Paracoccidioidomycosis manifested by sarcoid-like cutaneous lesions with severe systemic disease: a rare and challenging diagnosis

ABSTRACT Cutaneous involvement in paracoccidioidomycosis (PCM) can exhibit a highly polymorphic spectrum. The infiltrative pattern corresponds to up to 26.6% of observed skin lesions, including sarcoid-like plaques, a rare presentation of cutaneous lesions in PCM. This clinical expression is almost exclusively cutaneous, and its histology reveals a tuberculoid granuloma with a scarcity of fungi, leading to misdiagnosis as other granulomatous diseases. Here, we report a rare form of chronic multifocal paracoccidioidomycosis manifesting as sarcoid-like skin lesions misdiagnosed as granulomatous rosacea in a patient with severe systemic disease.

Granulomatous hepatitis, deciphering an elusive spectrum: a clinical case-based approach

Granulomatous hepatitis is a well-defined histopathologic entity characterized by aggregates of modified macrophages (epithelioid in appearance) and other inflammatory cells that accumulate after persistent exposure to antigens. It induces a cellular immune response mediated by the release of various cytokines (including interferon-gamma [INF-γ], tumor necrosis factor-alpha [TNF-α], and interleukin 12 [IL-12]) that stimulate mononuclear cell fusion, culminating in the formation of multinucleated giant cells with a surrounding border of lymphocytes and fibroblasts. It represents between 2% and 15% of all pathological liver studies, usually during an infiltrative or cholestatic biochemical pattern. A practical approach is proposed based on a challenging clinical case of a patient with a fever of unknown origin in an intermediate incidence area for tuberculosis, such as Colombia.

La hepatitis granulomatosa es una entidad histopatológica bien definida que se caracteriza por la presencia de agregados de macrófagos modificados (de aspecto epitelioide) y otras células inflamatorias que se acumulan luego de la exposición persistente a antígenos, lo que induce una respuesta inmunitaria celular mediada por la liberación de varias citocinas (entre las que se destacan el interferón gamma [INF-γ], el factor de necrosis tumoral alfa [TNF-α] y la interleucina 12 [IL-12]) que estimulan la fusión de células mononucleares para culminar en la formación de células gigantes multinucleadas con un borde circundante de linfocitos y fibroblastos. Representa entre el 2 % y el 15 % de todos los estudios anatomopatológicos de hígado, en el curso por lo general de un patrón bioquímico de tipo infiltrativo o colestásico. Se propone un enfoque práctico a partir de un caso clínico retador de un paciente con fiebre de origen desconocido en una zona de incidencia intermedia para tuberculosis, como lo es Colombia.

Pelvic Ewing Sarcoma: The Great Mimicker / Sarcoma de Ewing pélvico: o grande imitador

Abstract Ewing sarcoma is the most common malignant bone tumor of the pelvis in children and young adults. Even with aggressive treatment, its survival rate is amongst the poorest. Classical presentation may not be the rule. It may simulate clinically, imagiologically and histopathologically other nonmalignant entities. Therefore, its suspicion should not be overlooked. We report two cases of pelvic Ewing sarcoma: the first mimicking eosinophilic granuloma, and the second mimicking osteomyelitis. In the latter, we also report an atypical finding of its natural history: an initial response to antibiotic and anti-inflammatory treatment. In both cases, we highlight the possibility of an inconclusive percutaneous bone biopsy and the importance of immunochemistry and cytogenetics for the definitive diagnosis.

Resumo O sarcoma de Ewing é o tumor ósseo maligno da pelve mais comum em crianças e adultos jovens. Mesmo com tratamento agressivo, sua taxa de sobrevivência está entre as piores. A apresentação clássica pode não ser a regra. Ele pode simular clinicamente, imaginologicamente e histopatologicamente outras entidades não malignas. Portanto, sua suspeita não deve ser negligenciada. Relatamos dois casos de sarcoma pélvico: o primeiro imitando granuloma eosinofílico e o segundo imitando osteomielite. Neste último, também relatamos um achado atípico de sua história natural: uma resposta inicial ao antibiótico e ao tratamento anti-inflamatório. Em ambos os casos, destacamos a possibilidade de uma biópsia óssea percutânea inconclusiva e a importância da imunoquímica e da citogenética para o diagnóstico definitivo.

