Cryoglobulinemic Vasculitis in a Patient with Trismus Pseudocamptodactyly

Cryoglobulinemia is a condition where immunoglobulins precipitate at temperatures \u3c 37°C causing damage to blood vessels of the skin, joints, peripheral nervous system, and kidneys. Diagnosis is difficult due to various etiologies and clinical manifestations. We present a challenging case of idiopathic type III cryoglobulinemia. A 33-year-old man with a history of trismus pseudocamptodactyly syndrome (TPS), chronic pain, and polysubstance abuse presented with several days of worsening rash on both feet. The patient noted more restriction in his joints, increased from his baseline restriction due to TPS. Physical exam revealed palpable purpura on the dorsum of both feet. Extensive tests were performed (CBC, CMP, PT and INR, Lupus Anticoagulant (LA), Hepatitis B and C serology, HIV antibody, ANA panel, ANCA panel, serum complement) which were unremarkable. A punch biopsy of the right foot demonstrated epidermal necrosis with vascular thrombosis. The patient was discharged due to improvement of his condition. Two weeks later, the patient was readmitted for worsening pain in his feet. The purpuric lesions were more necrotic compared to his last visit. New petechiae appeared on the ventral forearms. Work-up for lupus, infectious etiologies, and malignancy were negative; however, a cryoglobulin test was positive. A follow-up SPEP revealed elevated polyclonal IgM of 622 mg/dL. A punch biopsy of the new lesions revealed leukocytoclastic vasculitis (LCV), which can be caused by mixed cryoglobulinemia (MC), further supporting the diagnosis. This case highlights the difficulty in making the diagnosis of cryoglobulinemia in a patient with a history of drug abuse and TPS. His clinical presentation was confounded by his inability to localize any particular joint involvement due to chronic pain, his history of polysubstance abuse raising concerns for drugseeking behavior, and his negative hepatitis panel making the diagnosis of MC less likely. Despite this, the patient did meet several classification criteria for cryoglobulinemia, which include: the presence of cryoglobulins, elevated monoclonal IgM, constitutional symptoms, and articular and vascular involvement

The Role of Saturated Fatty Acids in Connexin Expression on Endothelial Cells and Eosinophils

Eotaxin is a potent chemoattractant for eosinophils that becomes elevated in the tissues in response to inflammation and increased adiposity. Therefore, eosinophil migration into adipose tissue should increase in diet-induced obese individuals, yet it does not. This suggested to us that something within the cellular microenvironment of diet-induced obese individuals might be altering the endothelial leukocyte adhesion molecules (ELAM) such as VCAM-1 or selectins on the endothelial cells, thus preventing eosinophils from entering the inflamed tissue. Connexons are gap junctions in endothelial cells and on immune cells such as macrophages that are composed of connexins and have been shown to alter ELAM expression. In this study, we investigated whether connexin 43 expression can be modulated by saturated or unsaturated fatty acids. We found that the saturated fatty acids, palmitic and lauric acid, increased expression of connexin 43 in bEnd.3 endothelial cells over a 24-hour period at concentrations ranging from 100μM to 400μM. Conversely, linoleic acid, an unsaturated fatty acid, decreased the expression of connexin 43 over a 24-hour period at concentrations from 400μM to 800μM. Connexins 37 and 40 were also examined but were not detected under the conditions used. These results suggest that the concentration and type of fatty acids in the blood can significantly impact connexin expression by vascular endothelial cells and the subsequent regulation of adhesion molecule expression necessary for eosinophil migration into inflamed tissues

Erosio interdigitalis blastomycetica: A review of interdigital candidiasis

Erosio interdigitalis blastomycetica (EIB) is a Candida infection affecting the third web space, between the third and fourth fingers. In 1915, Gougerot and Goncea first described saccharomycetic organisms isolated from the hands and feet. Johannes Fabry later named it in 1917, well before the genus Candida was introduced in 1923. EIB is most common among those who work with their hands frequently in water, such as dishwashers, launderers, bartenders, and homemakers. Clinical presentation most commonly consists of a central erythematous erosion surrounded by a rim of white macerated skin involving at least one interdigital web space. The differential diagnosis is narrow, consisting of irritant contact dermatitis (ICD), erythrasma, inverse psoriasis, and bacterial infection (i.e. impetigo). The diagnosis is made by clinical examination in addition to fungal culture and KOH testing. The prognosis is good and treatment options include avoidance of frequent water immersion and topical or oral antifungal agents. Suspicion for secondary infections such as erysipelas and cellulitis should remain high until lesions have resolved. This review aims to address the history, epidemiology, pathophysiology, histopathology, clinical presentation, differential diagnoses, diagnosis, prognosis, and management of EIB. It also suggests an alternative name in place of the current misnomer

Assessing Public Interest in Mpox via Google Trends, YouTube, and TikTok

Public response to the recent Mpox outbreak was analyzed using internet search trends and social media posts

