Cutaneous mucormycosis with suspected dissemination in a patient with metastatic adrenocortical carcinoma.

Mucormycosis is a frequently lethal fungal infection that most commonly affects patients with poorly controlled diabetes or other immunosuppressed states. We report the case of a suspected disseminated Rhizopus infection in a patient who was pursuing naturopathic treatment including mud baths for metastatic adrenocortical carcinoma. He was empirically treated with liposomal amphotericin B but opted to stop treatment following multiorgan failure. The patient passed away on the tenth day of his hospital admission.

Clonal cutaneous and neurosyphilis: A pitfall in pseudolymphoma diagnosis.

Syphilis is a sexually transmitted infectious disease caused by the bacterium Treponema pallidum and can cause a wide variety of cutaneous manifestations, most commonly, a papulosquamous eruption of the trunk and extremities. Treatment with penicillin is curative. We report a case of a 69-year-old man who presented with recent onset of blurry vision and a nonpainful, nonpruritic eruption of pink-to-violaceous dermal nodules on his upper trunk and upper extremities. Biopsies of two separate locations revealed a dense superficial and deep perivascular atypical lymphocytic infiltrate with admixed plasma cells, histiocytes, and eosinophils. Some scattered cells expressed CD30, PD1, BCL-6, and ICOS. T-cell receptor (TCR)-rearrangement showed an identical TCR-gamma clone between both biopsy specimens. The patient was subsequently seen by ophthalmology and diagnosed with acute anterior uveitis. Rapid plasma reagin was reactive and cerebrospinal fluid studies showed findings consistent with a diagnosis of neurosyphilis. A T. pallidum immunostain of the skin biopsies was performed upon re-review, and was diffusely positive for spirochetes at the dermal-epidermal junction and within injured vessels. The patient was treated with penicillin G with near-resolution of his skin lesions. This case highlights the unusual ability of syphilis to mimic a T-cell lymphoma with matching clones across two different biopsy sites.

Granulomatous Facial Dermatoses.

Noninfectious facial papular granulomas can be the presentation of several conditions, including granulomatous periorificial dermatitis, granulomatous rosacea, lupus miliaris disseminatus faciei, and papular sarcoidosis. Although these entities are treated distinctly from one another, they share several clinical and histological characteristics. We present 2 cases of facial papular granuloma: one patient presented with granulomatous rosacea, and the other had a presentation consistent with sarcoidosis but also demonstrated features of granulomatous periorificial dermatitis and had a protracted course of treatment. Such cases exemplify heterogeneity in the evaluation and management of this cutaneous lesion and highlight the necessity of appreciating its various potential causes.

Sports Dermatology: Skin Disease in Athletes.

There are numerous disorders of the skin that occur in athletes. These include infections, mechanical injury, and inflammatory skin diseases such as dermatitis, urticaria, and others. This paper discusses some of the most common athletic skin diseases.

Nephrogenic Systemic Fibrosis Manifesting a Decade After Exposure to Gadolinium.

IMPORTANCE: Nephrogenic systemic fibrosis (NSF) is a fibrosing skin disorder that develops in patients with kidney failure and has been linked to exposure to gadolinium-containing contrast agents. The time between exposure to gadolinium and the initial presentation of NSF is typically weeks to months but has been documented to be as long as 3½ years. We report a case of NSF developing 10 years after exposure to gadolinium. OBSERVATIONS: A long-term hemodialysis patient was exposed to gadolinium several times between 1998 and 2004 during magnetic resonance angiography of his abdominal vessels and arteriovenous fistula. In 2014, he was seen at our clinic with new dermal papules and plaques. Biopsy of affected skin showed thickening of collagen, CD34+ spindle cells, and increased mucin in the dermis, supporting the diagnosis of NSF. CONCLUSIONS AND RELEVANCE: The clinical history and histopathological features of this case support the diagnosis of NSF 10 years after exposure to gadolinium. Although the use of gadolinium contrast agents in patients with kidney failure has markedly decreased, patients with exposure to gadolinium years to decades previously may manifest the disease.

Dermatology and skin disease in the American Civil War.

The Civil War happened at the end of the medical dark ages or, conversely, at the beginning of the modern medical era. The story of how physicians and nurses of the time approached a number of cutaneous diseases of importance in the military context is related. Entities discussed include the army itch/camp itch phenomenon, sexually transmitted diseases, scurvy and nutritional disorders, smallpox and spurious vaccination, and hospital gangrene.

General Halleck's itchy elbows.

General Henry Wager Halleck served as general-in-chief and chief of staff of the Federal army from 1862-1865. Unpopular with troops as well as with many members of the Lincoln administration, he was a particular source of irritation to Secretary of Navy Gideon Welles. In his posthumously-published diary of the war years, Welles viciously criticized Halleck for his failings as army commander. Welles also derided Halleck's personality and personal appearance. Welles found the general's habitual elbow-scratching annoying enough to mention it in five separate diary entries. This depiction of Halleck ceaselessly, nervously scratching his elbows has entered Civil War folklore. Why did Halleck scratch his elbows? Two possibilities exist. Either he did so compulsively, as a nervous habit, or he was scratching an itch. In this paper, I present a speculative argument that Halleck may have had a skin disease, possibly atopic dermatitis, and that this may have contributed to or have been the sole cause of his elbow scratching.

The "army itch:" a dermatological mystery of the American Civil War.

The army itch was a chronic, severely pruritic dermatosis which first appeared among soldiers and some civilians early in the American Civil War (1861-1865). As the war progressed, so did army itch, becoming epidemic in the Potomac Valley of Maryland in 1862 and in Virginia in 1864. Immediately after the war, civilian cases traceable to contact with returning soldiers focused attention on the disorder, but the postwar outbreaks were short-lived and the army itch disappeared by the end of 1867. The origin of army itch eluded medical observers of the time, though many considered epidemic scabies to be the cause. Many cases of army itch were successfully treated with scabicides, but the disease had a well-deserved reputation for intractability. After a review of the chronology of army itch and excerpts from the writings of physicians who saw and treated the disease, it is possible to conclude that army itch was epidemic scabies, though the clinical picture was frequently confounded by coexisting pediculosis, prurigo, and other pruritic dermatoses.