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Kalomeris TA, Grossman ME, Tepler J, Magro CM. TEMPI syndrome: A clinical, light-microscopic and phenotypic evaluation with review of the literature. J Cutan Pathol 2024; 51:299-305. [PMID: 38102936 DOI: 10.1111/cup.14572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 10/26/2023] [Accepted: 11/25/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND AND OBJECTIVES TEMPI (telangiectasias, elevated erythropoietin and erythrocytosis, monoclonal gammopathy, perinephric fluid collections, and intrapulmonaryshunting) syndrome is a rare multisystemic disease classified as a monoclonal gammopathy of cutaneous significance. The pathogenesis and etiology of TEMPIare not well known because of the rarity of this disorder. Although telangiectasias are the hallmark of this syndrome, skin biopsies are rarely performed. We aim to further characterize TEMPI syndrome through the evaluationof a skin biopsy. METHODS We reviewed the histopathology and immunophenotypic profile of a skin biopsy from a 53-year-oldwoman diagnosed with TEMPI syndrome. Other components of her syndromic complex included an IgA myeloma, elevated vascular endothelial growth factor (VEGF), and erythrocytosis. RESULTS A biopsy showed prominent vascular ectasia with some degree of microvascular basement membranezone thickening. Our patient had a reduction in neoplastic plasma cell burdenand clearing of her telangiectasias following myeloma directed treatment. CONCLUSIONS TEMPI can beviewed as a reactive vascular paraneoplastic syndrome in the setting of a plasma cell dyscrasia. Elaboration of VEGF from neoplastic plasma cells is likely pathogenetically implicated and appears to be a common link that explains other vascular lesions associated with monoclonal gammopathy syndromes.
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Affiliation(s)
- Taylor A Kalomeris
- Department of Pathology and Laboratory Medicine, New York-Presbyterian/Weill Cornell Medicine, New York, New York, USA
| | - Marc E Grossman
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut, USA
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Jeffrey Tepler
- Department of Hematology and Medical Oncology, Weill Cornell Medicine, New York, New York, USA
| | - Cynthia M Magro
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, USA
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2
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Stephan C, Grossman ME, Magro CM. Primary cutaneous acral CD8-positive T-cell lymphoproliferative disorder: A clinical and histologic retrospective cohort study. Clin Dermatol 2023; 41:666-679. [PMID: 37716580 DOI: 10.1016/j.clindermatol.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
Clonally restricted, non-epidermotropic, low-grade, CD8-positive T-cell infiltrates of the skin was recognized as a unique form of indolent CD8-positive lymphoproliferative disease in 2007 when it was first called primary cutaneous indolent CD8-positive lymphoid proliferation. More recently, the designation of primary cutaneous acral CD8-positive T-cell lymphoproliferative disorder has been used. It is unique as a cutaneous lymphoproliferative disorder because of relative uniformity in its clinical presentation and histomorphology. It has been recognized as having an interesting predilection for the ear and acral sites, characteristically presenting as a solitary lesion. The basic morphology is one characterized by a non-epidermotropic, tumefactive infiltrate of well-differentiated, noncerebriform, atypical, small- to intermediate-sized lymphocytes that exhibit a specific phenotype characterized by CD8 and TIA positivity in concert with a distinct perinuclear Golgi staining pattern for CD68. The typical presentation is in the context of a solitary lesion, which can be treated surgically or with local irradiation. We describe in detail two very unusual cases that expand the clinical spectrum of this condition given the non-acral localization, the multiplicity of lesions to involve the trunk and extremities, and, in one case, the stable but recalcitrant course over 30 years. In addition, the second patient developed paraneoplastic dermatomyositis. We also retrospectively review our database for other cases that represent the entity of primary cutaneous acral CD8-positive T-cell lymphoproliferative disorder and review the literature focusing on non-acral cases. Nomenclature evolution from its first recognition in 2007 to the present is discussed.
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Affiliation(s)
- Carla Stephan
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine/New York-Presbyterian, New York, USA
| | - Marc E Grossman
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Cynthia M Magro
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine/New York-Presbyterian, New York, USA.
