A Case of Desmoplastic Spitz Nevus with Pseudo-Gland Formation / 대한피부과학회지

Desmoplastic Spitz nevus is a rare variant of Spitz nevus characterized by predominantly spindle-shaped or epithelioid nevus cells within the fibrotic stroma that can be confused with fibrous lesions. A 43-year-old woman presented with a 1-cm-sized dome-shaped papule on the dorsum of her left foot. The lesion showed histopathological features of a desmoplastic Spitz nevus with structures that resemble adenoma. Immunohistochemical staining was positive for S-100 protein, Melan-A, and SOX-10. Herein, we report this case because desmoplastic Spitz nevus is rare and can lead to confusion regarding the diagnosis of adnexal neoplasms.

Guselkumab Treatment for Psoriasis in Bio-Naïve and Bio-Experienced Patients:Multicenter Study Based on a 1-Year Follow-Up / 대한피부과학회지

Background@#Guselkumab is a monoclonal antibody that selectively blocks the p19 subunit of interleukin-23. It has shown good efficacy and safety profile in several clinical trials of plaque psoriasis. However, studies on the efficacy of guselkumab in patients treated with other biologics are lacking. @*Objective@#We aimed to investigate the efficacy and safety profile of guselkumab in patients with moderate-to-severe plaque psoriasis. We also compared the efficacy of guselkumab between biologic-naïve (Bio-Naïve) and biologicexperienced (Bio-Ex) patients. @*Methods@#This multicenter, retrospective study included 72 patients treated with guselkumab. The patients’ clinical characteristics and psoriasis area and severity index (PASI) scores were recorded at each visit. The PASI90 and PASI100 responses and mean PASI scores were compared between the Bio-Naïve and Bio-Ex groups. @*Results@#Fifty-five Bio-Naïve patients and 17 Bio-Ex patients were included in the study. At week 20, there were no significant differences in the PASI90 (64.2% vs. 53.8%) and PASI100 (28.3% vs. 15.4%) responses between the groups. However, at weeks 36 and 44, the PASI90 response (week 36: 89.2% vs. 36.4% and week 44: 97.8% vs. 63.6%) and the PASI100 response (week 36: 64.9% vs. 18.2% and week 44: 68.9% vs. 27.3%) were significantly higher in the Bio-Naïve group (p＜0.05). There were no differences in PASI90 and PASI100 responses between the groups in terms of other clinical characteristics and comorbidities at week 20. @*Conclusion@#The efficacy of guselkumab remained consistent among patients in whom other biologics had failed. However, the efficacy was slightly lower in the Bio-Ex group than in the Bio-Naïve group.

Iatrogenic Cervical Spinal Cord Injury Associated with Acupuncture

Iatrogenic spinal cord injury resulting from direct needle injection is an exceedingly uncommon occurrence, mainly owing to the spinal cord’s protection by surrounding bony structures, with only a few exceptions, and its location a few centimeters beneath the skin. This study presents a case of a 27-year-old female who experienced cervical spinal cord injury following acupuncture treatment around the C3–4 region. The patient reported tingling paresthesia and persistent pain in her left arm for 1 month postinjection, with magnetic resonance imaging (MRI) revealing a syringomyelia in the direction of the injection.As determined at the follow-up, after undergoing 3 months of conservative treatments, including cervical intervention, medication, and education, her pain was reduced by approximately half. Cervical injections should be administered by a knowledgeable specialist well versed in musculoskeletal anatomy and potential complications, aided by radiological examination.

Cervical Myelopathy after Neck Manipulation

Spinal manipulation therapy (SMT) is commonly used to treat various musculoskeletal pains; however, it is associated with several complications. Mild complications resolve quickly; however, on rare occasions, they may cause severe complications that persist indefinitely. Here, we present a case of cervical myelopathy caused by a spinal manipulation. A 52-year-old man with a history of cervical radiculopathy at C4–7 underwent manipulation, performed by an unlicensed practitioner. After the manipulation, he explained abrupt muscle weakness in all four extremities. He was diagnosed with cervical myelopathy and had to undergo emergency surgery. Through this case, we aim to emphasize the role of doctors, with regard to spinal manipulation. Physicians must supervise the pre-evaluation of patients, manipulation, and post-manipulation monitoring, and the complications of SMT should be immediately reported.

