A non-traumatic, blue-purple auricle: case report

Abstract Objective: We report a typical case of earlobe lymphocytoma. Method: A case report and literature review are presented. Results: A 10-year-old girl presented with a blue-coloured earlobe. A diagnosis of Lyme disease was confirmed by serological tests. Lyme borreliosis is the most common tick-borne disease in the northern hemisphere. It is caused by the spirochete Borrelia burgdorferi sensu lato. The patient was successfully treated with antibiotics. Conclusion: The diagnostic process and ENT symptomatology of Lyme disease and borrelial lymphocytoma are summarised and discusse

Disfiguring Annular Sarcoidosis Improved by Adalimumab

Depending on the location, dermatoses can produce blemishes that severely impair quality of life and require highly effective treatment that is otherwise used for extensive skin involvement. We report the case of a 39-year-old, otherwise healthy male disfigured by an 8 × 7-cm hypopigmented and centrally atrophic annular plaque with erythematous indurated borders in an area of scar tissue on his forehead. Skin biopsies revealed non-caseating granulomas, and hilar involvement was identified, leading to the diagnosis of systemic sarcoidosis stage II with cutaneous involvement. The lesions proved resistant to multiple therapies, but responded within 4 months to adalimumab with regression of the lesion and inflammatory infiltrate. The visual analogue scale of disease activity decreased from 7/10 to 3.5/10, and the Dermatology Life Quality Index from 16/30 to 3/30 points. In conclusion, TNF-α inhibition can control inflammation and disfigurement by cutaneous sarcoidosis and restore quality of life

Dacarbazine (DTIC) versus vaccination with autologous peptide-pulsed dendritic cells (DC) in first-line treatment of patients with metastatic melanoma: a randomized phase III trial of the DC study group of the DeCOG

Background: This randomized phase III trial was designed to demonstrate the superiority of autologous peptide-loaded dendritic cell (DC) vaccination over standard dacarbazine (DTIC) chemotherapy in stage IV melanoma patients. Patients and methods: DTIC 850 mg/m2 intravenously was applied in 4-week intervals. DC vaccines loaded with MHC class I and II-restricted peptides were applied subcutaneously at 2-week intervals for the first five vaccinations and every 4 weeks thereafter. The primary study end point was objective response (OR); secondary end points were toxicity, overall (OS) and progression-free survival (PFS). Results: At the time of the first interim analysis 55 patients had been enrolled into the DTIC and 53 into the DC-arm (ITT). OR was low (DTIC: 5.5%, DC: 3.8%), but not significantly different in the two arms. The Data Safety & Monitoring Board recommended closure of the study. Unscheduled subset analyses revealed that patients with normal serum LDH and/or stage M1a/b survived longer in both arms than those with elevated serum LDH and/or stage M1c. Only in the DC-arm did those patients with (i) an initial unimpaired general health status (Karnofsky = 100) or (ii) an HLA-A2+/HLA-B44− haplotype survive significantly longer than patients with a Karnofsky index <100 (P = 0.007 versus P = 0.057 in the DTIC-arm) or other HLA haplotypes (P = 0.04 versus P = 0.57 in DTIC-treated patients). Conclusions: DC vaccination could not be demonstrated to be more effective than DTIC chemotherapy in stage IV melanoma patients. The observed association of overall performance status and HLA haplotype with overall survival for patients treated by DC vaccination should be tested in future trials employing DC vaccine

An adaptive signaling network in melanoma inflammatory niches confers tolerance to MAPK signaling inhibition

Mitogen-activated protein kinase (MAPK) pathway antagonists induce profound clinical responses in advanced cutaneous melanoma, but complete remissions are frustrated by the development of acquired resistance. Before resistance emerges, adaptive responses establish a mutation-independent drug tolerance. Antagonizing these adaptive responses could improve drug effects, thereby thwarting the emergence of acquired resistance. In this study, we reveal that inflammatory niches consisting of tumor-associated macrophages and fibroblasts contribute to treatment tolerance through a cytokine-signaling network that involves macrophage-derived IL-1β and fibroblast-derived CXCR2 ligands. Fibroblasts require IL-1β to produce CXCR2 ligands, and loss of host IL-1R signaling in vivo reduces melanoma growth. In tumors from patients on treatment, signaling from inflammatory niches is amplified in the presence of MAPK inhibitors. Signaling from inflammatory niches counteracts combined BRAF/MEK (MAPK/extracellular signal–regulated kinase kinase) inhibitor treatment, and consequently, inhibiting IL-1R or CXCR2 signaling in vivo enhanced the efficacy of MAPK inhibitors. We conclude that melanoma inflammatory niches adapt to and confer drug tolerance toward BRAF and MEK inhibitors early during treatmen

Lymphogranuloma venereum in Zurich, Switzerland: Chlamydia trachomatis serovar L2 proctitis among men who have sex with men