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3
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Grossman ME, Karaaslan S, Skrokov R, Valinotti M, Magro C. LOCALIZED PEMPHIGUS VEGETANS OF THE NOSE AND LIPS: A CLASSIC CASE OF A RARE ENTITY. JAAD Case Rep 2022; 25:67-71. [PMID: 35769193 PMCID: PMC9234149 DOI: 10.1016/j.jdcr.2022.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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4
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Mishra N, Ng J, Strom MA, Jain K, Thakkar R, Joshi S, Pereira M, Shah L, Grossman ME, Lee MJ, De Michele S, Silvers DN, Faust PL, Lipkin WI, Gallitano SM. Human Polyomavirus 9-An Emerging Cutaneous and Pulmonary Pathogen in Solid Organ Transplant Recipients. JAMA Dermatol 2022; 158:293-298. [PMID: 35138364 PMCID: PMC8829745 DOI: 10.1001/jamadermatol.2021.5853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
IMPORTANCE We describe the first report to our knowledge of cutaneous and systemic pathogenicity of human polyomavirus 9 in solid organ transplant recipients. OBJECTIVE Three solid organ transplant recipients developed a widespread, progressive, violaceous, and hyperkeratotic skin eruption. All died from pulmonary and multiorgan failure around 1 year from onset of the rash. Routine clinical diagnostic testing could not identify any causative agent; therefore, samples and autopsies were investigated for novel pathogens using high-throughput sequencing. DESIGN, SETTING, AND PARTICIPANTS This case series, including 3 solid organ transplant recipients who developed characteristic pink, violaceous, or brown hyperkeratotic papules and plaques throughout the body, was conducted at the Columbia University Medical Center. Lesional skin biopsies were collected from all 3 patients and subjected to high-throughput illumina sequencing for identification of microbial pathogens. Human polyomavirus 9 was identified in lesional skin biopsies. We subsequently collected ocular swabs, oral swabs, urine samples, and blood samples from patients, and organ tissues at autopsy in 1 patient. We investigated these samples for the presence of human polyomavirus 9 using in situ hybridization and quantitative polymerase chain reaction (PCR) assays. MAIN OUTCOMES AND MEASURES A description of the clinical and pathologic findings of 3 patients. RESULTS This case series study found that human polyomavirus 9 was detected in the skin biopsies of all 3 patients by a capture-based high-throughput sequencing method platform (VirCapSeq-VERT). Human polyomavirus 9 was also detected in blood, oral, ocular swabs, and urine by real-time polymerase chain reaction (PCR) assay. In situ hybridization and quantitative PCR assays were performed on the skin biopsies from 3 patients and lung autopsy of 1 patient, which showed the presence of human polyomavirus 9 messenger RNA transcripts, indicating active viral replication and pathogenesis in the skin and lungs. CONCLUSIONS AND RELEVANCE Human polyomavirus 9 was associated with the widespread cutaneous eruption. All 3 patients had progression of cutaneous disease, accompanied by clinical deterioration, pulmonary failure, and death. One patient underwent autopsy and human polyomavirus 9 was identified in the lungs and paratracheal soft tissue. These findings suggest that human polyomavirus 9 may be associated with cutaneous and possibly pulmonary infection and death in solid organ transplant recipients.
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Affiliation(s)
- Nischay Mishra
- Center for Infection and Immunity, Mailman School of Public Health, Columbia University, New York, New York
| | - James Ng
- Center for Infection and Immunity, Mailman School of Public Health, Columbia University, New York, New York
| | - Mark A. Strom
- Department of Dermatology, Mount Sinai Hospital, New York, New York
| | - Komal Jain
- Center for Infection and Immunity, Mailman School of Public Health, Columbia University, New York, New York
| | - Riddhi Thakkar
- Center for Infection and Immunity, Mailman School of Public Health, Columbia University, New York, New York
| | - Shreyas Joshi
- Center for Infection and Immunity, Mailman School of Public Health, Columbia University, New York, New York
| | - Marcus Pereira
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Lori Shah
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Marc E. Grossman
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut,Hofstra/Northwell Donald and Barbara Zucker School of Medicine, New Hyde Park, New York
| | - Michael J. Lee
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York
| | - Simona De Michele
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York
| | - David N. Silvers
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York,Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | - Phyllis L. Faust
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York
| | - W. Ian Lipkin
- Center for Infection and Immunity, Mailman School of Public Health, Columbia University, New York, New York
| | - Stephanie M. Gallitano
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
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5
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Grossman ME, Cohen M, Ravits M, Blume R, Magro CM. Cutaneous Collagenous Vasculopathy: A Report of 3 Cases. J Cutan Pathol 2021; 49:491-495. [DOI: 10.1111/cup.14192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 12/07/2021] [Accepted: 12/19/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Marc E. Grossman
- Associate Clinical Professor of Dermatology, Department of Dermatology Yale School of Medicine New Haven CT
- Adjunct Clinical Professor of Dermatology, Department of Dermatology, Hofstra/Northwell Donald and Barbara Zucker School of Medicine, New Hyde Park New York
| | - Marc Cohen
- State University of New York Downstate College of Medicine Brooklyn NY
| | | | - Ralph Blume
- Columbia University Department of Dermatology New York NY
| | - Cynthia M. Magro
- Weil Cornell Department of Dermatology, Department of Pathology and Laboratory Medicine New York NY
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6
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Grossman ME, Appel G, Little AJ, Ko CJ. Post-COVID-19 vaccination IgA vasculitis in an adult. J Cutan Pathol 2021; 49:385-387. [PMID: 34779011 PMCID: PMC8652641 DOI: 10.1111/cup.14168] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 10/31/2021] [Accepted: 11/09/2021] [Indexed: 12/15/2022]
Abstract
Leukocytoclastic vasculitis has been reported in the setting of COVID‐19 infection and post‐COVID‐19 vaccination. We report a case of IgA vasculitis (IgAV) post‐COVID‐19 vaccination, with immunoglobulin A (IgA) immune deposits in the skin and renal involvement. SARS‐CoV spike protein immunohistochemical staining was negative. IgAV with skin and renal involvement is a potential reaction to COVID‐19 vaccination.
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Affiliation(s)
- Marc E Grossman
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Gerald Appel
- Department of Internal Medicine, Columbia University Medical Center, New York, New York, USA
| | - Alicia J Little
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Christine J Ko
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut, USA.,Department of Pathology, Yale University School of Medicine, New Haven, Connecticut, USA
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7
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Chikeka I, Husain S, Grossman ME. Asymptomatic annular perianal sarcoidosis. JAAD Case Rep 2020; 6:1242-1244. [PMID: 33294554 PMCID: PMC7701034 DOI: 10.1016/j.jdcr.2020.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Ijeuru Chikeka
- Department of Pathology, Columbia University Medical Center, New York, New York
| | - Sameera Husain
- Department of Dermatology, Columbia University Medical Center, New York, New York
| | - Marc E Grossman
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut.,Department of Dermatology, Hofstra/Northwell Donald and Barbara Zucker School of Medicine, New Hyde Park, New York
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8
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Cohen PR, Grossman ME. The use of drug calendars for the diagnosis of cutaneous drug eruptions in the age of electronic medical records. Dermatol Online J 2020; 26:13030/qt1b20z85r. [PMID: 32239886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 03/26/2020] [Indexed: 06/11/2023] Open
Abstract
A morbilliform drug eruption is the most common condition leading to a dermatology consultation for a patient in the hospital. Timing is an important diagnostic tool since the onset of a skin rash usually takes place within days-to-weeks of the start of the implicated drug. A comprehensive, thorough, and reliable drug history by the clinician is essential. Therefore, to assist in the task of determining the causative medication of a new skin rash in a hospitalized patient, the creation of a drug calendar is recommended. The development of an electronic version of the drug calendar offers several benefits over the manual version. As the use of electronic medical records continues to become the standard in medicine, the electronic drug calendar will serve as an invaluable tool for the diagnosis of drug hypersensitivity.