Granuloma piogénico oral de comportamiento agresivo: Reporte de un caso

El granuloma piogénico es una lesión vascular reactiva benigna del tejido blando que surge en respuesta a irritantes crónicos de bajo grado. Rara vez crece más de 2 cm de diámetro y por lo general, no provoca cambios en el hueso alveolar. Presentamos un caso inusual de granuloma piógeno en una mujer de 19 años, de extenso tamaño y comportamiento agresivo, asociado a resorción ósea severa, movilidad dentaria, hemorragia, anemia ferropénica y recurrencias.

Pyogenic granuloma is a benign reactive vascular lesion of the soft tissue that arises in response to chronic low-grade irritants. It rarely grows more than 2 cm in diameter and usually does not cause changes in the alveolar bone. We present the case of a 19-year-old woman with an unusual pyogenic granuloma of extensive size and aggressive behavior, associated with severe bone resorption, tooth mobility, hemorrhage, iron deficiency anemia and recurrences.

Angioleiomioma oral mimetizando um granuloma piogênico: relato de caso raro / Oral Angioleiomyoma mimetizing a pyogenic granuloma: A rare case report

Angioleiomioma (AL) é um tumor benigno de origem perivascular que raramente é observado na cavidade oral, principalmente em localizações como a gengiva. Devido sua apresentação clínica inespecífica, os ALs podem mimetizar outras lesões orais, como tumores benignos de glândulas salivares e lesões reacionais, como o granuloma piogênico. O presente artigo objetiva relatar um caso raro de AL localizado em gengiva, em uma paciente de 19 anos. Clinicamente, a lesão apresentava-se como um tumor assintomático, oval, pedunculado, bem definido, com superfície lisa, consistência fibrosa e cor eritematosa, semelhante a um granuloma piogênico, Uma biópsia excisional foi realizada e o fragmento foi encaminhado para análise histopatológica, que revelou uma proliferação vascular de diversos calibres, contendo paredes musculares espessas e proliferação muscular adjacente, além de infiltrado inflamatório, predominantemente crônico, hemácias extravasadas e área de ulceração, consistente com o diagnóstico de AL inflamado. A histopatologia desempenha um papel importante no diagnóstico final de lesões raras e com características clínicas inespecíficas. A excisão cirúrgica da lesão é o tratamento de escolha mais eficaz para os ALs orais. (AU)

Angioleiomyoma (AL) is a benign tumor of smooth muscle of perivascular origin that is rarely seen in the oral cavity, mainly in locations like the gingiva. Due to their nonspecific clinical presentation, ALs can mimic other oral lesions, such as benign salivary gland tumors and reactional lesions, as a pyogenic granuloma. We reported a case of an AL located in the gingiva in a 19-year-old female patient. In clinical terms, the lesion was presented as an asymptomatic, oval, pedunculated, well-defined nodule with a smooth surface, fibrous consistency and erythematous color, similar to a pyogenic granuloma. An excisional biopsy was performed and the fragment was sent for histopathological analysis that revealed a vascular proliferation of different calibers, containing thick muscle walls and adjacent muscle proliferation, in addition to an inflammatory infiltrate, predominantly chronic, extravasated red blood cells and an area of ulceration, consistent with the diagnosis of inflamed AL. The histopathology plays an important role in the final diagnosis of rare lesions and with nonspecific clinical characteristics. The surgical excision of the lesion is the most effective treatment of choice for oral ALs. (AU)

