Not all that glitters is COVID-19: a case series demonstrating the need for histopathology when skin findings accompany SARS-CoV-2 infection.

BACKGROUND: Descriptions of cutaneous findings associated with COVID-19 have not been consistently accompanied by histopathology or confirmatory testing for SARS-CoV-2. OBJECTIVE: To describe and classify the cutaneous findings with supporting histopathology of confirmed COVID-19 inpatients. METHODS: We included consecutive inpatients with a confirmed diagnosis of COVID-19 for whom a dermatology consult was requested. A skin biopsy was performed in all cases. Skin findings were classified as being compatible with a cutaneous manifestation of COVID-19 or as representing a distinct clinical entity. RESULTS: Twenty-eight patients were studied in whom thirty-one dermatologic diagnoses were made. Twenty-two of the dermatoses were compatible with a cutaneous manifestation of COVID-19; nine entities were not associated with infection by SARS-CoV-2. The most common COVID-19-associated pattern was an exanthematous presentation. In four patients, a new pattern was observed, characterized by discrete papules with varied histopathological findings including a case of neutrophilic eccrine hidradenitis. No cases of pernio-like lesions were identified. Skin findings not associated with COVID-19 represented 29% of diagnoses and included Malassezia folliculitis, tinea, miliaria and contact dermatitis. LIMITATIONS: There is no gold-standard test to distinguish between viral exanthems and drug reactions. CONCLUSION: A histopathological study is critical before attributing skin findings to a manifestation of COVID-19.

Perineurioma versus meningioma. A multi-institutional immunohistochemical and ultrastructural studY.

The differential diagnosis between perineurioma (PN) and meningioma (MEN) can be difficult by histology and immunohistochemistry (IHC) because the perineurium and arachnoid have the same embryological origin. However, there are no comparative studies determining conclusive parameters for the differential diagnosis. The aim of this study is to compare IHC of PN and MEN and their ultra-structural characteristics to elucidate which are the useful data that allow differentiate both entities. Thirty-five MEN were analyzed, and 15 PN, (11 skin and soft tissues and four oral cavity). IHC for epithelial membrane antigen (EMA), Claudin-1, GLUT-1, somatostatin-2 receptor (SSTR-2), and progesterone receptor (RP) was performed. Ultrastructural studies were performed on 8 MEN and 15 PN. Only in PN Claudin-1 was positive in 9/11 (90%) cases and GLUT-1 in 7/11 (63%) cases. In MEN, the progesterone receptor was expressed in 21/35 (60%) cases and no case expressed Claudin-1 and GLUT-1; EMA was expressed in all MEN cases and 93% of PN. SSTR-2 was expressed weakly in six cases of MEN (17%), and it was not considered useful for differential diagnosis. On ultrastructure, PN showed thin and parallel processes, some caveolae, and lacked cell junctions. The cellular processes were surrounded by a collagenous stroma in 94% of the cases. MEN were characterized by curved cytoplasmic cell processes showing desmosomes in 75% of cases. Ultrastructural findings aid in the differential diagnosis between PN and MEN, especially if molecular studies are not available.

Functional Outcomes 18 Months After Total and Midarm Transplantation: A Case Report.

