A Rare Presentation of Drug-induced Liver Injury with Fluticasone and Vilanterol Inhaler Use

Drug-induced liver injury (DILI) is a rare and potentially lethal condition associated with the use of many commonly-used medications, including inhaled fluticasone-vilanterol. Therefore, a careful review of medications should always be obtained in the setting of acute onset hepatic dysfunction. We present the first reported case of idiosyncratic drug-induced liver injury associated with the use of this medication

Osteoma Cutis Associated with Nevus Sebaceus: Case Report and Review of Cutaneous Osteoma-associated Skin Tumors (COASTs)

Osteoma cutis is a benign cutaneous lesion characterized by the presence of bone within the dermis or subcutaneous fat. It most often develops in association with other skin lesions such as cutaneous tumors. Nevus sebaceus is a benign hamartoma of the skin that is composed of epidermal and dermal components. It most commonly appears on the scalp and may give rise to either benign or malignant secondary neoplasms. The clinical and pathologic features of a 36-year-old man with a nevus sebaceus and associated osteoma cutis are described. In addition, osteoma cutis-associated neoplasms are reviewed. Secondary osteoma cutis has been observed with both benign and malignant neoplasms as well as various non-neoplastic skin conditions. However, to the best of our knowledge, osteoma cutis has not previously been described in association with nevus sebaceus. Nevus sebaceus can now be added to the list of cutaneous osteoma-associated skin tumors (COASTs)

Verruciform Genital-Associated (Vegas) Xanthoma: report of a patient with verruciform xanthoma of the scrotum and literature review

Background: Verruciform xanthoma is a benign verrucous lesion characterized by epithelial acanthosis and lipid-laden foamy histiocytes in the connective tissue papillae. It typically presents as a papillomatous, polypoid, or sessile lesion. Verruciform xanthoma is most commonly observed within the oral cavity. However, albeit less frequently, it develops on the penis, scrotum, or vulva.Purpose:  We describe the clinical and pathologic findings of a man who developed a verruciform xanthoma on his scrotum. We also summarize the associated conditions, the differential diagnosis, the postulated pathogenesis, and the treatment options for this tumor.Materials and methods:  The features of a man with a scrotal verruciform xanthoma are presented. Using PubMed, the following terms were searched and relevant citations assessed: anogenital, foam cells, penis, scrotum, verruciform, verruciform xanthoma, vulva, and xanthoma. In addition, the literature on verruciform xanthoma is reviewed.Results:  Our patient developed an asymptomatic, exophytic, red filiform papule on his scrotum. A shave biopsy, attempting to remove the entire lesion, was performed. Based on correlation of the clinical presentation and histopathologic findings, a diagnosis of verruciform xanthoma was established. The patient applied mupirocin 2% ointment to the biopsy site, which subsequently healed without complication or recurrence.Conclusion:  Verruciform xanthoma is a benign tumor commonly located within the oral cavity and characterized by the development of a small verrucous, papillomatous, polypoid, or sessile growth. Extraoral sites of verruciform xanthoma often include the penis, scrotum, or vulva; we introduce the term 'Vegas' (Verruciform Genital-Associated) xanthoma for these lesions. The lesions are often mistaken for viral warts or malignancies.  Although the mechanism of pathogenesis is unknown, verruciform xanthoma may have a multifactorial etiology involving inflammation, local immunosuppression, and/or metabolic dysfunction. It has also been postulated that verruciform xanthoma is a secondary reaction to trauma-induced epithelial damage or degeneration. A biopsy for histopathologic examination is required to diagnose verruciform xanthoma. The treatment of verruciform xanthoma typically involves simple surgical excision

Sarcoidosis in Melanoma Patients: Case Report and Literature Review

Sarcoidosis is a systemic inflammatory disease characterized by the development of noncaseating granulomas in multiple organ systems. Many hematologic malignancies and solid tumors, including melanoma, have been associated with sarcoidosis. We describe the clinical and pathologic findings of a 54-year-old man with melanoma-associated sarcoidosis. In addition, we not only review the literature describing characteristics of other melanoma patients with sarcoidosis, but also the features of melanoma patients with antineoplastic therapy-associated sarcoidosis. Sarcoidosis has been described in 80 melanoma patients; sufficient information for analysis was provided in 39 of these individuals. In 43.6% of individuals (17 out of 39), sarcoidosis was directly associated with melanoma; in 56.4% of oncologic patients (22 out of 39), sarcoidosis was induced by antineoplastic therapy that had been administered for the treatment of their metastatic melanoma. The discovery of melanoma preceded the development of sarcoidosis in 12 of the 17 (70.5%) individuals who did not receive systemic treatment. Pulmonary and/or cutaneous manifestations of sarcoidosis were common among both groups of patients. Most patients did not require treatment for sarcoidosis. Melanoma patients—either following antineoplastic therapy or without systemic treatment—may be at an increased risk to develop sarcoidosis. In antineoplastic therapy naive melanoma patients, a common etiologic factor—such as exposure to ultraviolet light—may play a role in their developing melanoma and sarcoidosis

Palisaded Encapsulated Neuroma of the Trunk: A Case Report and Review of Palisaded Encapsulated Neuroma

Palisaded encapsulated neuroma is a rare, benign cutaneous tumor. It most commonly presents as a solitary, flesh-colored, dome-shaped nodule affecting the face. However, albeit rarely, palisaded encapsulated neuroma may also appear on the trunk, genitals, or extremities. We describe the clinical and pathologic findings of a male patient who presented with a palisaded encapsulated neuroma on his left flank. In addition, we review the characteristics of patients with truncal palisaded encapsulated neuromas and summarize the clinical and histologic differential diagnosis of this tumor

