An unusual skin infection with Achromobacter xylosoxidans.

Achromobacter xylosoxidans is an emerging, multidrug-resistant pathogen capable of forming biofilms on medical products that primarily infects immunocompromised patients. We present the case of a 50-year-old immunocompetent woman who developed an A xylosoxidans granulomatous abscess at the attachment site of her insulin pump. She was successfully treated with surgical excision and oral trimethoprim-sulfamethoxazole (TMP-SMX). This case demonstrates further emergence of A xylosoxidans as a potential pathogen, not only in immunocompromised individuals but in any patient with an indwelling catheter.

Lichen planus pemphigoides treated with ustekinumab.

A 71-year-old woman presented with pink to violaceous, flat-topped, polygonal papules on the volar wrists, extensor elbows, and bilateral lower legs of 3 years' duration. She also had erythematous, violaceous, infiltrated plaques with microvesiculation on the bilateral thighs of several months' duration. She reported pruritus, burning, and discomfort. Her medical history included type 2 diabetes mellitus, hypertension, and asthma with no history of skin rashes. Workup revealed lichen planus pemphigoides (LPP), a rare papulosquamous and vesiculobullous dermatosis that shares features of both lichen planus (LP) and bullous pemphigoid (BP). Despite multiple traditional therapies, her disease continued to progress, further developing mucosal disease. After a review of the literature on LP, BP, and LPP, it was noted that tumor necrosis factor α (TNF-α), along with other cytokines, plays a pivotal role in all 3 diseases. After several conventional systemic therapies failed, we treated our patient with ustekinumab with favorable results.