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Affiliation(s)
- Philip R Cohen
- Dermatologist, San Diego Family Dermatology, National City, CA Department of Dermatology, Touro University California College of Osteopathic Medicine, Vallejo, CA.
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9
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Cohen PR, Grossman ME. The use of drug calendars for the diagnosis of cutaneous drug eruptions in the age of electronic medical records. Dermatol Online J 2020. [DOI: 10.5070/d3262047409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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10
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Magro CM, Momtahen S, Coleman M, Grossman ME. Epidermotropic CXCR3 positive marginal zone lymphoma: a distinctive clinical histopathological entity potentially originating in the skin; it does not always indicate splenic marginal zone lymphoma. Dermatol Online J 2019; 25:13030/qt4207n83g. [PMID: 31450275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 08/02/2019] [Indexed: 06/10/2023] Open
Abstract
Epidermotropic B cell lymphoma represents a rare form of marginal zone lymphoma presenting as a disseminated skin rash resembling pityriasis rosea. To date there are 8 reported cases. In addition to the widespread nature of the skin rash, there is a proclivity for spleen and bone marrow involvement raising consideration regarding its categorization as a systemic lymphoma. We present an 89-year-old man with epidermotropic B cell lymphoma, who presented with a pityriasis rosea-like skin rash. An initial diagnosis of diffuse large cell B cell lymphoma was made based on the extent of dermal-based large cell infiltration. However, after recognizing the epidermotropic component and the distinctive clinical presentation, a diagnosis of epidermotropic B cell lymphoma was rendered. There was minimal bone marrow involvement based only on flow cytometric analysis, but there was no apparent bone marrow or splenic involvement on routine light microscopic assessment. Remission was = achieved with single agent rituximab chemotherapy and the patient remained symptom free. The neoplastic CD20 positive epidermotropic B lymphocytes expressed CXCR3. Similar to the prior reported cases by the authors, the neoplastic cells expressed CXCR3, a chemokine whose organ and tissue specific ligands could contribute to its relatively indolent clinicalcourse.
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MESH Headings
- Aged
- Aged, 80 and over
- Diagnostic Errors
- Female
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Lymphoma, B-Cell, Marginal Zone/diagnosis
- Lymphoma, B-Cell, Marginal Zone/drug therapy
- Lymphoma, B-Cell, Marginal Zone/pathology
- Male
- Middle Aged
- Receptors, CXCR3/analysis
- Remission Induction
- Skin/pathology
- Splenic Neoplasms/diagnosis
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11
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Traver EC, Husain S, Grossman ME. Touch preparation of skin biopsy specimen for rapid diagnosis of cutaneous Nocardia nova in the immunocompromised host. JAAD Case Rep 2019; 5:389-391. [PMID: 31008177 PMCID: PMC6454122 DOI: 10.1016/j.jdcr.2019.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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12
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Magro CM, Momtahen S, Coleman M, Grossman ME. Epidermotropic CXCR3 positive marginal zone lymphoma: a distinctive clinical histopathological entity potentially originating in the skin; it does not always indicate splenic marginal zone lymphoma. Dermatol Online J 2019. [DOI: 10.5070/d3257044803] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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13
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Lopez AT, Grossman ME. Facial calcinosis cutis in a patient with systemic lupus erythematosus: A case report of tissue injury owing to photosensitivity as the cause of dystrophic calcification. JAAD Case Rep 2017; 3:460-463. [PMID: 28936472 PMCID: PMC5597880 DOI: 10.1016/j.jdcr.2017.06.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Adriana T. Lopez
- Columbia University College of Physicians and Surgeons, New York, New York
- Correspondence to: Adriana T. Lopez, BA, 100 Haven Ave, T2#3c, New York, NY 10032.100 Haven Ave, T2#3cNew YorkNY10032
| | - Marc E. Grossman
- Dermatology Consultation Service, Columbia University Medical Center, New York, New York
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14
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Affiliation(s)
- Hannah M Singer
- Department of Dermatology, Columbia University, New York, New York
| | - Bobby Y Reddy
- Department of Dermatology, Massachusetts General Hospital, Harvard University, Boston, Massachusetts
| | - Marc E Grossman
- Medical and Cosmetic Dermatology, White Plains, Massachusetts
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15
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Hambro CA, Yin NC, Yang C, Husain S, Silvers DN, Grossman ME. Trichophyton rubrum tinea capitis in an HIV-positive patient with generalized dermatophytosis. JAAD Case Rep 2016; 3:19-21. [PMID: 28050591 PMCID: PMC5192346 DOI: 10.1016/j.jdcr.2016.10.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Caely A Hambro
- Department of Dermatology, Columbia University Medical Center, New York, New York
| | - Natalie C Yin
- Department of Dermatology, Columbia University Medical Center, New York, New York
| | - Christine Yang
- Department of Dermatology, Columbia University Medical Center, New York, New York
| | - Sameera Husain
- Department of Dermatology, Columbia University Medical Center, New York, New York; Department of Pathology, Columbia University Medical Center, New York, New York
| | - David N Silvers
- Department of Dermatology, Columbia University Medical Center, New York, New York; Department of Pathology, Columbia University Medical Center, New York, New York
| | - Marc E Grossman
- Department of Dermatology, Columbia University Medical Center, New York, New York