Metastatic Crohn's disease: a difficult diagnosis from different perspectives

Metastatic Crohn's disease (MCD) is a rare cutaneous manifestation of Crohn's disease (CD). The simultaneous involvement of the vulva and oral region is uncommon in clinical presentations of MCD. We present the case of a middle-aged woman with a family history of autoimmunity who initially presented with oral and vulvoperineal involvement. Initially, Behçet's disease was ruled out, but histopathological studies of the vulva revealed findings compatible with MCD. The patient had no gastrointestinal symptoms, and fecal calprotectin levels were normal. Upper and lower endoscopic examinations and capsule endoscopy of the small intestine (SI) did not reveal any significant findings. Treatment with anti-tumor necrosis factor (anti-TNF) agents was initiated but resulted in paradoxical psoriasis with adalimumab and infliximab. Cyclosporine was also used, but the patient experienced intolerable tachycardia. After 18 months, the patient developed episcleritis and experienced diarrhea accompanied by cramp-like abdominal pain. Repeat upper and lower endoscopic examinations showed normal results, while capsule endoscopy of the SI revealed CD enteritis. The patient was diagnosed with CD of the small intestine, along with extraintestinal manifestations of vulvoperineal MCD, oral involvement, and episcleritis. Management with azathioprine and ustekinumab was initiated, resulting in significant clinical improvement. MCD poses a diagnostic challenge due to its unusual manifestations. It may present without gastrointestinal tract involvement, mimicking other conditions. Therefore, timely diagnosis and the selection of the most appropriate therapeutic strategy are crucial.

La enfermedad de Crohn metastásica (ECM) es una entidad rara, es una manifestación cutánea en enfermedad Crohn (EC), y en su presentación clínica es inusual el compromiso vulvar y oral de modo concomitante. Se describe el caso de una mujer de edad media que tiene historia familiar de autoinmunidad, presenta inicialmente compromiso oral y vulvoperineal. En su abordaje inicial se descartó enfermedad de Behçet, pero los estudios histopatológicos a nivel vulvar tuvieron hallazgos compatibles para ECM. Hubo ausencia de síntomas gastrointestinales y sus niveles de calprotectina fecal eran normales. Los estudios endoscópicos altos y bajos, y la cápsula endoscópica del intestino delgado (ID) no tuvieron hallazgos relevantes. Se inició el tratamiento con antifactor de necrosis tumoral (anti-TNF) y presentó una psoriasis paradójica con adalimumab e infliximab. También se utilizó ciclosporina y presentó una taquicardia intolerable. 18 meses después de estos síntomas tuvo epiescleritis e inició con diarrea asociada a dolor abdominal tipo cólico, por lo que se repitieron los estudios endoscópicos altos y bajos, que resultaron normales, y cápsula endoscópica de ID mostró una enteritis por EC. Se consideró EC de ID con manifestaciones extraintestinales y con ECM vulvoperineal, compromiso oral y epiescleritis. Se requirió manejo con azatioprina y ustekinumab, con una mejoría clínica significativa. La ECM es un reto diagnóstico, pues es una manifestación inusual; en su debut puede haber ausencia de compromiso en el tracto gastrointestinal y también simular otras entidades. Debe buscarse lograr el diagnóstico oportuno y la estrategia terapéutica más segura.

Caracterización clínico-epidemiológica de la toxocariasis ocular

Objetivo: Caracterizar clínica y epidemiológicamente la toxocariasis ocular. Métodos: Se realizó un estudio observacional, descriptivo, de corte transversal con pacientes diagnosticados de toxocariasis ocular, atendidos en el Instituto Cubano de Oftalmología Ramón Pando Ferrer en el período de abril de 2019 a diciembre de 2022. Resultados: Predominó el sexo masculino (53,7 %) y el grupo etario de 0 a 10 años (73,1 %). El 56,1 % de los pacientes vivían en área rural. La convivencia con animales domésticos representó el 75,6 %. El síntoma más referido fue la disminución de la agudeza visual (48,8 %). La forma de presentación más frecuente fue el granuloma periférico de forma unilateral en ojo derecho (52,4 %). La complicación más observada fue el desprendimiento de retina (58,5 %). Conclusiones: La infección ocular por Toxocara spp. es una enfermedad prevenible e incapacitante que limita el desenvolvimiento educacional, laboral y de la vida en general de los pacientes afectados, particularmente la población infantil, el sexo masculino y los que residen en área rural en convivencia con animales domésticos, en especial perros.