Efficacy of Oral Ivermectin Combined with Topical Scabicide for the Treatment of Scabies in Routine Clinical Care / 대한피부과학회지

Background@#Oral ivermectin is an effective alternative to topical agents for scabies infestation, and may be beneficial in the treatment of crusted scabies in case of failure or impracticability of topical therapy. @*Objective@#The present study aims to evaluate treatment outcomes of patients with scabies treated with oral ivermectin. Furthermore, we analyzed the efficacy and safety of oral ivermectin based on clinical characteristics. @*Methods@#Overall, 16 patients with scabies received 200 μg/kg of ivermectin and topical scabicide (5% permethrin or 10% crotamiton) at 1-week intervals. Treatment outcome was evaluated by mineral oil test and medical examination at intervals of 1 or 2 weeks. If no improvement was observed at the follow-up, treatment was repeated. @*Results@#All patients achieved a clinical response. The average number of administrations of ivermectin was 2.69, and the mode was 3 (n=8). The average number of administrations was higher for those over 70 years of age than for those under 70 years of age (2.80 vs. 2.50), but this was not statistically significant (p=0.558). There were no significant differences based on clinical type. The mean time from the first administration of ivermectin to the negative conversion of the mineral oil examination was 18.43±7.26 days. No adverse events were observed. @*Conclusion@#Oral ivermectin is an effective and safe therapy for treating human scabies.

A Case of Bullous Pemphigoid after Administration of Erdafitinib / 대한피부과학회지

Bullous pemphigoid (BP) is an acquired autoimmune disease characterized by subepidermal vesicles and bullae. It is now well-accepted that BP could be associated with therapeutic drugs. Immunotherapy can induce BP; however, few reports of tyrosine kinase inhibitor of fibroblast growth factor receptor-induced BP exist in the literature. A 67-year-old male presented with pruritic erythematous variable-sized patches with bullae on entire body. The patient was diagnosed with left renal cancer and treated by erdafitinib for clinical trial purposes. Bullae formation began at the start of the 11th month of erdafitinib administration. Histopathologic examination of the skin lesion showed subepidermal blister with eosinophils and other inflammatory cells in epidermis and dermis. Direct immunofluorescence showed a linear pattern of immunoglobulin G and C3 deposition along the basement membrane zone. The results of ELISA with recombinant purified BP180 and BP230 were positive. Consequently, the patient was diagnosed with erdafitinib-related BP.

Pediatric Sarcoidosis Misdiagnosed as Hepatosplenic Abscesses: A Case Report and Review

Sarcoidosis is a systemic granulomatous disorder of unknown etiology characterized by granuloma formation. Due to the limited incidence of sarcoidosis in pediatric patients, little is known about the clinical course of this disease. A combination of clinical, radiologic, and pathologic examination is necessary to exclude other differential diagnoses (i.e., infection and granulomatous inflammatory disorder) and establish a diagnosis of sarcoidosis. Here, we report a case of histologically confirmed sarcoidosis initially misdiagnosed as hepatosplenic abscesses in an 11-year-old male. Treatment with corticosteroids improved his symptoms and resolved his skin and hepatosplenic lesions. A three-year follow-up was uneventful. This study emphasizes the importance of considering sarcoidosis in children presenting with findings of multi-organ involvement in the presence of histologic evidence of granuloma.

Efficacy and Safety of Risankizumab for the Treatment of Moderate to Severe Psoriasis in Korea: A Real-Life Experience / 대한피부과학회지

Background@#Risankizumab is a humanized immunoglobulin G1 monoclonal antibody that selectively binds to the p19 subunit of interleukin-23. Risankizumab has demonstrated rapid and excellent therapeutic effects in several clinical trials. Although a growing number of studies have reported data on the real-world efficacy and safety of risankizumab for the treatment of psoriasis, no such study has been conducted in Korea. @*Objective@#We evaluated the real-world efficacy and safety of risankizumab for the treatment of moderate-to-severe plaque psoriasis in Korean patients. @*Methods@#This was a retrospective single-center study. A total of 33 patients treated with risankizumab, for at least 16 weeks, were enrolled. Based on electronic medical records, the clinical characteristics, psoriasis area and severity index (PASI) score, body surface area, and adverse events were investigated. @*Results@#The mean PASI score was significantly reduced at 4 weeks of risankizumab treatment (3.27±2.15) and gradually reduced at week 16 (1.06±0.97) and week 52 (0.24±0.63) (p＜0.05). At week 16, all patients achieved a PASI 75 response, and 66.7% and 27.3% of patients achieved PASI 90 and PASI 100 responses, respectively. Obese patients (body mass index, BMI≥25 kg/m2 ) showed a lower PASI 90 response than non-obese patients (BMI＜25 kg/m2 ) at week 16. Older patients (age≥65 years) showed significantly higher PASI scores than younger patients (age＜65 years) at week 16. Mild to moderate adverse events were reported in four patients; however, no patient discontinued treatment. @*Conclusion@#Risankizumab was very effective in a real-world clinical practice with a favorable safety profile in Korean patients with moderate-to-severe psoriasis.