BACKGROUND: The function reported after arm transplantation is deemed beneficial relative to the marked disability that upper arm amputation causes. OBJECTIVE: We report a 51-year-old man with a Disabilities of the Arm, Shoulder and Hand (DASH) score of 75.83 who underwent bilateral arm transplantation in October 2015. PROCEDURE: The right arm was transplanted at the glenohumeral joint level, including transplantation of the humeral head, joint capsule, and rotator cuff ligaments and tendons. Additionally, neurorrhaphies were performed at the origin of the terminal branches of the brachial plexus, including the axillary and musculocutaneous nerves. Therefore, this was considered a total arm transplantation. The left arm was transplanted at the transhumeral level, with complete transplantation of the biceps and triceps brachii, and terminolateral neurorrhaphy of the donor musculocutaneous nerve to the receptor radial nerve. A maintenance triple immunosuppression scheme was administered, with tacrolimus levels kept at 10 ng/mL. RESULTS: At 18 months post-transplantation, the intrinsic musculature in the left hand showed electrical registry, DASH score was 67.5, Carroll test score was 28 in both extremities, Hand Transplant Score System was 67.5 in the right extremity and 77.5 in the left extremity, and Short Form-36 score was 96.1. The patient was healthy, with restored body integrity. He could lift medium-sized weightless objects, eat and go to the bathroom by himself, drink liquids with bimanual grasp, swim, dress almost independently, and drive. CONCLUSION: The functional evolution of the patient was similar to previously reported transplanted arms, even though the right arm transplant involved the glenohumeral joint and axillary and musculocutaneous nerve repair.

Treponema pallidum ssp. pallidum identification by real-time PCR targetting the polA gene in paraffin-embedded samples positive by immunohistochemistry.

Syphilis is a systemic and sexually transmitted infection caused by Treponema pallidum ssp. pallidum. This spirochete causes different clinical and subclinical stages depending on the duration of infection and immune status of the host. Several tests have been developed for diagnosis, and are classified into direct and indirect methods. The first one includes dark field microscopy, direct fluorescent antibody test in fluids or tissue, and molecular biology techniques. In the indirect method (serologic), the routine tests are used, and are divided in two categories: non-treponemal and treponemal ones. The objective of this work was to identify T. pallidum ssp. pallidum in paraffin-embedded skin biopsies positive by immunohistochemistry, using conventional polymerase chain reaction (PCR) and quantitative real time PCR (qPCR). We included a sample of 17 paraffin-embedded biopsies. DNA was extracted and processed by conventional PCR and real-time PCR with a TaqMan® probe to identify the polA gene. Using PCR, 11 tested positive (64.7%) and 6 (35.3%) were negative. With qPCR and TaqMan® probe, 100% of samples tested positive. The minimum number of spirochetes detected in each sample was 2. With this work, we can conclude that qPCR is a fast and very accurate method for diagnosis of syphilis in tissue specimens.

Púrpura de Henoch-Schönlein / Henoch-Schönlein purpura

Resumen Comunicamos el caso de una paciente de 24 años de edad con púrpura de Henoch-Schönlein, quien acudió a nuestro servicio con manifestaciones cutáneas extensas. Cursaba con evolución tórpida y complicaciones gastrointestinales y renales. La púrpura de Henoch-Schönlein es una vasculitis de pequeños vasos que afecta principalmente a pacientes en edad pediátrica, caracterizada por la tétrada de púrpura palpable, dolor abdominal, artralgias o artritis y daño renal. Es una enfermedad sistémica, con depósito de IgA. Por lo general es de alivio espontáneo, pero en algunos casos tiene graves complicaciones, principalmente enfermedad renal crónica. El tratamiento con esteroides se recomienda sólo en casos graves. El reconocimiento temprano de la enfermedad, así como el tratamiento multidisciplinario evitarán complicaciones fatales.

Abstract This paper reports the case of a 24-year-old female patient with Henoch-Schönlein purpura, who presented to our department with cutaneous manifestations. She has torpid evolution, and gastrointestinal and renal complications. Henoch-Schönlein purpura is a small vessel vasculitis that affects mainly pediatric patients, characterized by the tetrad of palpable purpura, abdominal pain, arthralgia or arthritis and kidney injury. It is a systemic disease with IgA. It is usually self-limiting, but in some cases serious complications may appear, mainly chronic kidney disease. Steroid treatment is recommended only in severe cases. Early recognition of the disease and the multidisciplinary management prevent fatal complications.

