenicum infiltrates other tissues, it causes infection in the blood, liver, lungs, peritoneum, skin and soft tissue, and central nervous system. 2-11 Cutaneous infections have been described in immunocompromised patients who are taking tumor necrosis factor (TNF) inhibitors and in otherwise healthy patients following a break in the skin and subsequent exposure to pond or salon water. [9][10][11] We report a case of nosocomially derived cutaneous infection. Institutional review board approval was waived, and informed consent was obtained. Report of a CaseA woman in her 70s presented with a 1-month history of a tender swollen papule on her right superomedial malar cheek near the medial canthus. She had a history of hypothyroidism, hyperlipidemia, basal cell carcinoma of the right temple and left lower eyelid, and lacrimal atresia with blockage for which she recently had undergone a right-sided dacryocystorhinostomy with Crawford tube placement. This procedure was performed 6 weeks before presentation in an outpatient setting. She was taking levothyroxine sodium, simvastatin, aspirin, and estradiol. Her other medical conditions were well controlled. She denied any fevers, chills, or night sweats at initial presentation. Physical examination revealed an erythematous, tender papule on her right superomedial malar cheek near the medial canthus (Figure 1). Evaluation included a 4-mm punch biopsy specimen from the lesion, tissue culture, complete blood cell count, and comprehensive metabolic panel.The complete blood cell count and comprehensive metabolic panel did not reveal any abnormalities. Histopathologic IMPORTANCE Nontuberculous mycobacterial infections of the skin can be seen in cases of immunosuppression and/or traumatic implantation of contaminated objects. Surgical settings with appropriate sterilization techniques have been immune to these types of infections. We report a case of nosocomially derived infection from a sterile procedure.OBSERVATIONS A woman in her 70s presented with a facial lesion after an ophthalmologic procedure that was discovered to be a nontuberculous mycobacterial infection. It was successfully treated with oral antibiotics.CONCLUSIONS AND RELEVANCE Nontuberculous mycobacterial infections should be considered in the differential diagnosis of new lesions arising after invasive procedures, even in immunocompetent patients in seemingly sterile settings.
ImportanceTumor necrosis factor α (TNF) inhibitor–induced psoriasiform eruption is well recognized in adults, but few reports document this paradoxical effect in children.ObjectiveTo characterize the clinical features and the clinical time course of TNF inhibitor–induced psoriasiform eruptions in children.Design, Setting, and ParticipantsA multicenter retrospective case series of children younger than 18 years seen between January 1, 2000, and December 31, 2016, who developed a new-onset psoriasiform eruption while taking a TNF inhibitor for a nondermatologic disorder. Participating sites were members of the Pediatric Dermatology Research Alliance. Data were entered into a Research Electronic Data Capture database at the Mayo Clinic (ie, the coordinating center).ResultsPsoriasiform eruptions were identified in 103 TNF inhibitor–treated patients (median age, 13.8 years [IQR, 11.7-16.4 years]; 52 female patients [50%]; 57 White patients [55%]), with 67 patients (65%) treated with infliximab, 35 (34%) with adalimumab, and 1 (1%) with certolizumab pegol. Most patients had no personal history (101 [98%]) or family history of psoriasis (60 patients [58%]). Inflammatory bowel disease was the most common indication for treatment with TNF inhibitor (94 patients [91%]). The primary extracutaneous disease was under control in 95 patients (92%) who developed the eruption. Most patients (n = 85 [83%]) developed psoriasiform eruptions at multiple anatomic sites, with scalp involvement being most common (65 patients [63%]). Skin disease developed at a median of 14.5 months (IQR, 9-24 months) after TNF inhibitor initiation. To treat the psoriasiform eruption, topical steroidal and nonsteroidal medication was prescribed for all patients. Systemic therapy was added for 30 patients (29%): methotrexate for 24 patients (23%), oral corticosteroids for 8 patients (8%), and azathioprine for 1 patient (1%). For 26 patients (25%), suboptimal effectiveness with topical medications alone prompted discontinuation of the initial TNF inhibitor and a change to a second-line TNF inhibitor with cutaneous improvement in 23 patients (88%) by a median of 3 months (IQR, 2-4 months). Eight patients (31%) who started a second-line TNF inhibitor developed a subsequent TNF inhibitor–induced psoriasiform eruption at a median of 6 months (IQR, 4-8 months). Persistent skin disease in 18 patients (17%) prompted discontinuation of all TNF inhibitors; 11 patients changed to a non-TNF inhibitor systemic therapy, and 7 discontinued all systemic therapy.Conclusions and RelevanceIn this case series, paradoxical TNF inhibitor–induced psoriasiform eruptions were seen in children treated with TNF inhibitors for any indication, and there appears to be a class effect among the varying TNF inhibitors. The majority of these children were able to continue TNF inhibitor therapy with adequate skin-directed and other adjuvant therapies.
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