Objective: To characterize ocular toxocariasis clinically and epidemiologically. Methods: An observational, descriptive and cross-sectional study was conducted with patients diagnosed with ocular toxocariasis, attended at the Instituto Cubano de Oftalmología Ramón Pando Ferrer in the period from April 2019 to December 2022. Results: The male sex predominated (53.7 %), together with the age group 0-10 years (73.1 %). 56.1 % of the patients lived in rural areas. Cohabitation with domestic animals accounted for 75.6 %. The most frequently reported symptom was decreased visual acuity (48.8 %). The most frequent form of presentation was peripheral granuloma in the right eye (52.4 %). The most observed complication was retinal detachment (58.5 %). Conclusions: Ocular infection by Toxocara spp. is a preventable, as well as incapacitating, disease that limits the educational, occupational and general life development of affected patients, particularly children, males and those living in rural areas cohabitating with domestic animals, especially dogs.

Complicaciones oculares como forma de presentación de la toxocariasis

La toxocariasis es una zoonosis prevalente con un importante impacto socioeconómico, particularmente en las comunidades pobres de todo el mundo. Es causada por formas larvarias de especies de nematodos, parásitos del género Toxocara. El espectro de manifestaciones clínicas en la toxocariasis varía ampliamente, desde casos asintomáticos a infecciones generalizadas. En el caso de la toxocariasis ocular, el deterioro de la agudeza visual es la manifestación más común cuando los síntomas están presentes. Las presentaciones oculares incluyen endoftalmitis crónica, granuloma de polo posterior o granuloma periférico. Presentamos el caso de una paciente de 12 años, con toxocariasis ocular en forma de granuloma de polo posterior con bandas traccionales a vítreo, acompañada de una lesión hiperpigmentada en el área macular en fase cicatrizal. El propósito de esta publicación es describir las múltiples complicaciones oculares que pueden concomitar en el paciente con toxocariasis ocular, que finalmente conllevan a una pérdida visual irreversible.

Toxocariasis is a prevalent zoonosis with a significant socioeconomic impact, particularly in poor communities around the world. It is caused by larval forms of nematode species, parasites of the Toxocara genus. The spectrum of clinical manifestations in toxocariasis varies widely from asymptomatic cases to systemic infections. In the case of ocular toxocariasis, impaired visual acuity is the most common manifestation when symptoms are present. Ocular presentations include chronic endophthalmitis, posterior pole granuloma, or a peripheral granuloma. We present the case of a 12-year-old patient with ocular toxocariasis in the form of a posterior pole granuloma with vitreous tractional bands, which is accompanied by a hyperpigmented lesion in the macular area in the healing phase. The purpose of our publication is to highlight the multiple ocular complications that can occur in patients with ocular toxocariasis, which ultimately lead to irreversible visual loss.

Intraoral healing type of pyogenic granuloma (A benign vascular tumor): A case report

Pyogenic granulomas represent tumor-like lesions affecting the skin and the oral cavity. This classic definition can be somewhat misleading because such lesion is not associated with infection and lacks any clinical evidence of pus or histological evidence of actual granulation tissue. This case report describes a surgical excision of the growth to exclude angiomatous proliferation. The patient reported a chief complaint of localized gingival overgrowth since 4 months. Intraoral examination revealed an irregular, sessile exuberant growth in respect to labial aspect and interdental gingiva of 31, 32, and 33, measuring about 1.6 × 1.1 cm. Based on the clinical findings, the case was provisionally diagnosed as “pyogenic granuloma“. A treatment was planned for the patient. A surgical excision was done irt 31, 32, 33, and the tissue was sent for histopathological examination, which was suggestive of a healing type of pyogenic granuloma.

