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>

Treatment response as a diagnostic feature in zinc deficiency-associated dermatitis in a three-month-old Filipino male: A case report

Introduction@#Zinc deficiency is of high magnitude in developing countries such as the Philippines. Zinc deficiency dermatitis is recognized through characteristic cutaneous presentation supported by diagnostic workups which may not be feasible or practical in low-resource settings.@*Case report@#A three-month-old Filipino male was brought in for erosions of three (3) weeks duration that were unrespon- sive to topical and systemic antimicrobial treatment. On examination, he had multiple erythematous erosions with yellowish to brownish, crusted borders with predilection on the face, inguinal and gluteal areas, flexures of the extremities, and digits. Workup revealed normal zinc levels, decreased alkaline phosphatase, and bacterial growth in cultures. Histopathology revealed intraepidermal vesiculobullous dermatitis. Given the clinicopathologic presentation, a diagnosis of zinc deficiency-associated dermatitis was made. Along with antimicrobials and topical care, oral zinc sulfate with elemental zinc at 3 mg/kg/day was started, with remarkable improvement within three (3) days and near-resolution after eight (8) days of zinc therapy. Zinc supplementation was administered for three (3) months with gradual tapering. The skin remained clear despite the withdrawal of zinc supplemen- tation. Response to treatment supported the impression of zinc deficiency, while sustained skin clearance upon withdrawal verified an acquired etiology.@*Conclusion@#Zinc deficiency-associated dermatitis is more common in areas where costly diagnostic modalities are not readily available. In clinically suspected zinc deficiency, response to treatment can serve as a retrospective diagnostic feature, and sus- tained clearance upon withdrawal may aid in identifying etiology. Trial of therapy may then be considered in optimizing the cost-ef- fective management of zinc deficiency-associated dermatitis.

Drug-induced chronic bullous disease of childhood in a two-year-old Filipino male triggered by cefaclor or cefuroxime: A case report

Introduction@#Chronic bullous disease of childhood (CBDC) is a rare immune-mediated subepidermal vesiculobullous eruption, characterized by linear IgA deposition along the basement membrane zone of the skin. Although mostly idiopathic, CBDC may be triggered by factors such as infection, and drugs. Clinical and immunohistopathological features of drug-induced cases are heterogeneous and indistinguishable from the idiopathic form.@*Case report@#A two-year-old Filipino male presented with pruritic vesicles and bullae on the back several days after finishing a course of cefuroxime, and cefaclor. Examination revealed multiple tense vesicles and bullae, some coalescing into a rosette pattern with central crusts on the perioral, scalp, neck, back, perineal, and perianal areas. Histopathology showed a subepidermal split with neutrophilic and eosinophilic infiltrates. Direct immunofluorescence revealed strong linear deposition of IgA, and granular deposits of C3 and IgM at the basement membrane zone, thus confirming the di- agnosis of CBDC. Dapsone at 2mg/kg/day was started, with oral prednisolone (1.3mg/kg/day), and cloxacillin syrup (40mg/kg/day). Topical care with betamethasone dipropionate and mupirocin ointment was included. After eight weeks, patient showed significant im- provement with few vesicles and resolved lesions healing with post-inflammatory hyperpigmentation.@*Conclusion@#We report a case of a two-year-old male presenting with vesiculobullous lesions after a course of cefuroxime, and cefaclor. As both were given and withdrawn in a period of close proximity, it is difficult to determine the probable culprit drug. Spontaneous resolution upon withdrawal of the suspected drug is variable. Systemic therapy such as dapsone may be necessary for treatment.

Skin manifestations of COVID-19: A preliminary report on 2 patients and review of related literature

@#CASE SUMMARY: A 51-year-old Filipino female without comorbidities presented with cough, rhinitis, and low-grade fever. Four days later, she developed pruritic, localized wheals on the arms, gradually involving the trunk and lower extremities. A 49-year-old Filipino female without comorbidities based in the Middle East presented with cough and fever. Four days after, she developed a generalized distribution of wheals and livedoid patches on both legs. Both patients recovered from COVID-19 with complete resolution of skin lesions. CONCLUSION: To the best of our knowledge, this is the first report of COVID-19 related dermatology cases collected in the Philippines.