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16
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Lauren CT, Antonov NK, McGee JS, de Vinck DC, Hibshoosh H, Grossman ME. Carcinoma en cuirasse caused by pleomorphic lobular carcinoma of the breast in a man. JAAD Case Rep 2016; 2:317-9. [PMID: 27556062 PMCID: PMC4987509 DOI: 10.1016/j.jdcr.2016.06.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Affiliation(s)
- Christine T Lauren
- Department of Dermatology, College of Physicians and Surgeons, Columbia University, New York, New York; Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Nina K Antonov
- Department of Dermatology, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Jean S McGee
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts
| | | | - Hanina Hibshoosh
- Department of Pathology and Cell Biology, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Marc E Grossman
- Department of Dermatology, College of Physicians and Surgeons, Columbia University, New York, New York
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17
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Affiliation(s)
- Emily V Twigg
- Conquest Hospital, Hastings, East Sussex, United Kingdom
| | - Nicole A Weitz
- Columbia University Medical Center, Department of Dermatology, New York, New York
| | - Richard K Scher
- Weill Cornell, Department of Dermatology, New York, New York
| | - Marc E Grossman
- Dermatology Consultation Service, Columbia University Medical Center, New York, New York
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18
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Affiliation(s)
| | - Nicole A. Weitz
- Department of Dermatology, Columbia University Medical Center, New York, New York
- Correspondence to: Nicole A. Weitz, MD, Department of Dermatology, Herbert Irving Pavillion, 12th Floor, 161 Fort Washington Ave, New York, NY 10032.Department of DermatologyHerbert Irving Pavillion12th Floor, 161 Fort Washington AveNew YorkNY10032
| | - Christina Day
- White Plains Hospital Center, White Plains, New York
| | - Alyssa R. Golas
- Department of Plastic Surgery, New York University Langone Medical Center, New York, New York
| | - Marc E. Grossman
- Department of Dermatology, Columbia University Medical Center, New York, New York
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19
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Yamany T, Reddy BY, Husain S, Grossman ME. Recurrent Richter's Transformation Presenting With a Penile Ulcer. JAMA Dermatol 2016; 152:586-7. [PMID: 26843375 DOI: 10.1001/jamadermatol.2015.5708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Tarek Yamany
- Consultation Service, Department of Dermatology, Columbia University, New York, New York
| | - Bobby Y Reddy
- Consultation Service, Department of Dermatology, Columbia University, New York, New York
| | - Sameera Husain
- Dermatopathology, Department of Dermatology, Columbia University, New York, New York
| | - Marc E Grossman
- Consultation Service, Department of Dermatology, Columbia University, New York, New York
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20
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Affiliation(s)
- Margaret L Dowd
- Columbia University, College of Physicians and Surgeons, New York
| | - Leah H Ansell
- Columbia University Medical Center, Department of Dermatology, New York
| | - Sameera Husain
- Columbia University Medical Center, Department of Dermatology, New York
| | - Marc E Grossman
- Columbia University Medical Center, Department of Dermatology, New York
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21
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Blackcloud P, Dabela E, Grossman ME. Grade 4 radiation dermatitis presenting with full-thickness ulcerations of the groin after radiation therapy for anal squamous cell carcinoma (SCC): An example of the "bolus effect" of radiation therapy. JAAD Case Rep 2016; 1:389-91. [PMID: 27051789 PMCID: PMC4809404 DOI: 10.1016/j.jdcr.2015.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Paul Blackcloud
- Department of Dermatology, Columbia University, New York, New York
| | - Ellen Dabela
- Department of Dermatology, Columbia University, New York, New York
| | - Marc E Grossman
- Department of Dermatology, Columbia University, New York, New York
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22
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Lederhandler M, Valins W, Zoghbi Z, Grossman ME. Leg ulcers in systemic lupus erythematosus associated with underlying dystrophic calcinosis and bone infarcts in the absence of antiphospholipid antibodies. JAAD Case Rep 2016; 2:164-7. [PMID: 27222878 PMCID: PMC4864114 DOI: 10.1016/j.jdcr.2016.02.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Margo Lederhandler
- Memorial Sloan Kettering Cancer Center, New York, New York
- Correspondence to: Margo Lederhandler, MD, Memorial Sloan Kettering Cancer Center, Margo Lederhandler C-1282, 1275 York Ave Box 8, New York, NY 10065.Memorial Sloan Kettering Cancer CenterMargo Lederhandler C-12821275 York Ave Box 8New YorkNY10065
| | - Whitney Valins
- Department of Dermatology, Columbia University Medical Center, New York, New York
| | - Zena Zoghbi
- Department of Dermatology, Columbia University Medical Center, New York, New York
| | - Marc E. Grossman
- Department of Dermatology, Columbia University Medical Center, New York, New York
- Dermatology Consultation Service, Columbia University Medical Center, New York, New York
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23
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Affiliation(s)
- Ilana J DeLuca
- Department of Dermatology, Columbia University, New York, New York
| | | | - Marcus R Pereira
- Department of Infectious Diseases, Columbia University, New York, New York
| | - Marc E Grossman
- Department of Dermatology, Columbia University, New York, New York
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Salik J, Tang R, Nord K, Schneiderman PI, Grossman ME. Mycophenolate mofetil-induced oral ulcerations in solid organ transplant recipients: A report of 3 cases. JAAD Case Rep 2015; 1:261-3. [PMID: 27051747 PMCID: PMC4809219 DOI: 10.1016/j.jdcr.2015.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Jonathan Salik