CYTOMORPHOLOGY PATTERN ON FNAC AND AFB POSITIVITY IN CASES OF TUBERCULAR LYMPHADENITIS IN A TERTIARY CARE CENTRE OF CENTRAL INDIA

Background- One of the most typical diagnoses at OPDs in a developing nation like India is tuberculous lymphadenitis. Anti-tubercular therapy, however, cannot be started based solely on clinical suspicion. Along with culture, cytomorphology with acid fast staining is an effective tool for diagnosing these cases. The purpose of the study was to examine the usefulness, limits, and relationships between Ziehl-Neelsen staining in tuberculous lymphadenitis and various cytomorphological presentations using fine needle aspiration cytology. At a tertiary care facility, the study was Materials and Methods- carried out over the course of a year with a total of 146 cases. Patients who had lymphadenopathy that was clinically suspected were chosen. There were 36.3% cases of tuberculous Resultlymphadenitis out of which 66.04% cases were overall AFB positive. The most frequent cytological finding was epithelioid cell granulomas with lymphocytes, and cases with granulomas and necrosis had the highest levels of AFB positivity. Most patients first showed up in their third or fourth decade of life. Solitary lymphadenopathy, as opposed to matted lymph nodes as reported by others, was the most frequent presentation and the cervical area was the most frequently involved site. Fine needle as Conclusion- piration cytology is a highly sensitive method for diagnosing tuberculous lymphadenitis that is inexpensive, safe, and dependable. By adding acid fast staining and culture procedures to cytomorphology, the diagnostic index can be raised even higher. However, FNAC combined with methods like ELISA and PCR would improve the current landscape of diagnostic and therapeutic options.

A Non-Classical Presentation of Oral Pyogenic Granuloma with Actinomycosis

Introduction: Pyogenic granuloma is a rather confusing reactive lesion of the oral mucosa, considering it is neither a bacterial infection nor does it produce any pus. In fact, even histologically, there is no formation of granulomas to substantiate the name. Intraoral actinomycosis is another interesting lesion due to its unique ability to masquerade itself as a swelling, abscess, or even a neoplasm. The occurrence of the two lesions separately is common in the oral cavity, however, their co-existence is extremely rare. Case Presentation: A 65-year-old female patient was referred from a private dental clinic with the chief complaint of a growth on her left posterior region of mouth, at the occlusal level of 15, 18 tooth regions for past 1 month. Conclusion: Clinicians should be aware about the occurrence of such rare combination of intraoral lesions, in order to make an accurate diagnosis and in turn, tailor a correct treatment protocol for these patients.

Transcutaneous injection of triamcinolone acetonide for persistent glottic granulation after laser microsurgery

Abstract Objective The aim of study was to demonstrate that transcutaneous intralesional injection of Triamcinolone Acetonide (TA) under fibrolaryngoscopy could be an option for persistent granulation after Transoral Laser Microsurgery (TLM) in glottic cancer patients. Methods We recruited 32 patients, who had conservative treatment but failed. 20 patients accepted TA injection monthly until the granulation disappeared or did not shrink further. 12 patients chose to closely monitor. Results For the 20 patients, 17 (85.0%) patients' granulations completely disappeared. 3 (15.0%) patients' granulations had reduced 80%. For the 12 patients, 3 (25.0%) patients' granulations disappeared but 9 (75%) patients' granulations did not have an obvious change. Recurrence was not observed. Conclusion Our experience showed that transcutaneous intralesional TA injection for persistent granulation after TLM through cricothyroid membrane is an efficient, security, harmless and low recurrence method. Especially suitable for huge granulation which blocks the glottis and recur after a second operation.

