Subungual squamous cell carcinoma of the great toe presenting as a pyogenic granuloma-like mass in a 64-year-old Filipino male: A case report

@#<p style="text-align: justify;"><strong>INTRODUCTION:</strong> Subungual squamous cell carcinoma is rare, though it is the most common primary malignant neoplasm in the nail unit. Fingernails are more commonly involved than toenails with nonspecific and mild features. Histopathologic presentation may be difficult to distinguish from other tumors. With this, there is often a delay in diagnosis.</p><p style="text-align: justify;"><strong>CASE REPORT:</strong> A 64-year-old male presented with a subungual yellowish granulomatous plaque, eventual dystrophy, and persistent bleeding on the fi rst digit of the right foot of two years' duration. Initially diagnosed as pyogenic granuloma through skin punch biopsy, debridement with ungiectomy was done. Upon recurrence, he underwent wide excision with matricectomy, wherein deeper sections revealed features of basosquamous carcinoma. A positive Epithelial Membrane Antigen and negative BerEP4 staining later confirmed a diagnosis of SCC. Since bone involvement was repeatedly suspected in magnetic resonance imaging after postoperative radiotherapy, amputation was eventually done.</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> We report a case of subungual SCC initially diagnosed as a pyogenic granuloma. Full-thickness biopsy should be done in persistent nail conditions using special stains to confirm the diagnosis. Surgical treatment or radiotherapy with or without systemic therapy is the first line of treatment for subungual SCC. In cases of bone involvement, amputation may be warranted.</p><p style="text-align: justify;"><strong>KEYWORDS:</strong> nail, pyogenic granuloma, squamous cell carcinoma, tumor</p>

Bullous henoch-schonlein purpura in 9-year old Filipino male: A case report

@#Henoch- Schonlein purpura (lgA vasculitis) is the most common vasculitis in the pediatric population. It usually affects the skin, synovia, gastrointestinal tract, and kidneys. It usually presents as a palpable purpura. The occurrence of hemorrhagic bullae in children with HSP is an uncommon presentation. We present a case of an otherwise healthy 9-year-old male with a three-day history of erythematous maculopapular lesions over the lower extremItIes which progressed to violaceous plaques with central hemorrhagic bullae affecting the bilateral lower extremities, buttocks and arms. Odynophagia and intermittent abdominal pain were present. Histopathology revealed small vessel leukocytoclastic vasculitis and direct immunofluorescence (DIF) showed granular deposition of lgA and fibrinogen along the walls of the papillary dermal blood vessels. The patient was successfully treated with prednisone at 1 mg/kg/day and showed resolution of lesions within 1 week of treatment with no recurrence at 1 month follow-up. We stress the importance of having a high index of suspicion in these atypical presentations in order to prevent delay in diagnosis and achieve maximal treatment gains.

Bejeweled: Chronic bullous disease of childhood in a 2-year old treated with colchicine: A case report

@#Linear IgA bullous dermatosis, also known as chronic bullous disease of childhood when present in the pediatric age group, is a rare blistering disease more predominantly seen in females less than five years old. This case describes a 2-year old girl who presented with scattered, tense vesicles and bullae on an erythematous base forming the classic “cluster of jewels” appearance. This clinical picture is often mistaken as bullous impetigo, commonly seen in children, delaying diagnosis and prompt treatment. Histopathologic examination showed subepidermal blistering with a predominantly neutrophilic inflammatory infiltrate. The direct immunofluorescence studies revealed a linear band of IgA deposition in the basement membrane zone consistent with the diagnosis of CBDC. The patient was started on colchicine and oral prednisone at 1 mg/kg/day and complete resolution was achieved within two weeks of therapy.