Recurrence of Cutaneous Coccidioidomycosis Six Years after Valley Fever: a Case Presentation and Literature Review

Coccidioidomycosis is usually acquired by inhalation of spores of Coccidioides immitis and C. posadasii. The disease ranges from a self-limited acute pneumonia (Valley Fever) to a disseminated disease. We present a 44-year-old healthy male who had patchy hair loss of several months duration resembling discoid lupus. He developed a firm non-scaly red plaque on the right forehead. Initial biopsy showed spongiotic dermatitis, and he was treated with systemic steroids. He then developed forehead and periorbital cellulitis and was treated with systemic antibiotics. A second biopsy showed fungal hyphae, and he was treated with itraconazole 200 mg bid for 4 months beyond clinical resolution. A year later, he presented with intermittent swelling of the right forehead lesion and worsening of the scalp lesions. A forehead biopsy showed interface dermatitis and negative PAS stain for fungi. Scalp biopsy was highly suggestive of discoid lupus and he was started on plaquenil. Many months later, a third biopsy showed fungal infection, and the culture grew C. immitis. He was treated with itraconazole. Retrospectively, the patient gave a history of Valley fever 6 years back when he was in Arizona, USA

Multiple dermatofibromas in a female with systemic lupus erythramatosus on immunosuppressive medications. Case report and a brief literature review

Background: Multiple dermatofibromas (“DFs”) are defined by the presence of 15 lesions in the same patient or the development of five to eight DFs over the period of 4 months. Fifty-six percent of multiple DFs are associated with other diseases. The most common associated disease is systemic lupus erythematosus (“SLE”) followed by immunodeficiency virus (“HIV”) infection. Main observation: We report a case of a 25-year-old Saudi Arab female with SLE on immunosuppressive drugs with multiple DFs. Conclusion: The most common association with multiple DFs is SLE followed by HIV. Most of the patients with SLE were on immune suppressive medications. Dermatologists, rheumatologists, surgeons and internists should note that patients with SLE who are on immune suppressive medications are at risk of developing multiple DFs

Minimal residual disease program for acute lymphoblastic leukemia at Dhahran Health Center

Background and Objectives: Minimal residual disease (MRD) assays for monitoring acute lymphoblastic leukemia (ALL) during treatment are defined as assays with a limit of detection of at least 0.01% leukemic blasts per mononuclear cells or total nucleated cells. Settings and Design: We retrospectively reviewed out experience at Dhahran Health Center in monitoring adult and pediatric ALL patients with a MRD assay based on immunophenotyping by flow cytometry with a level of detection of 0.01% leukemic blasts per mononuclear cells and compute Kaplan–Meier survival analysis for overall survival (OS) and relapse-free survival (RFS). We also demonstrated the incorporation of an estimated measurement uncertainty for the reported MRD values based on metrological principles. Methods: A retrospective review of all cases diagnosed with ALL from 2006 to 2012 was undertaken and after applying exclusion criteria, 26 cases were identified and patient chart review was done. Results: Although the Kaplan–Meier survival analysis for OS and RFS do demonstrate a statistically significant difference between MRD positive and negative patients, none of the pediatric ALL MRD positive cases have relapsed till now. Conclusions: The detection of MRD in ALL opens up the opportunity to intensify or alter treatment for patients with detectable levels by a highly sensitive assay before clinical relapse