ABSTRACT
Harlequin ichthyosis (HI) is an autosomal recessive disorder. It is a fatal disease and many infants born with HI die shortly after birth. The incidence is extremely rare and is reported to be about 1 in 300,000 births. The hallmark of the disease is alligator-like horned skin that is severely keratinized. Several cases of fetal HI have been reported, but to contribute to the collective knowledge of this rare severe skin disorder, we report the first case, from Medina, Saudi Arabia, of a 45-year-old woman who delivered a newborn infant with HI and has a previous history of six infants who died from a similar condition. Obtaining a prenatal diagnosis, in this case, is critical to alleviate the physical and mental suffering experienced by parents and relatives. Management is mainly supportive until now, as no curable therapy has been proven. Genetic counseling of the ABCA12 gene is advised in consanguinity marriage with positive family history.
ABSTRACT
Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is a rare auto-inflammatory condition involving cutaneous and osteoarticular manifestations. This study presents a case where a 16-year-old male with glucose-6-phosphate dehydrogenase (G6PD) deficiency presented with severe nodulocystic acne after three weeks of isotretinoin therapy. In addition to worsening acne, the patient had bone and joint pain with movement restriction. The patient's workup showed elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), bilateral symmetrical sacroiliitis on magnetic resonance imaging (MRI), and multiple bony lesions on bone scintigraphy. A diagnosis of SAPHO syndrome possibly induced by isotretinoin was made. Isotretinoin discontinuation, analgesia, topical acne medications, prednisolone, and adalimumab yielded considerable clinical improvement.
ABSTRACT
Nail changes elicited by Ibrutinib are relatively infrequent but are reported in the literature. Herein, we report on two cases that developed Ibrutinib-induced nail toxicities. A 63-year-old female, with relapsing mantle cell lymphoma on Ibrutinib 560mg/day for seven months developed paronychia, onychomadesis, Beau's lines, nail fragility, and brittleness over fingernails and toenails. On the other hand, an 80-year-old male with chronic lymphoid leukemia developed a bloody papule with hemorrhagic crust and nail-plate abnormalities. Skin toxicities manifested eight months after initiating Ibrutinib therapy. From a clinical perspective, Ibrutinib-induced chronic paronychia and PG have been established. All other PG triggers have been ruled out. After the cessation of Ibrutinib, the PG improved for both cases. The exact pathogenesis of PG induced by Ibrutinib is not yet understood but it had been compared to retinoid-related changes. Thus, further research and reporting of similar cases should be done to further understand the pathophysiology of such manifestations.
ABSTRACT
PURPOSE: Acne vulgaris is a common dermatological disease in adolescents that show high prevalence rates of anxiety and depression that may lead to consequences that affect quality of life. This study aimed to assess and compare anxiety and depression in patients with acne and a control group and to determine their correlation with other demographic data. PATIENTS AND METHODS: This was a case-control study conducted in 2019 for 3 months at the derma-tology department of Ohud Hospital and two other private clinics in the Medina region of Saudi Arabia. For this study, 296 consecutive patients in the age group of 12 to 60 years who were diagnosed as having acne vulgaris were enrolled and matched with a control group. Data were collected through a self-administered questionnaire, including sociodemographic data and Hospital Anxiety and Depression Scale scores. RESULTS: We found no significant differences between the two groups regarding sex, age group, nationality, and educational level, but found a significant difference in marital status (p < 0.001). Most (62.5%) of the acne cases were moderate in severity. The overall anxiety score in the acne group was 7.68 ± 4.90, with a significant difference with the control group (p = 0.031), whereas the anxiety level and depression score showed no significant difference (p = 0.082 and p = 0.656, respectively). Moreover, a strong correlation was found between anxiety and depression in the acne group (r = 0.732, p < 0.001). CONCLUSION: A positive correlation was found between the anxiety and depression scores in the patients with acne, which was not related to age group or educational level. However, the anxiety scores of the patients with acne showed a significant relationship with sex.
ABSTRACT
We report a case of a 57-year-old male with a past medical history of controlled hypertension and type 2 diabetes mellitus, who had unusual elevated serum concentration levels of vancomycin during oral treatment for Clostridium difficile pseudomembranous colitis. Both measured serum vancomycin levels of 39 µg/ml and cerebrospinal fluid level of 5.7 µg/mL were documented and associated with unexplained neurological symptoms and sexual dysfunction. After discontinuing of oral vancomycin and treating with hemodialysis, the patient had reduced serum concentration levels to 26 µg/mL accompanied by significant and rapid resolution of symptoms in addition to the general condition. Patients with intestinal disease and reduced renal function who are being treated with oral vancomycin may absorb and accumulate high serum level amounts of vancomycin, causing uncommon neurological toxication symptoms including headache, altered state of consciousness, confusion, and drowsiness in association with sexual dysfunction.