Enfermedad de Milroy o linfedema primario congénito asociado a carcinoma espinocelular invasor / Milroy disease or primary congenital lymphedema associated with invasive squamous cell carcinoma

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Coexistencia de vitiligo y psoriasis, serie de casos y perspectivas etiopatogénicas / Coexistence of vitiligo and psoriasis, case series and etiopathogenic perspectives

El vitiligo y la psoriasis se observan con frecuencia en la consulta dermatológica; sin embargo, pese a su alta prevalencia, no es frecuente que ambas se encuentren en un mismo paciente. Presentamos los casos de tres pacientes que exhiben esta situación y realizamos una revisión de la literatura, en cuanto a los aspectos fisiopatogénicos comunes, que podrían contribuir a generar la coexistencia de estas entidades.

Vitiligo and psoriasis are commonly seen in the dermatology clinic; yet, despite their high prevalence, it is infrequent to find them together in the same patient. We report three cases exhibiting this situation and we do a literature review regarding common pathophysiologic aspects that could generate the coexistence of these entities.

Coexistencia de vitiligo y psoriasis, serie de casos y perspectivas etiopatogénicas / Coexistence of vitiligo and psoriasis, case series and etiopathogenic perspectives

El vitiligo y la psoriasis se observan con frecuencia en la consulta dermatológica; sin embargo, pese a su alta prevalencia, no es frecuente que ambas se encuentren en un mismo paciente. Presentamos los casos de tres pacientes que exhiben esta situación y realizamos una revisión de la literatura, en cuanto a los aspectos fisiopatogénicos comunes, que podrían contribuir a generar la coexistencia de estas entidades.(AU)

Vitiligo and psoriasis are commonly seen in the dermatology clinic; yet, despite their high prevalence, it is infrequent to find them together in the same patient. We report three cases exhibiting this situation and we do a literature review regarding common pathophysiologic aspects that could generate the coexistence of these entities.(AU)

Esporotricosis diseminada con afección cutánea y testicular / Disseminated Sporotrichosis With Cutaneous and Testicular Involvement

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Giant onychomatricoma: report of two cases with rare clinical presentation.

BACKGROUND: Onychomatricoma was reported for the first time by Baran and Kint as a rare nail matrix tumor with specific clinical and histologic features, including a macroscopic appearance of filiform digitations originating from the nail matrix which are inserted in the nail plate.(1) The appearance of the lesion may resemble that of an "anemone." All previous reports have been mostly from Europe, with only one case from North America. These are the first case reports from Mexico. They show rare clinical characteristics, in particular tumor involving the entire nail matrix. METHODS: Two cases are presented: Case 1, a 59-year-old man with a 2-year history of deformity of the entire nail apparatus of the right thumb, clinically suggestive of onychomatricoma; Case 2, a 45-year-old woman with a 3-year history of gradual nail dystrophy, initially misdiagnosed as onychomycosis and treated unsuccessfully for several months with antimycotics by a general physician. In both cases, the entire nail plate was affected and, because of the clinical appearance, nail exploration and excisional biopsy of the tumors at the nail matrix were performed. RESULTS: During nail matrix surgical exploration, including avulsion of the nail plate, characteristic digitiform projections that were firmly attached to the nail plate were observed. In both cases, the entire nail matrix was affected, producing a giant form of onychomatricoma. Hematoxylin and eosin stain showed characteristic filiform projections that corresponded to the clinical appearance, with elongated epithelium from the nail matrix and fibromyxoid stroma with multiple basophilic cells, and typical clefts in between. CONCLUSIONS: Onychomatricoma has a classical clinical appearance; however, it is difficult to identify, as it is not until surgery, when the typical filiform projections are more visible, that the diagnosis can be made. Onychomatricoma is a rare tumor. The involvement of the entire nail matrix, with secondary nail dystrophy, in both cases presented here makes them interesting case reports of this unusual form of tumor.

Solitary subungual neurofibroma: an uncommon finding and a review of the literature.

We report an uncommon case of solitary subungual neurofibroma on the right first finger of a middle-aged healthy woman. Surgical excision was used for the treatment. Common clinical findings, treatment modalities, and reported recurrence rates in previous studies are reviewed.