Choroidal lesions in varicella zoster virus uveitis

Purpose: To evaluate choroidal lesions with spectral domain optical coherence tomography (SD?OCT) scan in varicella zoster virus (VZV) uveitis. Methods: VZV?uveitis cases which underwent OCT scan for choroidal lesions were studied. SD?OCT scan passing through these lesions was studied in detail. Subfoveal choroidal thickness (SFCT) during active and resolved stages was studied. Angiogaphic features were studied where available. Results: Thirteen out of 15 cases had same?sided herpes zoster ophthalmicus skin rashes. All except three patients had old or active kerato?uveitis. All eyes demonstrated clear vitreous and a single or multiple hypopigmented orangish?yellow choroidal lesions. The number of lesions remained unchanged during the follow?up on clinical examination. SD?OCT over lesions (n = 11) showed choroidal thinning (n = 5), hyporeflective choroidal elevation during active inflammation (n = 3), transmission effects (n = 4), and ellipsoid zone disruption (n = 7). The mean change in SFCT (n = 9) after resolution of the inflammation was 26.3 ?m (range: 3–90 ?m). Fundus fluorescein angiography showed iso?fluorescence over lesions in all (n = 5), but indocyanine green angiography (n = 3) showed hypofluorescence at lesions. Mean follow?up was 1.38 years (range: 3 months–7 years). De?novo appearance of choroidal lesion during the first relapse of VZV?uveitis was captured in one case. Conclusion: VZV?uveitis can cause focal or multifocal hypopigmented choroidal lesions with thickening or scarring of choroidal tissue, depending on the disease activity.

Hemangioma lobular capilar inusual en un paciente pediátrico. Reporte de caso y revisión de literatura / Unusual capillary lobular hemangioma in a pediatric patient. Case report and literature review

Lobular capillary hemangioma or pyogenic granuloma is a benign non-neoplastic lesion that is mainly presented as a tissue growth in response to irritation or trauma. It is located on the skin or on the mucous membrane, with the oral mucosa being the most frequent, with the gingiva standing out, but also appearing in other places such as the lips, buccal mucosa, palate and tongue, the latter being a very unusual location. This is a report of the case of a pediatric patient who underwent a surgical procedure of frenotomy, and who subsequently presented a lesion due to trauma possibly as a consequence of local anes-thesia, which forced an excisional biopsy, the histopathological diagnosis being capillary lobular hemangioma or pyogenic granuloma. Likewise, a literature review of this type of pathology is presented, with emphasis on its location in the tongue.

Linfoma de células T/natural killer extranodal de tipo nasal enmascarado en una sinusopatia

Introducción: El linfoma de células T citotóxico/natural killer extranodal de tipo nasal es poco frecuente, pero con alta tasa de mortalidad. Las manifestaciones clínicas de la enfermedad pueden simular una infección de senos paranasales. Objetivo: Presentar las manifestaciones clínicas de un paciente de 34 años de edad con diagnóstico de linfoma de células T citotóxico/natural killer extranodal de tipo nasal. Caso clínico: Se presenta un paciente masculino de 34 años de edad con rinorrea verdosa fétida recurrente y obstrucción en fosa nasal derecha. En la evaluación inicial sugiere sinusitis crónica, sin embargo, debido al empeoramiento de las manifestaciones clínicas se realiza una tomografía computarizada que muestra lesiones sugestivas de infiltración neoplásica, una biopsia de la lesión confirma el diagnóstico de linfoma de células T/natural killer extranodal de tipo nasal. Conclusiones: Los linfomas de células T citotóxico/natural killer extranodal de tipo nasal son considerados neoplasias poco frecuentes, caracterizadas por el patrón rápidamente progresivo con afectación ósea; en su etapa inicial presenta manifestaciones clínicas similares a una sinusitis. La tomografía computarizada y la histopatología, son indispensables en el diagnóstico de la enfermedad.

