Representation of Skin of Color in Rheumatology Educational Resources.

OBJECTIVE: To investigate the availability of images representing Black, Indigenous, and people of color in rheumatology educational resources. METHODS: Color images were collected from 5 major educational resources and cataloged by the resources they came from, underlying rheumatic conditions, and skin type. Fitzpatrick skin type (FST) was used to categorize images into "light," "dark," or "indeterminate." The images were initially scored by a fellow in the Division of Rheumatology and subsequently validated by a faculty member from the Department of Dermatology. RESULTS: Of the thousands of images reviewed, 1604 images met study criteria. FST validation from the Department of Dermatology resulted in the recoding of 111 images. The final scoring revealed 86% of the images to be light skin, 9% of images to be dark skin, and 5% of images to be indeterminate. CONCLUSION: The paucity of dark skin images in rheumatology resources is incongruent with current diversity estimates in the US. Significant efforts should be made to incorporate images of Black, Indigenous, and people of color into educational resources.

COVID-19-associated acute disseminated encephalomyelitis (ADEM).

A 51-year-old woman with COVID-19 infection developed coma and an impaired oculocephalic response to one side. MRI of the brain demonstrated acute multifocal demyelinating lesions, and CSF testing did not identify a direct cerebral infection. High-dose steroids followed by a course of IVIG was administered, and the patient regained consciousness over the course of several weeks. As more patients reach the weeks after initial infection with COVID-19, acute disseminated encephalomyelitis should be considered a potentially treatable cause of profound encephalopathy or multifocal neurological deficits.

Behcet's-like syndrome following pembrolizumab: An immune-related adverse event associated with programmed death receptor-1 inhibitor therapy.

INTRODUCTION: The landscape for the treatment of metastatic melanoma has been revolutionized with the introduction immune checkpoint inhibitors. Immune checkpoint inhibitors have now become the standard of care for the treatment of cancers. These immune agents including programmed death receptor-1 inhibitors, programmed death-ligand 1 inhibitors and cytotoxic T-lymphocyte antigen-4 inhibitors have shown promising results but have been associated with numerous immune-related complications. Pembrolizumab, a programmed death receptor-1 inhibitor, has been associated with a number of immune-related adverse events affecting multiple organ systems including integument, ocular, endocrine, cardiovascular, pulmonary, renal, gastrointestinal, and musculoskeletal system. CASE REPORT: We present a case of an 88-year-old Caucasian male with metastatic melanoma of the face with metastasis to the right fifth cranial nerve and into the right cavernous sinus. He underwent resection of the melanoma and was placed on pembrolizumab at 2 mg/kg every three weeks. Interestingly, 24 months on pembrolizumab therapy, he developed corneal erosions, oral and genital ulcerations. MANAGEMENT AND OUTCOME: Patient completed his 24 months of pembrolizumab and was started on prednisone and colchicine with improvement in his symptoms. At his follow-up eight months, he had recurrence of an oral ulcer. DISCUSSION: Here we present a rare case of an elderly male on pembrolizumab who suffered from corneal erosions, oral and genital ulcers, a syndrome similar to Behcet's disease. Given that pembrolizumab and other immune checkpoint inhibitors are being utilized in the treatment of cancers, physicians should be aware of the wide range immune-related adverse events including the possible Behcet's-like syndrome presentation.