- Columbia University, College of Physicians and Surgeons, New York, New York
| | - Randy Tang
- Department of Dermatology, Columbia University, College of Physicians and Surgeons, New York, New York
| | - Kristin Nord
- Department of Dermatology, Stanford University School of Medicine, Stanford, California
| | - Paul I Schneiderman
- Department of Dermatology, Columbia University, College of Physicians and Surgeons, New York, New York
| | - Marc E Grossman
- Department of Dermatology, Columbia University, College of Physicians and Surgeons, New York, New York
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Affiliation(s)
- Sheila Shaigany
- Department of Dermatology and Dermatology Consultation Service, Columbia University Medical Center, New York, New York
| | - Nicole A Weitz
- Department of Dermatology and Dermatology Consultation Service, Columbia University Medical Center, New York, New York
| | - Sameera Husain
- Department of Dermatopathology, Columbia University Medical Center, New York, New York
| | - Larisa Geskin
- Department of Dermatology and Dermatology Consultation Service, Columbia University Medical Center, New York, New York
| | - Marc E Grossman
- Department of Dermatology and Dermatology Consultation Service, Columbia University Medical Center, New York, New York
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26
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Patel AR, Zoghbi Z, Husain S, Grossman ME. Cystic nodule on the palm. Cutis 2015; 95:E1-E3. [PMID: 26125215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Asha R Patel
- Columbia University, Department of Dermatology, 161 Ft Washington Ave, 12th Floor, New York, NY 10032, USA
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Affiliation(s)
| | - Brian J Rebolledo
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Dean G Lorich
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Marc E Grossman
- Department of Dermatology, Columbia University, New York, New York
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Reddy BY, Shaigany S, Schulman L, Grossman ME. Resident Rounds Part III: Case Report: Fatal Cryptococcal Panniculitis in a Lung Transplant Recipient. J Drugs Dermatol 2015; 14:519-522. [PMID: 25942673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Cryptococcal panniculitis is a rare entity previously reported in only 13 solid organ transplant (SOT) recipients. Cutaneous cryptococcosis in SOT recipients warrants extensive systemic workup and treatment as if central nervous system (CNS) disease is present. It should be included in the differential diagnosis of panniculitis in the immunocompromised host, as early diagnosis and treatment are critical. We report a fatal case of cryptococcal panniculitis in a 44-year-old lung transplant recipient.
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Shaigany S, Dabela E, Teich AF, Husain S, Grossman ME. Resolution of urticarial vasculitis after treatment of neurocysticercosis. J Am Acad Dermatol 2015; 72:e32-3. [PMID: 25497947 DOI: 10.1016/j.jaad.2014.09.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 09/03/2014] [Accepted: 09/07/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Sheila Shaigany
- Department of Dermatology and Dermatology Consultation Service, Columbia University Medical Center, New York, New York.
| | - Ellen Dabela
- Department of Dermatology and Dermatology Consultation Service, Columbia University Medical Center, New York, New York
| | - Andrew F Teich
- Department of Neuropathology, Columbia University Medical Center, New York, New York
| | - Sameera Husain
- Department of Dermatopathology, Columbia University Medical Center, New York, New York
| | - Marc E Grossman
- Department of Dermatology and Dermatology Consultation Service, Columbia University Medical Center, New York, New York
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Affiliation(s)
- Sheila Shaigany
- Department of Dermatology and Dermatology Consultation Service, Columbia University Medical Center, New York, New York
| | - Ellen Dabela
- Department of Dermatology and Dermatology Consultation Service, Columbia University Medical Center, New York, New York
| | - Sameera Husain
- Department of Dermatopathology, Columbia University Medical Center, New York, New York
| | - Marc E Grossman
- Department of Dermatology and Dermatology Consultation Service, Columbia University Medical Center, New York, New York
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West ES, Kingsbery MY, Mintz EM, Hsu AP, Holland SM, Rady PL, Tyring SK, Grossman ME. Generalized verrucosis in a patient with GATA2 deficiency. Br J Dermatol 2015; 170:1182-6. [PMID: 24359037 DOI: 10.1111/bjd.12794] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2013] [Indexed: 12/16/2022]
Abstract
Generalized verrucosis is a characteristic of several genetic and immunodeficiency disorders including epidermodysplasia verruciformis; warts, hypogammaglobulinaemia, infections and myelokathexis (WHIM) syndrome; warts, immunodeficiency, lymphoedema and anogenital dysplasia (WILD) syndrome; severe combined immune deficiency and HIV, among others. In recent years, it has been consistently recognized in patients with GATA2 deficiency, a novel immunodeficiency syndrome characterized by monocytopenia, B-cell and natural killer-cell lymphopenia, and a tendency to develop myeloid leukaemias and disseminated mycobacterial, human papillomavirus (HPV) and opportunistic fungal infections. Mutations in GATA2 cause haploinsufficiency and track in families as an autosomal dominant immunodeficiency. GATA2 is a transcription factor involved in early haematopoietic differentiation and lymphatic and vascular development. We describe a case of generalized verrucosis with HPV type 57 presenting in a young man with GATA2 deficiency. GATA2 deficiency is a novel dominant immunodeficiency that is often recognized later in life and should be considered in the differential diagnosis of patients with generalized verrucosis.