Extramammary Paget disease

In 1874, Sir James Paget first described Paget disease of the nipple, also known as mammary Paget disease. In 1889, extramammary Paget disease (EMPD) of the scrotum and penis was identified. Although mammary and extramammary Paget disease are both characterized by epidermal Paget cells and share a similar clinical presentation, their uniqueness lies in anatomical location and histogenesis. EMPD presents as an erythematous plaque on apocrine gland bearing areas (i.e. vulva, perineum, perianal region, scrotum, and penis) in older men and women. It can be a focal, multifocal, or an ectopic process. Immunohistochemical staining allows for differentiation between primary and secondary EMPD in addition to the many other disease entities that clinically resemble this malignancy. When diagnosing a patient with EMPD, a full history and physical should be performed given the possibility of an underlying malignancy. Surgical excision currently is first line therapy and the prognosis is often favorable. Recent advances within the field have examined the expression of chemokine receptors within tumors, which may be applicable in determining prognosis. This review addresses the history, epidemiology, pathogenesis, clinical presentation, histopathology, differential diagnosis, diagnosis, management, and new observations with respect to extramammary Paget disease

Extramammary Paget disease

In 1874, Sir James Paget first described Paget disease of the nipple, also known as mammary Paget disease. In 1889, extramammary Paget disease (EMPD) of the scrotum and penis was identified. Although mammary and extramammary Paget disease are both characterized by epidermal Paget cells and share a similar clinical presentation, their uniqueness lies in anatomical location and histogenesis. EMPD presents as an erythematous plaque on apocrine gland bearing areas (i.e. vulva, perineum, perianal region, scrotum, and penis) in older men and women. It can be a focal, multifocal, or an ectopic process. Immunohistochemical staining allows for differentiation between primary and secondary EMPD in addition to the many other disease entities that clinically resemble this malignancy. When diagnosing a patient with EMPD, a full history and physical should be performed given the possibility of an underlying malignancy. Surgical excision currently is first line therapy and the prognosis is often favorable. Recent advances within the field have examined the expression of chemokine receptors within tumors, which may be applicable in determining prognosis. This review addresses the history, epidemiology, pathogenesis, clinical presentation, histopathology, differential diagnosis, diagnosis, management, and new observations with respect to extramammary Paget disease

Dermatology in Doximity

Doximity, currently the largest online social networking service for United States (US) health care professionals and medical students, provides a wide variety of content to a large audience. In fact, its database includes 1,078,305 physicians in the US. It is therefore important to evaluate this content from time to time. Our objective is to analyze both the residency rankings and news content presented in Doximity, with respect to dermatology. The study compared the residency rankings created by Doximity to another dermatology residency ranking system that used a different algorithm. In terms of dermatology content, seven dermatology-related search terms were entered into the Doximity search query and data was collected on the first 20 “relevant” articles. Our study evaluated a total of 140 articles. The search term “skin cancer” yielded the most articles totaling 6,001. Informative articles were the most common type of article for each content item searched except for “dermatology”, yielding research articles as the most common content type (70%). The search term “melanoma awareness” had the largest number of shares (19,032). In comparing dermatology residency rankings on Doximity with another ranking system that accounted for scholarly achievement, there was 50% overlap. In conclusion, it is vital to evaluate content on social media websites that are utilized by US medical students and health care professionals. We hope this information presented provides an up-to-date analysis on the quality of one particular social media platform

Dermatology in Doximity

Doximity, currently the largest online social networking service for United States (US) health care professionals and medical students, provides a wide variety of content to a large audience. In fact, its database includes 1,078,305 physicians in the US. It is therefore important to evaluate this content from time to time. Our objective is to analyze both the residency rankings and news content presented in Doximity, with respect to dermatology. The study compared the residency rankings created by Doximity to another dermatology residency ranking system that used a different algorithm. In terms of dermatology content, seven dermatology-related search terms were entered into the Doximity search query and data was collected on the first 20 “relevant” articles. Our study evaluated a total of 140 articles. The search term “skin cancer” yielded the most articles totaling 6,001. Informative articles were the most common type of article for each content item searched except for “dermatology”, yielding research articles as the most common content type (70%). The search term “melanoma awareness” had the largest number of shares (19,032). In comparing dermatology residency rankings on Doximity with another ranking system that accounted for scholarly achievement, there was 50% overlap. In conclusion, it is vital to evaluate content on social media websites that are utilized by US medical students and health care professionals. We hope this information presented provides an up-to-date analysis on the quality of one particular social media platform

Risky business: Behaviors associated with indoor tanning in US high school students

Background: Understanding of associations between indoor tanning and risky health related behaviors such as sexual activity and substance abuse among high school students across the United States is incomplete.Objective: To identify risky health related behaviors among high school students utilizing indoor tanning and analyze differences between state specific data.Methods: Results from the Youth Risk Behavior Surveillance System (YRBSS) 2013 in 14 different states were analyzed. Participants were 90,414 high school students. Responses to questions assessing indoor tanning habits, sexual activity, and use of substances were analyzed.Results: Sexual activity was associated with indoor tanning in 10 of 14 states, with Nebraska having the strongest association (adjusted odds ratio, 3.8; 95% CI, 2.4-6.2; p<0.001). Indoor tanning was also associated with use of alcohol, marijuana, ecstasy, cocaine, prescription medications, and cigarettes.Limitations: Only 15 states asked students about their personal history of indoor tanning use, and Minnesota was excluded from our analysis as they administered a non-YRBS questionnaire. Additionally, our study only analyzed results from the 2013 YRBS. Lastly, our data was analyzed in 14 individual data sets, giving a high likelihood of Type 1 error.Conclusions: High school students utilizing indoor tanning are more likely to engage in sexual activity and substance abuse as compared to students who do not utilize indoor tanning