A Review Study Toward Clinical and Histopathological Diagnosis Agreement in Skin Diseases.

Background: It is important to evaluate the agreement between clinical diagnosis and histopathological diagnosis. The aim of this study was to review studies and to calculate the degree of agreement between clinical and histopathological diagnosis. Objective: The aim of this review was to find out the concordance level between clinical and histopathological diagnosis; to find out in which type of pathology concordance was the highest; to identify the types of pathologies for which biopsy was mostly performed and the anatomical region selected for biopsy. Results and Discussion: Review was carried out in accordance with the PRISMA 2020 flow diagram for the selection of articles that met the criteria (years 2005-2021). Articles were found in Google scholar, PubMed, Scopus databases using different keywords. The main criterion was to involve studies that reported data about clinical and histopathological diagnosis. A mean concordance value was calculated and resulted of 72.8 % (95% CI). Conclusion: To our knowledge, our study was the first review done regarding concordance between clinical and histopathological diagnosis in skin diseases with the aim to provide researchers with enriched literature and encourage them to bring about an appropriate systematic review study.

Activation of Herpes Simplex Infection after Tattoo.

Tattooing is a procedure where ink is applied to an area of the skin, mostly intraepidermally (1). This procedure is carried out mainly for aesthetic purposes. Lately, it has been used as a corrective medical procedure following amputation of mammilla. The procedure is aggressive (2), and the fact that skin is punctured many times with the same needle which cannot be fully sterilized may cause infection of the treated area with bacterial, fungal, or viral agents that may lead to health consequences manifesting in the form of verrucae vulgaris, molluscum contagiosum, and herpes simplex. On the other hand, complications such as granulomas, allergic reactions, Koebner phenomenon, lupus erythematosus, psoriasis, lichen ruber planus, hepatitis C, and HIV infections should also be considered as potential consequences of tattooing (3-7). Even systemic reactions have been reported. Herein we describe a case of herpes infection activation after tattooing. Herein we present the case of a 46-year-old woman, employed in the medical sector, with a two-day history of herpes simplex in the labial area that manifested following application of a cosmetic tattoo meant to outline the lips (Figure 1). Two days after tattoo application, the vesicular lesions appeared along the area that was filled with ink, followed by sub-febrile temperature and fever and a subjective feeling of itching initially, followed by burning sensation and pain. The skin signs located on erythematous base were mainly grouped vesicles with sharply demarcated borders. Regional lymphatic nodes, mainly retro auricular, were enlarged. Within 48 hours, the patient was treated with acyclovir tablets in a dose of 800 mg three times a day and an antipyretic. Acyclovir ointment was administered during the first two days, as well as tetracycline ointment after the second day of the eruption. On the fifth day, we observed regression of the skin changes (Figure 2), and complete healing was achieved after one week. We assessed the medical history of the patient, which revealed the following: hypothyreosis due to lobectomy performed for the treatment of toxic adenoma. The patient was under substitutional therapy with 75 mg levothyroxine. The patient had herpes simplex before, and this was the second herpetic eruption. Herpes simplex is caused by a herpes simplex virus (HSV) type-1 infection that is transmitted through droplets of saliva or direct contact with the affected area, for example during kissing (8-10). Histology reveals intraepidermal blisters, degeneration in epidermal cells at the base of the vesicle, and multilocular eosinophilic inclusional bodies inside cells. Infection is usually more pronounced in the initial phase of disease, where the symptoms are also more intense. Activation of the infection occurs when the body undergoes a decrease in immunity (1), in situations of extensive exposure to the sun, and also in some other circumstances, such as the application of a tattoo as described herein. Tattooing can inoculate the virus or trigger the activation of the herpes virus and other viruses (1,8-10). Tattooing, apart from bringing social stigma in some cases, which is one of the major issues for persons who undergo the procedure, may also cause injuries, contact dermatitis, foreign body granuloma, infections, and allergic reactions including anaphylaxis. Herpes simplex infections are also possible, either by inoculation or reactivation of the HSV. Except in situations where the tattoo is performed for medicinal purposes, tattooing is not a procedure that is supported by dermatologists. Furthermore, tattooing also causes a number of side effects. Allergic reactions (3,4), anaphylactic shock, foreign body granuloma, lichen ruber planus (5), granuloma pyogenes (5), verruca vulgaris, molluscum contagiosum, herpes simplex, and some other bacterial and viral infections.

Erythema exsudativum multiforme induced by a taurine-containing energy drink.

Erythema exsudativum multiforme is an immunologically mediated skin condition caused by viruses, bacteria, food, and drugs. There are different forms, and depending on the severity of the disease there is a major and minor form. Whereas the minor form passes without consequences, the major form and Stevens-Johnson syndrome affect the mucosa and may result in death. The disease affects all age groups but is more often observed in young individuals. Typical signs of the disease are skin lesions termed herpes iris. Taurine is an organic compound used in energy drinks and food that can cause many forms of hypersensitivity reactions, and one of these is erythema exsudativum multiforme. As consumption of energy drinks containing taurine increases, the problem of an increase in cases presenting with various forms of hypersensitivity reactions should be considered. Here we present the case of a 19-year-old man with erythema exsudativum multiforme caused by a drink containing taurine. We excluded all other factors that may have caused erythema multiforme and the patient was hospitalized, having been referred to us for the second time presenting with the same problem caused twice by the same drink.

Tinea Corporis, Caused by Microsporum Canis - a Case Report From Kosovo.