BACKGROUND: Whereas until 2003 Lymphogranuloma venereum (LGV) was rare in industrialised countries, there have been increasing reports of cases of LGV proctitis in men having sex with men (MSM) over the last six years in Europe, America and Australia. PATIENTS AND METHODS: After the alarming message from the Netherlands in 2003, physicians in a dermatological and STI private clinic in Zurich started examining rectal swabs from patients with proctitis for LGV serovars of C. trachomatis on a regular basis. A test system based on PCR with sequencing and databank comparison was used. Clinical files of all patients with proctitis observed in this time period were examined. RESULTS: Since 2003 twelve cases of proctitis, all in MSM, caused by the LGV serovar L2 C. trachomatis were observed. Of the overall 11 patients the majority were HIV positive and only 2 were HIV negative. Only one patient reported previous sexual contacts outside Europe (Thailand) as the likely place of infection. The clinical presentation was characterised by anorectal pain, discharge, tenesmus and change in stool frequency. Four patients were successfully treated with a single dose of 1 g azithromycin. In all seven cases treated with doxycycline 2 x 100 mg for 10-20 days clinical cure and a negative PCR result after treatment were observed, except for one patient lost to follow-up. CONCLUSIONS: Zurich has not been spared by the recent outbreaks of LGV proctitis in MSM. Anorectal LGV infections may progress to severe destructive changes, with formation of granulomas, strictures, and perirectal abscesses. Increased awareness of this problem and establishment of reliable diagnostic tools are required

A non-traumatic, blue-purple auricle: case report

Objective: We report a typical case of earlobe lymphocytoma. Method: A case report and literature review are presented. Results: A 10-year-old girl presented with a blue-coloured earlobe. A diagnosis of Lyme disease was confirmed by serological tests. Lyme borreliosis is the most common tick-borne disease in the northern hemisphere. It is caused by the spirochete Borrelia burgdorferi sensu lato. The patient was successfully treated with antibiotics. Conclusion: The diagnostic process and ENT symptomatology of Lyme disease and borrelial lymphocytoma are summarised and discussed

Non-melanoma skin cancer: Appendageal tumours

Sudoriferous tumours represent approximately 1% of all primary cutaneous neoplasias. They have a variable, often unspecific clinical presentation and a wide histologic spectrum. According to their origin, cutaneous sweat gland tumours can be classified as eccrine, apocrine, eccrine and apocrine (mixed origin), or composite adnexal tumours. Further, they can be classified as benign or malignant, tumours of the sweat ducts or of the sweat glands secretory apparatus. Carcinomas of the eccrine and apocrine glands are neoplasms with infiltrative and metastatic potential. Some malignancies have benign counterparts from which they must be differentiated. Features that suggest malignancy include asymmetry of the lesion, invasion, irregular arrangement of neoplastic cells, cytonuclear atypia and pleomorphism, and significantly increased mitotic activity in the presence of abnormal mitotic figures. Other sweat gland carcinomas present differently from any benign tumour. Differentiating primary cutaneous sudoriferous carcinomas from metastatic carcinomas can often pose a serious challenge. Clinical history, histomorphological features, and immunohistochemical stains are all very important

Lichenoid drug eruption following intravenous application of orally formulated diamorphine, a semisynthetic heroin

BACKGROUND: Lichen planus is a common skin disorder of unknown etiology. Most cases are idiopathic, but substances such as gold, antimalarials, penicillamine, thiazide diuretics, β-blockers, arsenic and nonsteroidal anti-inflammatory drugs have been implicated as trigger factors. CASE PRESENTATION: We report the case of a lichenoid eruption in a male drug addict who administered oral heroin (diamorphine) intravenously. Diamorphine was stopped immediately. Following topical steroids, phototherapy and oral acitretin, the lesions gradually disappeared. A lymphocyte transformation test was negative for pure morphine and codeine. DISCUSSION: A coincidental association between the intravenous application of orally formulated semisynthetic heroin and the lichenoid eruption cannot be completely ruled out. However, the diagnosis of a lichenoid drug eruption is favoured over idiopathic lichen planus because of the clear chronological correlation between drug use and appearance as well as drug withdrawal and disappearance of the skin lesions, and because of a flare-up following repeated intravenous application of diamorphine

Borrelial pseudolymphoma of the nose

A 52-year-old Colombian woman, a patient with psoriasis, undergoing phototherapy with (ultraviolet B narrowband) UVBnb, presented with a symptomless solitary diffuse erythaematous plaque on her nose for 3 months. Initially, she was treated with pimecrolimus 1% cream for 8 weeks, which was then combined with metronidazole cream for 4 weeks, with the initial diagnosis of UV-triggered rosacea, without improvement. A punch biopsy was performed and the histology showed a pseudolymphomatous reaction. The diagnosis of nasal pseudolymphoma of borreliosis was confirmed with PCR. The lesion completely resolved following oral doxycycline therapy