Dot in circle sign on MRI in foot mycetoma

Mycetoma or Maduramycosis is a chronic granulomatous infectious condition encountered mostly in tropical and subtropical regions. It affects the deep subcutaneous tissues, which may progress to involve the muscles and bones later in the course of the disease. It can be caused by fungi (eumycetoma), and bacteria (actinomycetoma) predominantly affecting the foot. Demonstration of the causative agent by biopsy and microbiological studies helps to establish a confirmative diagnosis, and choosing correct antimicrobial therapy. However, it may be delayed resulting in increased patient morbidity. Thus, imaging plays a vital role in early recognition & prompt treatment, especially MRI which is a non-invasive procedure demonstrating the hallmark dot in circle sign. Here we report a case of mycetoma foot with pathognomic MRI findings.

Case Report: Leathery black plaque on the temple and scalp

Background

Epidermal nevus sebaceous, commonly known as the nevus sebaceous of Jadassohn, is a congenital sebaceous hamartoma. It typically manifests as a single yellowish plaque across the head and neck and is composed of sebaceous glands. It commonly occurs during infancy and grows during puberty. Usually, it follows a benign course; however, in a few cases, it can be malignant. This is the case of a 13-year-old child with verrucous plaques on the temple and scalp.

Case report

We report the case of a 13-year-old boy with a steadily developing hyperpigmented verrucous plaque on the scalp and ipsilateral side of his face. A dermoscopic examination revealed ridges and fissures in a cerebriform pattern with yellowish-gray globules and a papillary appearance. Physical examination and laboratory tests revealed no abnormalities. Biopsies were taken from the scalp and temple area, and the findings were consistent with the diagnosis of nevus sebaceous. The patient was referred to a plastic surgeon for a staged excision.

Conclusions

We describe a unique example of a sebaceous nevus that affected the scalp and ipsilateral side of the face. As this hamartomatous growth carries the risk of cancer development, a dermatologist must identify the condition and begin treatment before malignant transformation occurs. This example of multiple verrucous plaques is an exception.

Successful Management of Folliculitis Decalvans

Folliculitis decalvans (FD) is a rare disease that causes inflammation on the scalp, leading to scarring alopecia. It commonly affects young and middle-aged men and is characterized by pustules, papules, scarring, hemorrhagic crusts, and erosions. The exact cause of FD is not fully understood, but it is believed that Staphylococcus aureus may play a role in its development. The condition is thought to be influenced by a combination of genetic, allergic, infectious, and immunological factors. This report describes a 20-year-old male patient who experienced painful pustules on his scalp for six months. The pustules first appeared on the occipital region and then spread to the crown. The patient was diagnosed with FD after a thorough clinical and pus culture examination. Treatment involved a month-long prescription of doxycycline (100 mg BD) and topical ozenoxacin (2%), which led to successful remission of the lesions.

Paclitaxel-Induced Cutaneous Lupus Erythematosus and Raynaud's Phenomenon

Taxanes, in combination with platinum-based drugs, are considered the initial treatment option for certain types of cancer, including ovarian cancer. Here, we report the case of a 59-year-old woman who developed a malar rash on her face, a maculopapular rash on her forearms, and bluish discoloration on her fingers immediately following the end of the third cycle of chemotherapy. After discontinuing paclitaxel and using oral and topical steroids for rash and diltiazem and topical minoxidil for the treatment of Raynaud's phenomenon, the symptoms completely resolved. While taxanes are known to cause drug-induced lupus, there has never been any information on taxanes causing isolated Raynaud's phenomenon. This is the first case report that suggests paclitaxel-induced Raynaud's phenomenon along with paclitaxel-induced lupus.

A Rare Case of Acral Lentiginous Melanoma

Acral lentiginous melanoma (ALM) is named so for its site and histological orientation. It is an infrequent form of melanoma that usually presents with lesions on the palms, soles, or nails. Although rare, it's the most commonly discovered subtype of melanoma in the non-Caucasian population, including Africans, Chinese, Koreans, and Latin Americans. It's most likely to be diagnosed in the sixth or seventh decade of life. Acral lentiginous melanoma can clinically mimic ulceration, verrucous lesions, onychomycosis, subungual hematomas, vascular lesions, and infections. Here, we are presenting the case of a 65-year-old male who was admitted to the surgery ward in Acharya Vinobha Bhave Rural Hospital with a chief complaint of a lesion over the plantar surface of his left foot for the last one or two years and was referred to the Department of Dermatology for the same. The lesion was sighted by the patient a long time before his visit to Acharya Vinobha Bhave Rural Hospital. A physical examination showed a blackish, poorly delineated soft tissue lesion on the left heel. An excisional biopsy and proper management were carried out for the patient. Patient education and greater awareness about this tumor and its early detection can serve as important weapons to increase the patient survival rate and prognosis of acral lentiginous melanoma.