Introduction: Nasal-type extranodal natural killer/cytotoxic T-cell lymphoma is rare but has a high mortality rate. The clinical manifestations of the disease can mimic a paranasal sinus infection. Objective: To present the clinical manifestations of a 34-year-old patient diagnosed with nasal-type extranodal natural killer/cytotoxic T-cell lymphoma. Clinical case: A 34-year-old male patient with recurrent greenish fetid rhinorrhea and obstruction in the right nostril is presented. In the initial evaluation, it suggests chronic sinusitis, however, due to the worsening of the clinical manifestations, a computed tomography is performed that shows lesions suggestive of neoplastic infiltration, a biopsy of the lesion confirms the diagnosis of T-cell lymphoma/extranodal natural killer. Conclusions: Nasal-type extranodal natural killer/cytotoxic T-cell lymphomas are considered rare neoplasms characterized by a rapidly progressive pattern with bone involvement; in its initial stage it presents clinical manifestations similar to sinusitis. Computed tomography and histopathology are essential in the diagnosis of the disease.

Sole, An Uncommon Location of Borderline Tuberculoid Hansen’s Disease

Leprosy a chronic granulomatous infection, frequently affects areas with relatively low temperature and which are trauma prone. Areas like scalp, palms and soles, groins, genitalia, axillae, eyelids, and perineum, have been described as “immune” to development of leprosy. But clinic-pathological and bacteriological evidence of involvement of these so-called “immune zones” has rarely been documented. Palmoplantar involvement is uncommon in leprosy and could be easily misdiagnosed. We report here a case of 65-year-old male who had a single, well defined, round, 5*5 cm, dull erythematous to hyperpigmented plaque with central clearing over medial aspect of left foot extension as single, erythematous, roundish 2*2cm, plaque with central clearing over medial aspect of left foot just below ankle, for 3 months. There was decreased sensation to hot and cold temperature and to fine touch and pain over the lesions. Sensory examination elsewhere on the body was normal. There was no motor loss, no thickened nerves, no deformities, trophic ulcers or evidence of reaction. Histopathology of sole lesion suggested borderline tuberculoid Hansen’s disease. Stain for AFB was negative. Slit skin smear was negative. Good response to MDT was seen at end of 4 months. Such presentation needs to be kept mind for diagnosis of leprosy for instituting timely and appropriate treatment

A Case Report of Annular Elastolytic Giant Cell Granuloma / 罕见病研究

Annular elastolytic giant cell granuloma(AEGCG) is a rare granulomatous skin condition. We present a case of a 67-year-old man with annular plaques on the face, neck, shoulder, back and upper limbs, and mildly pruritis exceeding one year. Histopathological examination demonstrated granulomatous inflammatory infiltration of lymphocytes, histiocytes and multinuclear giant cells in the middle and the upper dermis, with more local eosinophils. Elastic fiber staining showed that elastic fibers were absent in granuloma area and were engulfed by multinucleated giant cells. Based on the clinical and histopathological findings, a diagnosis of AEGCG was made. The etiology and pathogenesis of this condition are unclear, and atypical manifestations of non-exposed areas can also occur.It is usually related to systemic diseases lacks specific treatment at present.

Cholesterol granuloma as a rare differential in bone erosion of the orbit: A case report

Objective@#We report a case of orbitofrontal cholesterol granuloma as a rare differential diagnosis of orbital erosion in the diploe of the frontal bone. @*Methods@#This is a case report. @*Results@#A 50-year-old man presented with right eye proptosis. Computed tomography (CT) scan of the orbit showed a fairly delineated homogeneous mass centered in the diploe of the right frontal bone with calcification and rugged erosion of the frontal bone and with expansion into the right superotemporal orbit. The patient was initially diagnosed with malignant lacrimal gland tumor on the right. He underwent orbitotomy with excision of the mass. Histopathologic studies of the excised mass revealed a cholesterol granuloma.@*Conclusion@#Cholesterol granulomas of the frontal bone in the superotemporal orbit are rare benign lesions that present with bone destruction and can be mistaken for lacrimal gland malignancies. Surgical excision has a high success rate with low incidence of recurrence.