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Affiliation(s)
- E S West
- Department of Dermatology, Columbia University Medical Center, 161 Fort Washington Avenue 12th Floor, New York, NY, 10032, U.S.A
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Yamany T, Levender M, Silvers DN, Grossman ME. Erythema multiforme-like reaction with mucosal involvement following administration of idelalisib for relapse of chronic lymphocytic leukemia. Leuk Lymphoma 2014; 56:1872-3. [DOI: 10.3109/10428194.2014.969259] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Affiliation(s)
- Ilana J DeLuca
- Department of Dermatology, Columbia University, New York, New York.
| | - Marc E Grossman
- Department of Dermatology, Columbia University, New York, New York
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O’Malley JT, D’Agati VD, Sherman WH, Grossman ME. Acquired Cutis Laxa Associated With Heavy Chain Deposition Disease Involving Dermal Elastic Fibers. JAMA Dermatol 2014; 150:1192-6. [DOI: 10.1001/jamadermatol.2014.725] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- John T. O’Malley
- Department of Dermatology, Columbia University Medical Center, New York, New York
| | - Vivette D. D’Agati
- Department of Pathology, Columbia University Medical Center, New York, New York
| | - William H. Sherman
- Department of Medicine, Columbia University Medical Center, New York, New York
| | - Marc E. Grossman
- Department of Dermatology, Columbia University Medical Center, New York, New York
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Affiliation(s)
- Ilana J. DeLuca
- Correspondence to: Ilana J. DeLuca, MD, PhD, Department of Dermatology, Columbia University, 161 Fort Washington Ave, 12 Floor, New York, NY 10032.
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36
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Yang CC, Tolpinrud WL, Grossman ME. Trigeminal trophic syndrome secondary to recurrent meningioma. J Am Acad Dermatol 2014; 70:e110-1. [DOI: 10.1016/j.jaad.2013.09.049] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 09/10/2013] [Accepted: 09/23/2013] [Indexed: 11/29/2022]
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37
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Nguyen CV, Patel AR, Husain S, Grossman ME. Umbilicated facial papules in an immunosuppressed patient. JAMA Dermatol 2013; 149:1101-2. [PMID: 23863914 DOI: 10.1001/jamadermatol.2013.353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Cuong V Nguyen
- University of California, San Diego, School of Medicine, La Jolla
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38
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O'Malley JT, Lieb JL, Weiser JA, Grossman ME. Persistent serpentine supravenous hyperpigmentation--a possible cutaneous manifestation of HIV infection or a normal racial variant: a report of 3 cases. Skinmed 2013; 11:93-94. [PMID: 23745227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Persistent serpentine supravenous hyperpigmentation (PSSH) describes a hyperpigmentation of the skin overlying peripheral veins. This cutaneous finding is typically seen in association with systemic chemotherapy or collagen vascular diseases such as progressive systemic sclerosis, systemic lupus erythematosus, and rheumatoid arthritis. Three dark-skinned patients with idiopathic serpentine supravenous hyperpigmentation (ISSH) without collagen vascular disease or prior intravenous cytotoxic treatments were reported. All 3 patients were dark-skinned men with symmetric, uniform hyperpigmentation of the supravenous network of the bilateral lower extremities that had been present for years. The serpentine supravenous hyperpigmentation on the lower extremities was uniform in width and color, which contrasts with the darker discoloration near the site of infusion seen with PSSH associated with chemotherapy. Interestingly, 2 of the patients had advanced human immunodeficiency virus (HIV) disease in association with their ISSH while the HIV status of the third patient was unknown. Thus, we contend that ISSH be considered a normal racial variant or a possible cutaneous manifestation of HIV disease.
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Affiliation(s)
- John T O'Malley
- Department of Dermatology, Columbia University Medical Center, New York, NY, USA.
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39
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Weitz NA, Lauren CT, Weiser JA, LeBoeuf NR, Grossman ME, Biagas K, Garzon MC, Morel KD. Chlorhexidine Gluconate–Impregnated Central Access Catheter Dressings as a Cause of Erosive Contact Dermatitis. JAMA Dermatol 2013; 149:195-9. [DOI: 10.1001/jamadermatol.2013.903] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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40
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Kingsbery MY, Grossman ME, Nguyen H. Consider antilaminin gamma-1 pemphigoid when faced with conflicting histopathology and immunofluorescence results. J Am Acad Dermatol 2013; 68:e60-1. [PMID: 23317996 DOI: 10.1016/j.jaad.2012.08.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Revised: 08/15/2012] [Accepted: 08/27/2012] [Indexed: 10/27/2022]
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41
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Avarbock AB, Gill KZ, Lauren CT, Chong DH, Silvers DN, Grossman ME. Serpentine supravenous hyperpigmentation secondary to superficial venous thrombosis in autoimmune hemolytic anemia. Int J Dermatol 2013; 53:e96-7. [PMID: 23330569 DOI: 10.1111/j.1365-4632.2012.05721.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Andrew B Avarbock
- Department of Dermatology, Columbia-Presbyterian Medical Center, New York, NY, USA.
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42
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Harp JL, Marcus R, Husain S, Grossman ME. Metastatic cystic nodule of rectal SCC with basaloid features mimicking a BCC of the face. J Am Acad Dermatol 2012; 67:e160-2. [PMID: 22980281 DOI: 10.1016/j.jaad.2011.12.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Revised: 12/20/2011] [Accepted: 12/29/2011] [Indexed: 11/18/2022]
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43
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Colaco SM, Bakr FS, Silvers DN, Grossman ME. Drug hypersensitivity reactions presenting as a morbilliform eruption with islands of sparing. Cutis 2012; 89:173-174. [PMID: 22611744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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44
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Barnett CR, Bakr FS, Grossman ME. Cutaneous angiosarcoma with skin metastases and persistent bloody pleural effusions. Cutis 2012; 89:129-132. [PMID: 22530330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Cutaneous angiosarcoma is a rare aggressive malignancy of vascular origin that usually arises in the scalp or face of elderly men. We describe a case of primary cutaneous angiosarcoma with skin metastases and presumed metastases to the lung in a 58-year-old man who presented with persistent bloody pleural effusions, an asymptomatic nontraumatic red patch on the forehead of 2 to 3 months' duration, and a pair of purpuric papules on his left mid back of unknown duration. Cutaneous metastases of angiosarcoma are uncommon. Spontaneous persistent bloody effusions without hemoptysis are distinctly uncommon, and pleural fluid cytology is repeatedly negative in lung or pleural angiosarcoma, making it difficult to diagnose without tissue biopsy.
