Trichodysplasia spinulosa in a renal transplant patient: A case report of successful treatment.

Trichodysplasia spinulosa is a rare cutaneous disease caused by the trichodysplasia spinulosa-associated polyomavirus. It occurs more frequently in immunocompromised patients, particularly in solid organ transplants. A few successful treatments have been described in the literature. In our report, we present a biopsy-proven trichodysplasia spinulosa case in a kidney transplant recipient who rapidly responded to a reduction of his immunosuppressive therapy.

Toxic epidermal necrolysis associated with pembrolizumab.

INTRODUCTION: Stevens-Johnson syndrome and toxic epidermal necrolysis are severe cutaneous drug eruptions characterized by epidermal detachment. Pembrolizumab is a monoclonal antibody that binds to the programmed death-1 receptor, and it has been associated with numerous cutaneous adverse side-effects, including Stevens-Johnson syndrome. CASE REPORT: We describe a 63-year-old male with metastatic lung adenocarcinoma who developed a rapidly progressing maculopapular rash three days after a first dose of pembrolizumab. On day 16, the rash affected more than 80% of body surface area with detachment of large sheets of necrolytic epidermis in 30-40% of body surface area. However, the patient only presented with mild mucosal involvement. Histopathologic examination of a skin biopsy showed a subepidermal blister with overlying prominent full thickness epidermal keratinocytic necrosis and a superficial perivascular infiltrate of lymphocytes. A toxic epidermal necrolysis secondary to pembrolizumab was then diagnosed. Management and outcome: In addition to supportive cares, the patient received corticosteroids and cyclosporine. The patient responded rapidly to the immunosuppressant therapy, and nearly complete re-epithelialization was achieved 24 days after the start of the reaction. DISCUSSION: In our review of the literature, 15 other cases of Stevens-Johnson syndrome/toxic epidermal necrolysis were reported with programmed death-1/programmed cell death ligand-1 inhibitors. To our knowledge, this is the first case of toxic epidermal necrolysis secondary to pembrolizumab published in the literature. The American Society of Clinical Oncology guidelines suggest that cyclosporine, in addition to corticosteroids, be initiated when toxic epidermal necrolysis is suspected. Clinicians should be aware of this rare dermatological emergency with the increasing use of pembrolizumab in oncology.

Learning-by-Concordance for Family Physicians: Revealing its Value for Continuing Professional Development in Dermatology.

This article was migrated. The article was marked as recommended. Introduction Continuous Professional Development (CPD) is an important part of a physician's professional life. Yet, providing effective in-service training solutions is a persistent challenge for CPD planners. Methods Primary care physicians are frequently confronted with skin lesionsthey feel ill-prepared to manage. A dermatology Learning-by-concordance (LbC) online activity was developed and offered to family physicians for CPD credit. We were interested in finding out whether this online tool was suitable for CPD. Following a pilot phase, the on-line activity was launched and 45 geographically dispersed primary care physicians completed it. They participated in a telephone conference a week later with an expert to discuss outstanding questions. Evaluation was carried out by a survey that was available immediately after the last case. Results Participants found the on-line training tool user friendly and should be implemented on a larger scale. Participants found the dermatology concepts discussed allowed them to increase their knowledge and apply it to their practice. Discussion Among the strengths of LbC is that the learning task resemble those of a primary physician's daily practice. Finally, our study reveals that LbC is easily integrated in busy work schedules and thus is an effective learning solution for CPD.

Lateral trunk displacement and stability during sit-to-stand transfer in relation to foot placement in patients with hemiparesis.

BACKGROUND: In hemiparetic individuals, sit-to-stand (STS) transfer is characterized by asymmetric weight-bearing and altered trunk kinematics that can be improved by positioning the affected foot behind the nonaffected one. OBJECTIVE: To examine the influence of frontal trunk kinematics on medio-lateral displacements of the center of pressure (CP) during STS performed with the feet placed in 2 different positions, as well as relationships between these parameters, medio-lateral stability, and clinical scores of the participants. METHODS: Eighteen patients with chronic stroke and 15 control individuals were evaluated during sit-to-stand transfers either in spontaneous foot position or with their affected or dominant foot placed behind, respectively. Medio-lateral CP, pelvis, and shoulder displacement were analyzed using 3D kinematic and kinetic data recordings of the whole task. Motor and sensory impairment, spasticity, muscle strength, and equilibrium were evaluated by standard scales. The possible time during which a participant could prevent a fall (minimal time-to-contact) was used as a stability index. RESULTS: Spontaneously, the deviation of the CP of stroke participants paralleled the tilt of the trunk toward the nonaffected side, as early as the first third of the task. With the affected foot placed behind, trunk position did not differ from those of control participants who executed the transfer spontaneously. Hemiparetic participants were less stable than control participants. Placement of the feet had no significant effect on the stability of either group. Stability was strongly associated with better motor scores on the Chedoke-McMaster Stroke Assessment. CONCLUSIONS: In hemiparetic individuals, improving STS symmetry by positioning the affected foot behind the nonaffected one did not decrease medio-lateral stability, which was associated with the level of stroke-related motor impairments.

Interactions between foot placement, trunk frontal position, weight-bearing and knee moment asymmetry at seat-off during rising from a chair in healthy controls and persons with hemiparesis.

OBJECTIVE: To assess the interaction of foot placement, trunk frontal position, weight-bearing and knee moment asymmetry at seat-off when rising from a chair. DESIGN: Cross-sectional study. SUBJECTS: Seventeen subjects with hemiparesis and 15 healthy controls. METHODS: Trunk position, weight-bearing and knee moment asymmetry were quantified by kinetic and kinematic analysis when the subjects rose from a chair using 3 different foot placements: spontaneous, symmetrical and asymmetrical. Asymmetry was defined by the ratio between sides. RESULTS: In the healthy controls, the spontaneous and symmetrical foot placements were associated with an almost vertical trunk position and a symmetrical weight-bearing and knee moment. The asymmetrical foot placement resulted in a trunk displacement towards the foot placed behind, with more weight-bearing and higher moment on this side. The opposite was observed in the hemiparetic participants where the spontaneous and symmetrical foot conditions determined a trunk position and an asymmetry bias towards the unaffected side. Placing the affected foot behind the other reduced the asymmetrical behaviour. CONCLUSION: Changes in weight-bearing are partly associated with the frontal trunk position, and foot placement manipulations can be used to modify weight-bearing distribution. Inference on weight-bearing is possible by observing the trunk position during the sit-to-stand task in persons with hemiparesis.