The Rare Adverse Effect of Myalgia After Dupilumab Biologic Therapy for Refractory Atopic Dermatitis.

Dupilumab, a systemic injectable biologic, can be prescribed to patients with atopic dermatitis who do not respond to topical treatments. Atopy can frequently subside by blocking inflammatory pathways, such as interleukin-4 (IL-4) and interleukin-13 (IL-13) in the immune system. Dupilumab is generally well-tolerated and mild; the most common adverse reactions listed are arthralgia, back pain, and conjunctivitis, which clears upon cessation or finalization of dupilumab therapy. This case report describes a patient experiencing severe myalgia - a rare adverse effect. The patient's atopic dermatitis was refractory toward topical treatments, but within one month of starting dupilumab, he experienced severe myalgias and muscle spasms, which prompted cessation of dupilumab despite it working well for his atopic dermatitis.

Successful Treatment of Refractory Generalized Granuloma Annulare with Upadacitinib.

Granuloma annulare is a poorly understood dermatosis that, when generalized, can occur in up to 15 percent of patients. In these cases, treatment is frustrating and experimental. We report a case of a 60-year-old woman and a 41-year-old woman who demonstrated resolution of recalcitrant, generalized granuloma annulare (GA) following oral treatment with upadacitinib. After showing little to no response to other various treatments, such as steroids, antibiotic regimens, and systemic therapies, each patient was started on 15 mg of daily upadacitinib. At 2 months, one patient had complete clearance of all lesions while the other patient experienced noticeable improvement. Within 4 months, the other patient reached total resolution of her lesions. These cases provide evidence of a therapeutic option that may shorten disease duration and provide relief from cutaneous disease.

Phytophotodermatitis From Lime Margaritas on a Mexico Vacation.

Phytophotodermatitis is a type of contact dermatitis that occurs upon skin exposure to certain plant chemicals, known as furocoumarins, along with simultaneous sun exposure. This case details a 34-year-old patient who presented to the office with an asymptomatic, irregularly shaped, and hyperpigmented patch located on the left inferior middle back that had been present since a recent beach vacation in Mexico. Upon gathering the history, clinicians should inquire about recent sunlight exposure while consuming and/or touching phytotoxic plant derivatives found in most citrus plants. The history should correspond with the skin examination findings and conclude that a cutaneous phytotoxic reaction had occurred when a lime margarita contacted the hand, which was subsequently rubbed onto the patient's back. This case highlights the importance of both taking a thorough history and physical examination and being aware of the broad range of skin manifestations to prevent unnecessary treatment, such as topical corticosteroids, for other skin disorders (the irregular presentation of atopic dermatitis, allergic contact dermatitis, and dermatitis unspecified) or improperly suspected child abuse in younger patient presentations.

En Coup de Sabre in a Pediatric Patient Treated With Calcipotriene.

En coup de sabre (ECDS) is a form of linear scleroderma or morphea that distinctly appears on the forehead and/or frontoparietal scalp. We report a case of a 6-year-old female that presented with a linear, hyperpigmented scar on her left forehead extending to her scalp with resultant alopecia and discoloration in the affected area. The patient was subsequently treated with topical calcipotriene ointment and had an excellent response with normalization of the sclerotic skin, hair regrowth, and improved hyperpigmentation. This report demonstrates that a conservative approach to treating pediatric patients with ECDS via calcipotriene ointment can be safe and effective.

Origin, behaviour, and genetics of reproductive workers in an invasive ant.

BACKGROUND: Worker reproduction has an important influence on the social cohesion and efficiency of social insect colonies, but its role in the success of invasive ants has been neglected. We used observations of 233 captive colonies, laboratory experiments, and genetic analyses to investigate the conditions for worker reproduction in the invasive Anoplolepis gracilipes (yellow crazy ant) and its potential cost on interspecific defence. We determined the prevalence of worker production of males and whether it is triggered by queen absence; whether physogastric workers with enlarged abdomens are more likely to be reproductive, how normal workers and physogastric workers compare in their contributions to foraging and defence; and whether worker-produced males and males that could have been queen- or worker-produced differ in their size and heterozygosity. RESULTS: Sixty-six of our 233 captive colonies produced males, and in 25 of these, some males could only have been produced by workers. Colonies with more workers were more likely to produce males, especially for queenless colonies. The average number of days between the first appearance of eggs and adult males in our colonies was 54.1 ± 10.2 (mean ± SD, n = 20). In our laboratory experiment, queen removal triggered an increase in the proportion of physogastric workers. Physogastric workers were more likely to have yolky oocytes (37-54.9%) than normal workers (2-25.6%), which is an indicator of fertile or trophic egg production. Physogastric workers were less aggressive during interspecific aggression tests and foraged less than normal workers. The head width and wing length of worker-produced males were on average 4.0 and 4.3% greater respectively than those of males of undetermined source. Our microsatellite DNA analyses indicate that 5.5% of worker-produced males and 14.3% of males of undetermined source were heterozygous, which suggests the presence of diploid males and/or genetic mosaics in A. gracilipes. CONCLUSIONS: Our experimental work provides crucial information on worker reproduction in A. gracilipes and its potential cost to colony defence. The ability of A. gracilipes workers to produce males in the absence of queens may also contribute to its success as an invasive species if intranidal mating can take place between virgin queens and worker-produced males.

Beauveria bassiana and Metarhizium anisopliae endophytically colonize cassava roots following soil drench inoculation.

We investigated the fungal entomopathogens Beauveria bassiana and Metarhizium anisopliae to determine if endophytic colonization could be achieved in cassava. An inoculation method based on drenching the soil around cassava stem cuttings using conidial suspensions resulted in endophytic colonization of cassava roots by both entomopathogens, though neither was found in the leaves or stems of the treated cassava plants. Both fungal entomopathogens were detected more often in the proximal end of the root than in the distal end. Colonization levels of B. bassiana were higher when plants were sampled at 7-9 days post-inoculation (84%) compared to 47-49 days post-inoculation (40%). In contrast, the colonization levels of M. anisopliae remained constant from 7-9 days post-inoculation (80%) to 47-49 days post-inoculation (80%), which suggests M. anisopliae is better able to persist in the soil, or as an endophyte in cassava roots over time. Differences in colonization success and plant growth were found among the fungal entomopathogen treatments.

Recurrent varicella in an immunocompetent woman.

Varicella-zoster virus (VZV) infection causes 2 distinct disease processes. Primary VZV infection results in varicella (chickenpox), a common generalized eruption, and subsequent reactivation of VZV classically results in herpes zoster (shingles), which presents as a unilateral, dermatomal eruption. Although a single VZV infection typically confers protection against its reactivation, recurrent varicella rarely is reported, particularly in immunocompetent patients. We present the case of a 52-year-old black woman with an intact immune system who demonstrated 3 VZV infections.