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Affiliation(s)
- Channing R Barnett
- Department of Dermatology, Columbia University Medical Center, New York, New York, USA
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45
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Young AL, Marji J, Grossman ME. Drug hypersensitivity in the age of electronic medical records. J Drugs Dermatol 2011; 10:1430-1431. [PMID: 22134567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Cutaneous drug eruptions are a common adverse reaction to medication. Creation of a drug calendar that covers a two-week span prior to the onset of rash is useful to identify the culprit agent. However, the creation of a drug calendar is often labor intensive. We developed an electronic version of a drug calendar that has considerably increased the ease and efficiency of completing a dermatology consultation.
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46
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Weiser JA, Scully BE, Bulman WA, Husain S, Grossman ME. Periumbilical parasitic thumbprint purpura: strongyloides hyperinfection syndrome acquired from a cadaveric renal transplant. Transpl Infect Dis 2011; 13:58-62. [PMID: 20525017 DOI: 10.1111/j.1399-3062.2010.00516.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Periumbilical parasitic thumbprint purpura may be a presenting sign of hyperinfection strongyloidiasis in the immunocompromised host. We report a case of fatal hyperinfection strongyloidiasis acquired from a cadaveric renal allograft, diagnosed by the pathognomonic periumbilical thumbprint purpuric eruption, confirmed by skin biopsy and laboratory testing.
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Affiliation(s)
- J A Weiser
- Department of Dermatology, Columbia University Medical Center, New York, New York 10032, USA.
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47
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Fox LP, Lightdale CJ, Grossman ME. Lichen planus of the esophagus: what dermatologists need to know. J Am Acad Dermatol 2011; 65:175-83. [PMID: 21536343 DOI: 10.1016/j.jaad.2010.03.029] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2009] [Revised: 03/20/2010] [Accepted: 03/29/2010] [Indexed: 12/14/2022]
Abstract
BACKGROUND Esophageal lichen planus (ELP) is a rare manifestation of mucocutaneous lichen planus (LP). OBJECTIVES We aimed to report our experience and review all cases of ELP reported in the English-language literature. METHODS We report our experience with 4 cases and reviewed PubMed for reports of ELP. Cases were evaluated for age of onset, sex, location of LP, relationship of the onset of ELP to extra-ELP, endoscopic findings, whether biopsy was performed, histopathology of esophageal biopsy specimens, medical history (including gastrointestinal history), development of esophageal squamous cell carcinoma, therapies tried, and response to treatment. RESULTS A total of 72 cases of ELP were studied. In all, 87% of patients were female, with a median age of 61.9 years at time of diagnosis. Dysphagia was present in 81% and odynophagia was present in 24%. Oral LP was present in 89%, anogenital/vulvar LP in 42%, and cutaneous LP in 38%. Fourteen patients developed ELP as the sole or first manifestation of LP. Proximal esophageal lesions were present in 64%, distal in 11%, and both proximal and distal in 26%. Histology was "consistent with" LP in 71%. Four patients developed squamous cell carcinoma in association with ELP. LIMITATIONS This is a review of our cases and others reported in the literature. CONCLUSIONS ELP is underrecognized and underreported. There is often a significant delay between the onset of symptoms and the diagnosis. Malignant transformation of ELP to squamous cell carcinoma has been reported.
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Affiliation(s)
- Lindy Peta Fox
- Department of Dermatology, University of California, San Francisco, California 94115, USA.
