Lower extremity nodules in an immunocompetent woman

A 79-year-old otherwise healthy Puerto Rican woman is seen for a 3-month history of a rapidly enlarging mass on her right foot. The involved areas are occasionally tender, affecting her ability to walk. Physical examination reveals many confluent, deep red to purple, eroded, grapelike nodules affecting all aspects of the foot and extending to the distal part of the leg. The largest confluent mass is on the heel extending to the posterior side of the ankle. She has no history of immunosuppression

Sarcoid-like reaction in a patient recovering from coronavirus disease 19 pneumonia

As coronavirus disease 2019 (COVID-19) cases continue to increase, so do the reported extrapulmonary manifestations of this disease. To date, described dermatologic manifestations of COVID-19 include pernio-like acral nodules, dengue fever–like petechiae, vesiculobullous eruptions, pityriasis rosea and viral-like exanthems, retiform purpura, and livedo reticularis.1 We describe a patient with new-onset, biopsy confirmed sarcoid-like reaction in the setting of COVID-19 pneumonia and postulate a role for this immunologic reaction in hastening disease recovery

Adult-onset bilateral Parry-Romberg syndrome

Parry-Romberg Syndrome (PRS), or progressive hemifacial atrophy, is an uncommon disorder characterized by progressive unilateral loss of adipose tissue and underlying structures including muscle, cartilage, and bone, often with little or no sclerosis. PRS and morphea en coup de sabre (ECDS) have significant overlap, often coexist, and are likely different phenotypes of morphea.1 PRS usually presents in the first decade of life, but later presentations have been described.1 It is more common in females and the pathogenesis is not completely understood.1 Neurologic symptoms are the most common extracutaneous systemic manifestation. Bilateral disease occurs in rare instances.1 We describe a woman with profound bilateral facial atrophy whose presentation does not follow the typically reported disease course or histopathologic findings seen in PRS

Asymptomatic vesicular eruption on the chest in a breast cancer survivor. Diagnosis: Benign lymphangiomatous papules (BLAP) of the skin following radiotherapy

A 47-year-old woman with a history of inflammatory breast cancer presented with a 2- to 3-week history of asymptomatic lesions of the right chest and axilla. The cancer in her right breast had been treated 3.5 years earlier by bilateral mastectomy, right axillary lymph node dissection, tamoxifen therapy, and radiotherapy to the right chest. Physical examination revealed grouped vesicles, some on a background of mild erythema, and scattered, flesh-colored, flat-topped papules overlying the patient\u27s mastectomy scars and radiation field on the right chest and axilla (Figure 1). The left chest and axilla were unaffected. Results from a Tzanck preparation, direct fluorescent antibody testing for herpes simplex virus and varicella zoster virus, and viral cultures were negative. A punch biopsy specimen was obtained from the right axilla (Figure 2 and Figure 3)

Lichen planus pigmentosus in a blaschkoid distribution

Lichen planus pigmentosus is a pigmentary disorder of unknown etiology, with diffuse hyperpigmentation of sun-exposed areas, more commonly seen in some ethnic and racial groups. We report an unusual case of lichen planus pigmentosus in a 40-year-old man with Fizpatrick type III skin that was present in a blaschkoid distribution on the trunk, a distribution that has been rarely reported. This unique presentation of lichen planus pigmentosus may contribute to better understanding of the etiology, as the blaschkoid distribution may reflect underlying cutaneous mosaicism that renders those cells more susceptible to an insult that results in lichen planus pigmentosus. This disorder should be considered in the differential diagnosis of macular hyperpigmentation, especially in those from more commonly affected ethnic and racial groups, even when the distribution is atypical and in the absence of history of sun exposure

A case of Hansen Disease presenting as tinea versicolor

Hansen Disease (leprosy) is an infectious disease that targets macrophages and Schwann cells, caused by the acid fast intracellular organism, Mycobacterium leprae. Clinically, it presents with a spectrum of findings that may include hypopigmented macules, erythematous plaques and nodules, and thickened or tender peripheral nerves. The most feared complication is mutilating damage to facial structures or digits resulting from loss of sensation in affected skin. In non-endemic areas, the diagnosis of leprosy is frequently delayed because it may mimic other more common skin conditions. We present a case of borderline/lepromatous leprosy in an otherwise healthy young Brazilian man that was initially diagnosed as tinea versicolor, but did not respond to appropriate treatment. This case highlights the importance of having a high index of suspicion for leprosy in patients from endemic areas who present with lesions that could be consistent with this disease

Lichen planus pigmentosus in a blaschkoid distribution

Lichen planus pigmentosus is a pigmentary disorder of unknown etiology, with diffuse hyperpigmentation of sun-exposed areas, more commonly seen in some ethnic and racial groups. We report an unusual case of lichen planus pigmentosus in a 40-year-old man with Fizpatrick type III skin that was present in a blaschkoid distribution on the trunk, a distribution that has been rarely reported. This unique presentation of lichen planus pigmentosus may contribute to better understanding of the etiology, as the blaschkoid distribution may reflect underlying cutaneous mosaicism that renders those cells more susceptible to an insult that results in lichen planus pigmentosus. This disorder should be considered in the differential diagnosis of macular hyperpigmentation, especially in those from more commonly affected ethnic and racial groups, even when the distribution is atypical and in the absence of history of sun exposure

Multifocal cutaneous alternariosis in a 70-year-old kenyan renal transplant patient

Alternaria species are a group of dematiaceous fungi that are ubiquitous in nature and are becoming an increasingly important cause of disease in immunocompromised patients.  We present a case of a 70 year old renal transplant recipient with multiple areas of cutaneous Alternaria infections likely introduced during local trauma.  Treatment has required a combination of systemic therapy and surgical excision.  This case illustrates the importance of recognizing fungal infections with cutaneous manifestations, such as alternariosis, in immunosuppressed patients

Localized bullous pemphigoid after knee replacement surgery

Bullous pemphigoid (BP) most commonly presents as widespread, itchy, tense blisters in older patients. Localized bullous pemphigoid is a less common form of BP that can be more difficult to diagnose because of its similarity to more common conditions such as allergic contact dermatitis or bullous cellulitis. Prompt recognition of localized BP is important so that appropriate treatment can be started. We present a 57-year-old woman who presented with pruritic tense bullae overlying the surgical scar from a knee replacement 6 months prior on her anterior right knee. This case illustrates the potential for localized BP to be triggered by surgical procedures