Pili multigemini of the eye: unusual and rare presentation

Pili Multigemini (PM) is an uncommon, pilar dysplasia characterized by clusters of hair shafts emerging from a single follicle. We present a rare and unique case of PM involving the eye. A 43 year old Caucasian male, presented with a prolonged history of a recurrent lesion at the right upper eyelid, present for two years. Clinical examination revealed a subcutaneous cyst with a prominent follicular pore with a differential diagnosis of epidermoid cyst, nevus and pili bifurcati. Excisional biopsy was performed and microscopy showed a benign malformed hair follicle containing multiple different hair shafts enclosed in a common outer root sheath; consistent with the diagnosis of Pilli Multigemini. Pili Multigemini was first described by Flemming in 1883 and is frequently found in the beard of adults and scalp of children. To our knowledge, this is the first case of Pilli Multigemini involving the eye. its noteworthy to consider during diagnostic workup; as well as to exclude other follicular and inflammatory abnormalities involving the eye

Trichostasis Spinulosa of the Heel: Unique Presentation with Characteristic Morphology

Trichostasis Spinulosa is a peculiar lesion of the hair follicle that typically presents on the face. We present a case of a 59 years old Middle Eastern male who presented with a dark lesion on his heel. Examination revealed a 1.7 cm well-circumscribed black necrotic plaque with surrounding overhanging border with a differential diagnosis of melanoma. Histologically, the lesion was formed by inflamed clusters of numerous small hair shafts, consistent with Trichostasis Spinulosa of the heel. We report this case because of its unusual location and unique presentation

Clinico-Laboratory Profile and Outcome of COVID-19 in Patients with Chronic Immune Thrombocytopenia

Background/Case Studies: Thrombocytopenia is a well-described complication of COVID-19, with numerous proposed mechanisms among which is immune thrombocytopenia (ITP). There are limited data on the characteristics and impact of COVID-19 on patients with previously diagnosed ITP. Study Design/Methods: This is a retrospective review of all chronic ITP patients who were diagnosed with COVID-19 between 03/2020 and 01/2022 at a tertiary care center. The study was approved by the IRB. Patients with secondary thrombocytopenia, missing data, and unavailable follow up after COVID-19 diagnosis, were excluded. Demographic data, comorbidities, clinico-laboratory findings before and after COVID-19 diagnosis, management of COVID-19 and outcome were collected. Analyses were performed using SPSS; a p value of \u3c0.05 was considered significant. Results were presented as median plus range, mean +/- standard deviation, or percentages as indicated. Variables were compared using the independent two-sample Student t-test for continuous variables, and the Pearson\u27s Chi-square test or Fisher\u27s exact test for categorical variables. Early mortality was defined as death from any cause within 30 days of admission. Results/Findings: 45 patients were included. The median age was 66 (32–93) years; 27 (60%) were females. 28(62%) patients were Caucasian. The median time from ITP diagnosis to COVID-19 was 5 (1–35) years. A 27 (60%) patients required treatment for ITP before COVID-19, and only 4 patients were on low-dose prednisone at the time of COVID-19 diagnosis. The most common symptoms of COVID-19 were shortness of breath (53%), fever (31%), and cough (22%). 29 (64%) patients were hospitalized with 12 of them requiring ICU care. Median time of hospitalization was 8 (2–45) days. COVID-19 specific treatments included steroids (42%), remdesivir (24%), chloroquine (9%), azithromycin (9%), and tocilizumab (2%). Three patients had thrombosis (2 DVTs, and 1 DVT and PE), 2 had intracranial bleeding, and 3 had mucosal bleeding. Early mortality rate was 15.6%; death was attributed to respiratory failure in 3 patients, multi-organ failure in 3 patients, and cardiac arrest in 1 patient. None of the analyzed parameters (gender, ethnicity, age, comorbidities, severity of thrombocytopenia, thrombotic or bleeding events) was associated with ICU admission or early mortality. Patients\u27 platelet count before COVID-19 diagnosis did not differ from the platelet count at the time of COVID-19 diagnosis with a mean platelet count of 108.5 (+/- 49.0) and 93.8 (+/- 92.8) (p = 0.299), respectively. In addition, there was no significant difference in the platelet before COVID-19 and after recovery. Conclusion: Thrombocytopenia of chronic ITP patients did not worsen during COVID-19 infection or after recovery. Mortality of chronic ITP patients due to COVID-19 was not different from reported mortality of hospitalized COVID-19 patients. Our findings should be validated in larger cohorts

Pretibial Myxedema, Nodular Variant: Unique Presentation and Clinical Course

Literature has shown morphological diversity in the presentation and occurrence of pretibial myxedema following I-131 treatment. We present a case of a 47 y.o African American male with post I-131 hypothyroidism for Graves disease that presented with enlarging bilateral lower extremity and ankle lesions. Examination revealed firm, tender, hemispherical, large, hyperpigmented nodules. Ultrasound demonstrated nonspecific hypovascular nodular thickening of the skin. Excisional biopsy showed reactive dermal and subcutaneous fibrosis with dermal mucinosis. Alcian blue stain confirmed the diagnosis. Graves’ dermopathy is generally rare, with the nodular variant accounting for 10% of cases. Our case reflects a variable appearance of post-I-131 treatment dermopathy partially resistant to the multimodal treatment

A case of salivary gland hyalinizing clear cell carcinoma (HCCC) with cutaneous metastasis

Hyalinizing clear cell carcinoma (HCCC) is a rare malignant tumor of the minor salivary glands with low-grade morphology and generally favorable outcome. In up to 16.4% of cases, aggressive disease and metastasis has been reported. We report the case of a 44 year-old female with history of HCCC arising at the base of her tongue which had the typical EWSR1-ATF1 fusion. She received wide local excision followed by adjuvant radiation, chemotherapy and immunotherapy. However, over the following few years, the tumor metastasized to multiple visceral sites. Interestingly, she also developed two closely adjacent nodules on her scalp which demonstrated variably sized aggregations of atypical pale-cuboidal cells with surrounding sclerosis filling the dermis and abutting the epidermis, morphologically resembling her previously known HCCC. To our knowledge, this is the first reported case HCCC with cutaneous metastasis, which is noteworthy because it can cause diagnostic confusion given the morphologic and immunophenotypic similarity to other primary skin adnexal tumors