A recalcitrant case of toxic epidermal necrolysis.

We describe a case that was initially diagnosed and treated as toxic epidermal necrolysis (TEN) by an outside hospital. After failure to improve on high-dose steroids and intravenous (IV) immunoglobulin, the patient was transferred to our hospital where he was subsequently diagnosed with a disseminated herpes simplex virus (HSV) infection. The patient recovered after 21 days of antiviral therapy. We review key physical examination findings that will help the clinician diagnose a viral etiology in the setting of an acute blistering eruption with mucosal involvement.

An update on pediatric cutaneous drug eruptions.

One of the early lessons learned in dermatology training is "any drug, any rash." This maxim quickly summarizes the vast array of cutaneous reactions that can be seen in response to systemic medications. We have reviewed common and unusual drug eruptions in pediatric patients that span the morphologic spectrum. These reactions can have an equally broad range of severity, from harmless to lethal, and by the end of this paper the reader will be better equipped to sort one from the other.

Pseudo-sudden deafness.

OBJECTIVES: We describe the symptom complex and management of a clinical entity we refer to as "pseudo-sudden deafness," which is an episode of acute otitis media that leads to sensorineural hearing loss with reduced speech discrimination. METHODS: We included 8 adult patients with audiometrically confirmed, asymmetric sensorineural hearing loss with decreased speech discrimination that presented after an episode of acute otitis media. Magnetic resonance imaging ruled out retrocochlear disease. Both physical examination and myringotomy helped confirm the diagnosis of serous otitis media (SOM). Myringotomy, tympanostomy tubes, oral antibiotics, and otic antibiotic-steroid drops were used to treat the SOM. Oral steroids were used to treat the sensorineural component. RESULTS: Pretreatment and posttreatment audiograms showed an improvement in speech discrimination score, pure tone thresholds, or both after treatment for underlying SOM and sensorineural hearing loss in 6 of the 8 patients. CONCLUSIONS: Patients who present with an acute onset of unilateral sensorineural hearing loss with decreased speech discrimination may be mistakenly thought to have idiopathic sudden sensorineural hearing loss when, in fact, they may have an SOM-induced phenomenon that is potentially reversible. The distinguishing feature is a preexisting otitis media, which must be treated first, before the administration of steroids.

Long-term effects of hearing aids on word recognition scores.

OBJECTIVES: The purpose of this study was to retrospectively examine how monaurally fitted hearing aids affected word recognition scores in patients with bilateral symmetric sensorineural hearing loss. METHODS: Sixty-six patients from 2 separate institutions were included in this study. In addition to having bilateral symmetric sensorineural hearing loss due to presbycusis, each patient had to have worn a single hearing aid for at least 5 months and have valid pre-aid and post-aid audiograms. Word recognition scores were analyzed with a table of confidence levels generated by Thornton and Raffin that determined the probability of differences between word recognition scores. RESULTS: Hearing aids did not improve or preserve word recognition scores to the degree that has been previously reported in the literature. The unaided (control) ear demonstrated a decrease in word recognition scores over time, as was expected from previous studies. The aided ears demonstrated a similar decline in word recognition scores when compared to the unaided ears. When the conventional confidence level of 0.05 was used, the aided ears showed no advantage over the unaided (control) ears. CONCLUSIONS: These findings are not consistent with the acclimatization first reported by Silman et al in 1993. Such a discrepancy in the results calls for further studies to evaluate just how effective unilateral hearing aids are in patients with bilateral symmetric sensorineural hearing loss.

A rare variant of generalized granuloma annulare presenting with chronic Epstein-Barr virus infection: coincidence or association?

We report a rare variant of generalized granuloma annulare (GGA) in a 62-year-old male patient. The patient presented with large, annular, violaceous patches on the upper arms and thighs. Histological findings were consistent with interstitial granuloma annulare. In addition, high titers of Epstein-Barr Viral Capsid Antigen (EBV VCA) and EBV Nuclear Antigen (EBVNA) antibodies were found. In-situ hybridization did not reveal EBV RNA in the skin lesions. Immune dysregulation in the setting of chronic EBV infection has been suggested as a contributing factor to the development of this rare variant of GGA.