INTRODUCTION: Tinea corporis (B35.6) caused by Microsporum canis which is fungal species that causes numerous forms of disease. It is part of a group of fungi known as Dermatophytes. Though mostly well known for ringworm in pets, it is also known to infect humans. This fact makes this pathogen both anthrophilic and zoophilic in nature. Microsporum canis is a communicable pathogen. CASE REPORT: We will report about a case, 22-year-old female, residing in a village, with typical changes of a mycotic infection caused by M. Canis. Dermatological description can be summarized with polymorphic erythematous, papulosquamous changes, erosions mainly on genital organ and spread to the thighs and lower abdomen which are accompanied with itching and burning. Diagnosis B35.6 was determined on the basis of clinical appearance complemented with anamnesis, microscopic examination and culture. The patient was treated successfully with general and local antimycotics and antibiotics.

Dermatoglyphics and Reproductive Risk in a Family with Robertsonian Translocation 14q;21q.

AIM: The present study is carried out to evaluate the risk of giving birth to children with Down syndrome in a family with Robertsonian translocation 14q;21q, and to find the dermatoglyphic changes present in carriers of this translocation. METHODS: Cytogenetics diagnosis has been made according to Moorhead and Seabright method, while the analysis of prints (dermatoglyphics analysis) was made with the Cummins and Midlo method. RESULTS: Cytogenetic diagnosis has been made in a couple who suffered the spontaneous miscarriages and children with Down syndrome. Robertsonian translocation between chromosomes 14 and 21 (45, XX, der (14; 21) (q10; q10)) was found in a female partner who had four pregnancies, in two of which was found fetus karyotype with trisomy in chromosome 21 and pregnancies were terminated. The outcome of fourth pregnancy was twin birth, one of them with normal karyotype and another with Down syndrome due to Robertsonian translocation inherited by mother side. Specific dermatoglyphics traits are found in the child carrying Down syndrome, whereas several traits of dermatoglyphics characteristic of Down syndrome have been displayed among the silent carriers of Robertsonian translocation 14q;21q. CONCLUSION: Robertsonian translocation found in female partner was the cause of spontaneous miscarriages, of giving birth to a child with Down syndrome, and of trisomy of chromosome 21 due to translocation in two pregnancies.

Falls in Diagnosis of Cutaneous Larva Migrans-a Case Report from Kosovo.

INTRODUCTION: Cutaneous larva migrans (CLM) is a dermatitis caused by hookworm larvae inoculation in the skin, most commonly acquired among individuals in tropical and sub-tropical areas or travelers who have visited those areas. The typical clinical presentation consists of itchy serpiginous lesion that advances. CASE REPORT: We are reporting a long time misdiagnosed case of a 37-year-old farmer from continental European region with a typical clinical presentation, and no history of traveling to endemic areas. We made the diagnosis of the CLM based on the patient's history of itchy skin that had advanced for a few months, and clinical characteristics of the lesion in the right gluteus region consisting of erythema, papula and vesicles, together with erythematous/livid serpiginous tracks that formed an irregular and capricious path. The patient was successfully treated with oral mebendazole twice daily for three days and local therapy.

Acrodermatitis enteropathica.

AIM: The aim of the work was the presentation of one case with Acrodermatitis enteropathica. METHODS: Acrodermatitis enteropathica is diagnosed based on the pedigree, typical clinical manifestations on the skin, laboratory results, small bowel biopsy, skin biopsy and kariotype. RESULTS: The patient was a two years old male toddler, hospitalized due to skin changes, chronic diarrhoea and total alopecia. Skin changes appeared on akral of the limbs, inguinal and perineal region, joints, perioral area and eyes. These changes appeared in different forms (erythematous, squamous, eczematiod, psoriasisforme and crusted). In the eyes were present these changes: blepharitis and conjunctivitis. Also total alopecia was prezent. Diarrhoea was chronic and specific. Laboratory findings showed the existence of sideropenic anemia, hypoproteinemia with hypoalbuminemia and low plasma zinc concentration (7.5 micromol/L). Hystopathological changes on the small bowel and skin biopsy were not typical for this disease. Following the beginning of treatment with zinc sulphate, all clinical skin manifestations disappeared within two months, but the disease itself was characterized with the periods of exarcerbation and remission. CONCLUSION: Acrodermatitis Enteropathica is a rare hereditary autosomal recessive disease. Mandatory clinical manifestations are: skin changes, chronic diarrhoea and alopecia. Treatment with zinc is obligatory for the life time.

Presenting colorectal carcinoma cases in our department.

BACKGROUND: Colorectal carcinoma is second commonest cancer causing death in Kosova. METHODOLOGY: In our study we present diagnostic methods, treatment, localization and laboratory findings in 155 patients, during 4 year period in patients with colorectal carcinomas treated in our clinic. RESULTS: Ninety four 94 (61.4%) of patients were male gender and 59 (38.6%) were female. Eritrosedimentation was elevated in 103 (67.3%) of patients, number of white blood cells was increased in 21 (7.2%) of patients and high level of glycemia is present in 11 (7.2%) of patients. The most involved age is from 41-50 years. The most common site of involvement was the rectum in 79 (51.6%), localization in sigma was in 37 (23.5%), the transverse colon in 21 (13.7%) of cases and the ascendant colon in 18 (11.1%) patients. Adenocarcinoma (98%) was the most common histiotype. CONCLUSION: We concluded, that all patients, especially with positive familial history must begin screening in age 40, during which colorectal carcinoma can be diagnosed in an early stage.