Tobacco-associated yellow discoloration of upper lip hair: smoker's mustache

Background: Hair is susceptible to exogenous sources of discoloration. There are several exogenous etiologies for yellow hair discoloration, including tobacco.Purpose: We describe the clinical features of five men with tobacco-associated yellow discoloration of their mustache, a condition known as "smoker's mustache." We also review the characteristics of men with tobacco-associated yellow discoloration of their scalp or mustache hair.Materials and methods: The features of five men with smoker's mustache are presented. Using PubMed, the following terms were searched and relevant citations assessed: 4-4'-methylenedianiline, acid, dithranol, MDA, mustache, nicotine, picric, resorcin, smoker, tar, tobacco, and yellow. In addition, the literature on smoker's mustache is reviewed.Results: Smoker's mustache was an incidental finding and not the reason for patients presenting for medical attention. The condition was asymptomatic. In our patients, 60% (3 of 5) also had tobacco-related clinical findings on the distal soft tissue and/or nails of their fingers.Conclusion: Smoker's mustache refers to tobacco-associated discoloration of the hair of the upper lip of men. It is an asymptomatic condition that usually presents as an incidental finding. Indeed, patients tend to be unaware of the condition until it is brought to their attention. In addition to hair manifestations, patients may also demonstrate other tobacco-associated skin and nail findings, particularly brown or yellow-brown discoloration of their fingertip and/or fingernail. We postulate that discontinuation of smoking would eventually result in spontaneous resolution of the condition. However, all of our patients were determined to continue smoking

Verruciform Genital-Associated (Vegas) Xanthoma: report of a patient with verruciform xanthoma of the scrotum and literature review

Background: Verruciform xanthoma is a benign verrucous lesion characterized by epithelial acanthosis and lipid-laden foamy histiocytes in the connective tissue papillae. It typically presents as a papillomatous, polypoid, or sessile lesion. Verruciform xanthoma is most commonly observed within the oral cavity. However, albeit less frequently, it develops on the penis, scrotum, or vulva.Purpose:  We describe the clinical and pathologic findings of a man who developed a verruciform xanthoma on his scrotum. We also summarize the associated conditions, the differential diagnosis, the postulated pathogenesis, and the treatment options for this tumor.Materials and methods:  The features of a man with a scrotal verruciform xanthoma are presented. Using PubMed, the following terms were searched and relevant citations assessed: anogenital, foam cells, penis, scrotum, verruciform, verruciform xanthoma, vulva, and xanthoma. In addition, the literature on verruciform xanthoma is reviewed.Results:  Our patient developed an asymptomatic, exophytic, red filiform papule on his scrotum. A shave biopsy, attempting to remove the entire lesion, was performed. Based on correlation of the clinical presentation and histopathologic findings, a diagnosis of verruciform xanthoma was established. The patient applied mupirocin 2% ointment to the biopsy site, which subsequently healed without complication or recurrence.Conclusion:  Verruciform xanthoma is a benign tumor commonly located within the oral cavity and characterized by the development of a small verrucous, papillomatous, polypoid, or sessile growth. Extraoral sites of verruciform xanthoma often include the penis, scrotum, or vulva; we introduce the term 'Vegas' (Verruciform Genital-Associated) xanthoma for these lesions. The lesions are often mistaken for viral warts or malignancies.  Although the mechanism of pathogenesis is unknown, verruciform xanthoma may have a multifactorial etiology involving inflammation, local immunosuppression, and/or metabolic dysfunction. It has also been postulated that verruciform xanthoma is a secondary reaction to trauma-induced epithelial damage or degeneration. A biopsy for histopathologic examination is required to diagnose verruciform xanthoma. The treatment of verruciform xanthoma typically involves simple surgical excision

Tobacco-associated yellow discoloration of upper lip hair: smoker's mustache

Background: Hair is susceptible to exogenous sources of discoloration. There are several exogenous etiologies for yellow hair discoloration, including tobacco.Purpose: We describe the clinical features of five men with tobacco-associated yellow discoloration of their mustache, a condition known as "smoker's mustache." We also review the characteristics of men with tobacco-associated yellow discoloration of their scalp or mustache hair.Materials and methods: The features of five men with smoker's mustache are presented. Using PubMed, the following terms were searched and relevant citations assessed: 4-4'-methylenedianiline, acid, dithranol, MDA, mustache, nicotine, picric, resorcin, smoker, tar, tobacco, and yellow. In addition, the literature on smoker's mustache is reviewed.Results: Smoker's mustache was an incidental finding and not the reason for patients presenting for medical attention. The condition was asymptomatic. In our patients, 60% (3 of 5) also had tobacco-related clinical findings on the distal soft tissue and/or nails of their fingers.Conclusion: Smoker's mustache refers to tobacco-associated discoloration of the hair of the upper lip of men. It is an asymptomatic condition that usually presents as an incidental finding. Indeed, patients tend to be unaware of the condition until it is brought to their attention. In addition to hair manifestations, patients may also demonstrate other tobacco-associated skin and nail findings, particularly brown or yellow-brown discoloration of their fingertip and/or fingernail. We postulate that discontinuation of smoking would eventually result in spontaneous resolution of the condition. However, all of our patients were determined to continue smoking

Polydactylous Transverse Erythronychia: Report of a Patient with Multiple Horizontal Red Bands Affecting the Fingernails

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