Digital ulcerative lichenoid dermatitis in a patient receiving anti-PD-1 therapy

Programmed cell death receptor 1 inhibitors (anti-PD-1) constitute a form of immunotherapy for the treatment of several cancers. They are associated with cutaneous immune-related adverse events (irAE), occurring in up to 50% of patients. Lichenoid dermatitis is frequent and several presentations have been described. Although attempts have been made to study these reactions, they are yet to be fully characterized and the relationship with tumor response is unclear. We describe a case of digital ulcerative lichenoid dermatitis resembling ulcerative cutaneous lichen planus that occurred during pembrolizumab therapy for oral squamous cell carcinoma. The patient developed a painful ulcer on his index finger 18 months into therapy. Biopsy revealed epidermal ulceration with intense lichenoid dermatitis. Immunohistochemical study revealed intense CD8 positivity at the ulcer's edges and marked CD163 positivity at its base. Although idiopathic forms of this type of lichenoid dermatitis are particularly recalcitrant, our case was successfully managed with topical therapy and oncologic treatment did not require modification. One year after ending treatment the patient remains free of disease progression. It is unclear if this reaction is associated with his favorable oncologic response. This report adds an undescribed reaction to the increasing diversity of cutaneous irAE associated with anti-PD-1 therapy

Apocrine hidrocystoma on the nipple: the first report in this unusual location

Apocrine hidrocystoma is a rare, benign, cystic tumor of the apocrine sweat glands. They are most commonly located around the eyes and may also be found on the scalp and neck. However, despite the fact that the nipple and areola contain numerous apocrine sweet glands, apocrine hydrocystomas have not been described previously in this area to the best of our knowledge. We report the first case of this cyst in this unsual location

Protein Identification and Haplotype Description of Homozygote Mutation Causing Congenital Plasminogen Deficiency

Severe type I Plasminogen (PLG) deficiency was clinically diagnosed after hyaline-positive periodic acid Schiff material was detected in the histologic study of superior tarsal conjunctiva and vulvar pseudomembrane of the patient. Direct immunofluorescence also confirmed multiple deposits of fibrinogen in the dermis. Plasma plasminogen activity was calculated in a <5% value (reference values, 75% to 150%) and sequencing of the PLG gene evidenced the homozygous mutation in c.2377T/A (p.Tyr793Asn), confirming the molecular diagnosis of congenital deficiency of plasminogen type 1. Genotype-Phenotype correlation among family members evidenced the recessive hereditary pattern of clinical manifestations of chronic inflammatory disease of the mucous membranes due to PLG deficiency, but co-dominance effect to present a decreased plasma plasminogen activity (46%) among heterozygous asymptomatic individuals. SNPs/CNVs whole genome array hybridization analysis in the patient, detected long Loss of Heterozygosity regions (LOH) and demonstrated the consanguinity in the family. Proteomic analysis identified impaired secretion of mutant PLG tissue specific proteins, as definitive molecular etiopathogenesis of the type I PLG deficiency in the patient

Características epidemiológicas, clínicas y microbiológicas de los pacientes de la unidad de infecciones de transmisión sexual del Hospital General Universitario de Valencia

Las infecciones de transmisión sexual (ITS) son un grupo de enfermedades infecciosas, cuyas manifestaciones clínicas se pueden localizar en genitales o no y que se contagian en actos sexuales, aunque éste no sea siempre el modo de transmisión. En la última década, el incremento en la incidencia de ITS ha conllevado la creación de Unidades específicas de ITS (UITS), orientadas a realizar un diagnóstico, tratamiento y seguimiento preciso de estos pacientes ante las elevadas tasas de comorbilidades o reinfecciones que presentan. El objetivo del estudio es describir las características epidemiológicas, clínicas y microbiológicas de los pacientes que consultan en la UITS del Hospital General Universitario de Valencia. Material y método Para evaluar los objetivos propuestos en el estudio de la tesis doctoral se ha diseñado un estudio observacional ambispectivo, donde se han recogido datos tanto de forma retrospectiva como de forma prospectiva y consecutiva de todos los pacientes que han consultado en la UITS del Servicio de Dermatología del CHGUV, desde enero de 2016 hasta junio de 2019. Para el estudio, el dermatólogo ha sido el encargado de recoger las características clínico-epidemiológicas de los pacientes, así como las muestras necesarias siguiendo el protocolo de actuación de nuestra UITS, dentro de la práctica clínica habitual. Todos los pacientes fueron citados a visitas sucesivas donde se analizaron los patógenos aislados y el diagnóstico definitivo. Resultados Se han diagnosticado un total de 1003 ITS. Las ITS más frecuentemente diagnosticadas fueron: condilomas acuminados (36,1%), uretritis confirmadas microbiológicamente (19,5%), herpes genitales (13,5%) y sífilis (12,4%). En 24,1% de pacientes con condilomas acuminados genotipados se detectó al menos un genotipo de alto riesgo, siendo el más frecuente de ellos el genotipo 16. Entre los pacientes diagnosticados de uretritis, el 28,1% presentó una uretritis gonocócica, el 55,1% una uretritis no gonocócica (UNG) y el 16,8% una uretritis mixta. Entre los pacientes diagnosticados de UNG, el patógeno más frecuentemente aislado fue Haemophylus spp. seguido de Chlamydia trachomatis. El diagnóstico de herpes genital se realizó mediante una PCR positiva para VHS tipo 1 o para VHS tipo 2 en el 89% de pacientes, detectándose VHS tipo 1 en el 47,1%, especialmente entre mujeres jóvenes (p < 0,01). Los pacientes diagnosticados de sífilis eran frecuentemente hombres que tenían sexo con hombres y el 34,7% tenían VIH. El estadio más frecuente al diagnóstico fue el secundario (52,4%), seguido del primario (29%). Conclusiones Presentamos el primer trabajo que recoge las características epidemiológicas, clínicas y microbiológicas de los pacientes diagnosticados de ITS en nuestro medio. Por orden de frecuencia, los diagnósticos más frecuentes son: condiloma acuminado, uretritis, herpes genital y sífilis

Acneiform eruption induced by vedolizumab

The development of new biological drugs for the treatment of advanced oncological processes or severe inflammatory diseases brings with it the appearance of new adverse effects. Vedolizumab, an α4β7 integrin inhibitor antibody, is approved for induction and maintenance therapy in both Crohn disease and ulcerative colitis. We report a case of severe acneiform eruption induced by vedolizumab in a 17-year-old woman with ulcerative colitis

Acneiform eruption induced by vedolizumab

The development of new biological drugs for the treatment of advanced oncological processes or severe inflammatory diseases brings with it the appearance of new adverse effects. Vedolizumab, an α4β7 integrin inhibitor antibody, is approved for induction and maintenance therapy in both Crohn disease and ulcerative colitis. We report a case of severe acneiform eruption induced by vedolizumab in a 17-year-old woman with ulcerative colitis

Effective treatment of nail psoriasis with apremilast: report of two cases and review of the literature

Nail psoriasis can cause great morbidity and a negative impact on the personal and work-related life of the patients. However, it responds more poorly to most drug therapies. Classically, the first line of treatment for nail psoriasis has been topical medication, but the new biological drugs seem to be the most effective treatment. Apremilast is another systemic oral drug that has shown a significant reduction of the severity in moderate-severe plaque psoriasis, as well as nail and scalp psoriasis. We present two cases of patients who exhibited a rapid response to treatment with apremilast