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48
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Martin SJ, Cohen PR, MacFarlane DF, Grossman ME. Cutaneous manifestations of Strongyloides stercoralis hyperinfection in an HIV-seropositive patient. Skinmed 2011; 9:199-202. [PMID: 21675505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
A 41-year-old human immunodeficiency virus (HIV)-positive man was hospitalized with complaints of a 4-week history of nausea and vomiting, associated with decreased oral intake, and a 4-day history of frontal headache and fever. His medical history was significant for a gunshot wound to the head 3 years prior, with a residual seizure disorder. He also had two previous hospitalizations, both for culture-negative bacterial meningitis; the first episode occurred 12 months before admission and the second episode occurred 5 months later. At that time, he was found to be positive for serum antibodies against HIV and a CD4+ T-lymphocyte count of 126/mm3. He had no known drug allergies and was not receiving any medication. On admission, the patient was febrile (104.0 degrees F) and hypotensive (blood pressure, 92/40 mm Hg). Pertinent physical examination findings included cachexia with bitemporal wasting, dry mucus membranes, adherent white patches on the oral mucosa, and negative Kernig's and Brudzinski's signs. His laboratory results revealed macrocytic anemia, a decreased serum sodium of 125 mEq/L, and a normal total leukocyte count with a CD4+ T-lymphocyte count < 50/mm3. Lumbar puncture opening pressure was elevated at 160 mm Hg, and cerebrospinal fluid analysis showed an increased white cell count of 97/microL (84% lymphocytes), a decreased glucose level of 26 mg/dL, and a decreased protein level of 42 mg/dL. The patient was started on empiric therapy that included intravenous ampicillin and cefotaxime, oral Bactrim, and clotrimazole lozenges for thrush. Cerebrospinal fluid culture was positive for Escherichia coli, sensitive to cefotaxime. Two days later, the patient developed fine, erythematous, nonblanchable macules primarily on his abdomen, with minimal involvement of his thorax and back. His skin lesions remained unchanged for the next 2 weeks. Repeat lumbar puncture was performed after 14 days of cefotaxime. The cerebrospinal fluid analysis showed an elevated white cell count of 7/microL (100% lymphocytes), a decreased glucose level of 53 mg/dL, and a decreased protein level of 33 mg/dL. The cerebrospinal fluid culture was now positive for Pseudomonas aeruginosa resistant to cefotaxime. The patient was started on imipenem. On day 34 of his admission, the patient became tachypneic with complaints of dyspnea. A chest roentgenogram revealed bilateral patchy infiltrates. He was transferred to the intensive care unit and intubated for hypoxemic respiratory failure (arterial blood gas values on 6 L of oxygen: pH, 7.46; bicarbonate, 23; and oxygen saturation, 37). That evening, the patient was also noted to have diffuse petechiae and purpura in a reticulated pattern over his abdomen (Figure 1A and 1B), most heavily concentrated in the periumbilical region, extending to the axillae and upper thighs. A 3x3-mm punch biopsy from abdominal skin demonstrated Strongyloides stercoralis larvae in the dermis (Figure 2A and 2B). His sputum specimen was teeming with adult S stercoralis worms (Figure 3) and, subsequently, numerous S stercoralis larvae were observed not only from the bronchoalveolar lavage but also from the nasogastric fluid specimen. These findings confirmed the diagnosis of disseminated strongyloidiasis. On hospital day 35, the patient was doing poorly and was started on thiabendazole (1250 mg twice daily for 28 days). Nine days later, ivermectin (4.5 mg once daily for 3 days for 2 courses) was also added. He continued to clinically deteriorate. The patient died 31 days after systemic antihelminthic treatment was initiated.
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49
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Young AL, Bailey EE, Colaço SM, Engler DE, Grossman ME. Anti-laminin-332 mucous membrane pemphigoid associated with recurrent metastatic prostate carcinoma: hypothesis for a paraneoplastic phenomenon. Eur J Dermatol 2011; 21:401-4. [PMID: 21527374 DOI: 10.1684/ejd.2011.1360] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Anti-epiligrin cicatricial pemphigoid is an autoimmune blistering disorder that has recently been associated with the development of solid organ malignancy. We describe a patient with recurrent metastatic prostate carcinoma who was diagnosed with this disorder. We provide a hypothesis as to the relationship between the development of this disease and its possible association with cancer pathogenesis.
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Affiliation(s)
- Alexis L Young
- Department of Dermatology, Columbia University Medical Center, New York, NY, USA.
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50
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Weiser JA, Markowitz DM, Husain S, Grossman ME. An unusual cutaneous manifestation of Crohn's disease. Skinmed 2011; 9:196-198. [PMID: 21675504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
A 61-year-old man with a 12-year history of quiescent Crohn's disease on mesalamine presented to his gastroenterologist in April 2009, complaining of abdominal cramping, diarrhea, and a 25-lb weight loss over 6 weeks. He did not respond to prednisone 50 mg and 6-mercaptopurine 100 mg daily. Abdominal computed tomography findings revealed diffuse submucosal edema consistent with extensive colitis. Colonoscopy demonstrated diffuse inflammation with erythema, friability, and shallow ulcerations in the rectum and colon. Biopsies were consistent with Crohn's colitis. He was admitted for infliximab infusion for his unremitting diarrhea. Five days before admission, the patient noted mild swelling and redness of the left lower eyelid, which progressed to involve the right lower eyelid with frank pus draining from both eyes. He had no visual impairment or eye pain. Two days before admission, an ophthalmologist prescribed a steroid eyedrop with no relief. He also complained of seropurulent painful skin lesions on his face and scalp, which spread to involve his upper trunk and proximal arms. On admission to the hospital, dermatology, ophthalmology, and infectious disease consultations were obtained to rule out disseminated infection before initiation of infliximab therapy. The patient was afebrile and hemodynamically stable. His oral mucosa was normal. He had prominent bilateral lower eyelid edema, erythema, and superficial erosions with hemorrhagic crusting and frank green purulent drainage from both eyes, with crusting along the lower lash line and bilateral sclera injection (Figure 1). On his scalp, face, trunk, and proximal extremities, he had 25 to 30 erythematous, 4- to 8-mm papulopustules with narrow red halos, some with central necrosis and crusting (Figure 2). Cultures from the purulent ocular drainage and pustules on the trunk and arms were all negative for bacteria, virus, and fungi. Gram stain from the eye drainage showed polymorphonuclear leukocytes without organisms. Tissue cultures were negative for bacterial, fungal, and mycobacterial infection. Skin biopsy taken from the central upper back demonstrated subcorneal pustules with areas of eroded epidermis and collections of neutrophils in the superficial dermis (Figure 3). Special stains were negative for organisms. He received infliximab infusion 5 mg/kg for a total dose of 420 mg over 2 hours. Within 48 hours of infusion, there was notable decrease in size of lesions, in addition to reduction of purulent drainage from both eyes. The patient was discharged home following infliximab infusion. His skin lesions resolved during a period of 2 weeks, leaving small pink atrophic scars. He received his second infusion of infliximab 2 weeks after discharge with continued improvement in his gastrointestinal symptoms.
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Affiliation(s)
- Jessica A Weiser
- Department of Dermatology, Columbia Presbyterian Medical Center, New York, NY, USA.
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