Multiple Xanthogranulomas in an Adult: Known Entity, New Association

Isotretinoin-Induced Thrombocytosis in a Patient With Acne Vulgaris: A Case Report

Isotretinoin is one of the first-line medications for the treatment of acne. One of the reported side effects of isotretinoin is thrombocytopenia, in addition to other abnormalities such as incomplete blood count. However, reports on thrombocytosis associated with isotretinoin are controversial. The present report discusses the case of a patient with acne vulgaris who was treated with isotretinoin and consequently suffered from isotretinoin-induced thrombocytosis.

A 20-year-old female patient was diagnosed with acne vulgaris and started treatment with systemic isotretinoin (20 mg once daily) for one month. A baseline complete blood count was performed, as well as another blood count after one month of medication administration. Platelet count was recorded at each visit. The baseline platelet count was within the normal range; however, it was found to be elevated after one month of treatment. Accordingly, the medication was discontinued, and the platelet count returned to normal levels after one month, as measured during the monthly visit. The patient also experienced seizure episodes during treatment, which did not cease with the treatment discontinuation. Although isotretinoin-induced thrombocytosis is considered a rare side-effect for isotretinoin, it should be routinely monitored in high-risk patients and those undergoing surgeries. Further prospective studies on isotretinoin-induced thrombocytosis need to be conducted to gain a deeper insight into the various aspects related to the condition.

Multiple Xanthogranulomas in an Adult Patient with Myelodysplastic Syndrome

Adult multiple xanthogranuloma (XG) is a rare late-onset variant of juvenile XG. It is characterized by the appearance of papules or nodules located preferably on the trunk. A case of a 54-year-old man with myelodysplastic syndrome is presented as a history of interest, who consulted due to the appearance of multiple brownish papules distributed mainly in the trunk. So far, there are only 22 cases of this clinical form reported in the literature, 9 of them associated with malignant hematological processes. We highlight the importance of this entity as a possible cutaneous marker of blood dyscrasias.

Multiple xanthogranulomas in an adult patient: clinical, dermoscopic, reflectance confocal microscopy and histopathological features

A case of multiple xanthogranulomas located bilaterally on arms, armpits, legs, trunk, abdomen, scalp, neck and plantar surfaces in a 25-year-old man is reported. The patient was evaluated by polarised light dermoscopy and reflectance confocal microscopy (RCM) that showed peculiar aspects. In particular, dermoscopy showed a homogeneous orange-yellowish hue that is related to the histopathological presence of foamy histiocytes and Touton giant cells; the last typically appeared at RCM as peculiar giant cells surrounded by highly refractive ring due to the cytoplasm rich of lipids. Laboratory investigations, including routine haematological examination, liver and renal function tests, serum lipid and sugar levels were normal. The patient started isotretinoin 20 mg once daily. After 6 months, some lesions flattened, leading to yellowish or hyperpigmented macules, but new lesions raised up.