Cervical Spine CT Using Spectral Shaping: Can It Be a Solution to Overcome Artifacts in the Lower Cervical Spinal Region?

OBJECTIVE: To investigate the image quality, radiation dose, and intermodality agreement of cervical spine CT using spectral shaping at 140 kVp by a tin filter (Sn140-kVp) in comparison with those of conventional CT at 120 kVp. MATERIALS AND METHODS: Patients who had undergone cervical spine CT with Sn140-kVp (n = 58) and conventional 120 kVp (n = 49) were included. Qualitative image quality was analyzed using a 5-point Likert scale. Quantitative image quality was assessed by measuring the noise and attenuation within the central spinal canals at C3/4, C6/7, and C7/T1 levels. Radiation doses received by patients were estimated. The intermodality agreement for disc morphology between CT and MRI was assessed at C3/4, C5/6, C6/7, and C7/T1 levels in 75 patients who had undergone cervical spine MRI as well as CT. RESULTS: Qualitative image quality was significantly superior in Sn140-kVp scans than in the conventional scans (p < 0.001). At C7/T1 level, the noise was significantly lower and the decrease in attenuation was significantly less in Sn140-kVp scans, than in the conventional scans (p < 0.001). Radiation doses were significantly reduced in Sn140-kVp scans by 50% (effective dose: 1.0 ± 0.1 mSv vs. 2.0 ± 0.4 mSv; p < 0.001). Intermodality agreement in the lower cervical spine region tended to be better in Sn140-kVp acquisitions than in the conventional acquisitions. CONCLUSION: Cervical spine CT using Sn140-kVp improves image quality of the lower cervical region without increasing the radiation dose. Thus, this protocol can be helpful to overcome the artifacts in the lower cervical spine CT images.

Global hemostatic assay of different target procoagulant activities of factor VIII and factor IX

BACKGROUND: Korean National Health Insurance reimburses factor VIII (FVIII) and factor IX (FIX) clotting factor concentrate (CFC) infusions to discrepant activity levels, allowing elevation of FVIII activity to 60 IU/dL and FIX to 40 IU/dL. We aimed to assess hemostatic response to these target levels using global hemostatic assays. METHODS: We enrolled 34 normal healthy men, 34 patients with hemophilia A, and 36 with hemophilia B, with residual factor activity of 3 IU/dL or less and without inhibitors. Patients with hemophilia A and B received injected CFCs according to reimbursement guidelines. Fifteen minutes after injection, we assessed hemostatic response with global hemostatic assays: thrombin generation assay (TGA), thromboelastography (TEG), and clot waveform analysis (CWA). RESULTS: Normal healthy men and patients with hemophilia A and B were 36.7, 37.2, and 35.1 years old, respectively. FVIII and recombinant FIX concentrate doses were 28.8 IU/kg and 43.6 IU/kg. Post-infusion FVIII activity rose from 0.5 IU/dL to 69.4 IU/dL, while FIX activity rose from 1.4 IU/dL to 46.8 IU/dL. Post-infusion peak thrombin concentrations in hemophilia A and B were 116.6 nM/L and 76.4 nM/L (P < 0.001). Post-infusion endogenous thrombin potential (ETP) in hemophilia A and B was 1349.8 nM/min and 915.6 nM (P < 0.001). TEG index of hemophilia A and B was 0.11 and −0.51 (P=0.006). CONCLUSION: Current reimbursed doses for FIX concentrates are insufficient to achieve hemostatic responses comparable to those after reimbursed doses for FVIII concentrates in terms of peak thrombin concentration, ETP, and TEG index.