Epidemiological characteristics of Mycobacterium marinum infection cases in a hospital in Shandong province, 2019 to 2021 / 中华皮肤科杂志

Objective:To investigate epidemiological characteristics of Mycobacterium marinum infection cases in the Dermatology Hospital of Shandong First Medical University from January 2019 to December 2021. Methods:Data were collected from patients with Mycobacterium marinum infection in the Dermatology Hospital of Shandong First Medical University from January 2019 to December 2021. Demographic characteristics, clinical features and prognosis of patients were retrospectively analyzed. Differences between groups were analyzed using t test, Chi-square test and Fisher′s exact test; factors influencing the time to diagnosis (the time from the first appearance of skin manifestations to the diagnosis of Mycobacterium marinum infection in the hospital) longer than 12 months were analyzed using Chi-square test and multivariate logistic regression model, and the odds ratio ( OR) and 95% confidence interval (95% CI) were calculated. Results:From 2019 to 2021, a total of 373 cases of Mycobacterium marinum infection were diagnosed in the hospital, and the number of cases in 2021 was 4.06 times that in 2019; the male-to-female ratio was 1∶1.49, and their age was 54.24 ± 14.04 years. Among the 373 patients, 211 (56.57%) had a history of trauma caused by aquatic products (e.g., fishes, shrimps), of which 51 (24.17%) were stung by sea perch. Skin lesions involved unilateral limbs in 327 (87.67%) patients, only involved the hands or wrists in 188 (50.40%) patients, and 258 (69.17%) had multiple skin lesions. Among the 341 patients with treatment information, 105 (30.79%) were given one antibiotic, 214 (62.76%) received combination treatment with two antibiotics, and 15 (4.40%) were treated with three antibiotics. The response rate was 98.77% (321/325), and the time to diagnosis [ M ( Q1, Q3) ] was 5.03 (3.00, 8.37) months. Multivariate logistic regression analysis indicated higher proportions of males ( OR [95% CI]: 1.95[1.11 - 3.41], P = 0.02), patients aged > 55 years ( OR [95% CI]: 1.82[1.04 - 3.18], P = 0.04), patients with skin lesions only involving hands, arms or lower limbs ( OR [95% CI]: 3.48[1.83 - 6.61], P<0.001) among the patients whose time to diagnosis was longer than 12 months. Conclusions:The number of patients with Mycobacterium marinum infection was increased in the Dermatology Hospital of Shandong First Medical University year by year from 2019 to 2021, and fish sting wounds were the main cause of infection. The most common treatment regimen was the combination of two antibiotics, with a high efficacy profile.

Pyogenic granuloma of the gums and lips caused by camrelizumab: case report and literature review / 口腔疾病防治

Objective@# To investigate the clinical manifestations, pathological features, and treatment of oral and maxillofacial pyogenic granulomas induced by camrelizumab. @*Methods@# A case of pyogenic granuloma of the gums and lips caused by camrelizumab was reported along with a literature review. @*Results@# After 4 months of treatment with camrelizumab for liver cancer, the patient developed systemic reactive capillary hyperplasia (RCH), followed by multiple masses on the lower lip and gingiva. After periodontal therapy, the masses on the lower lip and the gingiva were removed, and camrelizumab administration was stopped. The pathological result was gingival pyogenic granuloma/granulomatous hemangioma. No new masses were found in the oral cavity during postoperative follow-up. A review of the literature showed that RCH is the most common adverse drug reaction to camrelizumab but it occurs infrequently in the oral cavity. At present, the etiology of RCH has not been clarified, but the research has shown that camrelizumab may trigger tissue proliferation into hemangiomas by activating vascular endothelial cells, and the combined use of camrelizumab is safer than single use. RCH is self-limiting and most cases resolve spontaneously after discontinuation of the drug. If the mass causes dysfunction, surgical excision is feasible.@*Conclusion @#Camrelizumab can cause oral and maxillofacial reactive capillary hyperplasia complicated by pyogenic granuloma.