The use of 1320nm Nd:YAG laser for the treatment of acne scar in Asians

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The use of 1320nm Nd:YAG laser for the treatment of acne scar in Asians

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Diffuse large B-cell lymphoma of the central nervous system in mycophenolate mofetil-treated patients with systemic lupus erythematosus

We report the third case of primary lymphoma of the central nervous system (PCNSL) in a patient with systemic lupus erythematosus (SLE) given long-term mycophenolate mofetil (MMF). Our 43-year-old patient has a history of lupus nephritis and has been treated with MMF 500 mg/day in addition to azathioprine (AZA) for 8 years. She presented with subacute left-sided weakness. Magnetic resonance imaging revealed a gadoliniumenhancing mass in the right parietal region which was isointense on T2-weighted imaging. Brain biopsy revealed diffuse sheets of large lymphoid cells which demonstrated strong membranous expression of CD20 by immunohistochemistry and positive signal for Epstein Bar virus (EBV)–encoded RNA by in-situ hybridization study. Complete remission of PCNSL was achieved after discontinuation of MMF and administration of rituximab and whole brain radiotherapy. Patients with SLE are predisposed to development of lymphoma regardless of immunosuppressive use. One meta-analysis found that non-Hodgkin’s lymphoma was more common in SLE patients with a standardized incidence rate ranging from 5.2 to 44.4. However, the development of PCNSL secondary to immunosuppressive use is being increasingly recognised especially in MMF-treated renal transplant recipients with onset of PCNSL after a median of 14 months. It has also been described in some MMF-treated autoimmune conditions such as myasthenia gravis, dermatomyositis and relapsing polychondritis. Although AZA in combination with corticosteroids has been shown to predispose post-renal transplant patients to lymphoproliferative disease with a relative risk of 12.7, the association of AZA and EBV-related lymphoma is rare. The approach to management of this condition includes withdrawal of MMF and judicious use of future immunosuppressive agents.published_or_final_versionThe 15th Medical Research Conference (15th MRC), Department of Medicine, University of Hong Kong, Hong Kong, 16 January 2010. In Hong Kong Medical Journal, 2010, v. 16 n. 1, suppl. 1, p. 54, abstract no. 9

Primary malignant ocular melanoma: A bone marrow diagnosis

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Dermato-venereological Quiz

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A middle-aged man with self-healing papulonecrotic lesions over the trunk and proximal limbs

Lymphomatoid papulosis is a clinically benign, but histologically malignant form of cutaneous T-cell lymphoma. Regular surveillance is warranted to monitor development of another systemic lymphoma. We report a case of lymphomatoid papulosis, presenting as widespread papulonecrotic skin lesions. The patient developed multiple asymptomatic, self-healing lesions over the trunk and proximal limbs which resolved spontaneously within 3 months.link_to_OA_fulltex

Scleromyxedema: A cutaneous paraneoplastic syndrome associated with thymic carcinoma

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Degos' disease: A rare condition simulating rheumatic diseases

Dego's disease is an uncommon thrombo-occlusive vasculopathy that presented with skin rash and thrombotic complications affecting internal organs that may simulate rheumatic diseases and may be brought to the attention of rheumatologists. We present here a case of a middle-aged woman who presented with acute bowel infarction, persistent fever, elevated inflammatory markers and reversed albumin/globulin ratio suspicious of systemic vasculitis clinically. The diagnosis of Dego's disease was made from the classical skin lesions which were pink to brown papules with central depression and surrounding violaceous rim that were distributed over the trunk and extremities. Histology showed typical wedge-shaped infarction in the affected organs with endothelial proliferation and occlusion by thrombus. Our patient was put on aspirin but suffered from recurrent bowel infarction 1.5 years later and eventually succumbed to septic complications. © Clinical Rheumatology 2009.link_to_subscribed_fulltex