scholarly journals Atypical presentations of superficial dermatophytoses associated with Ruocco’s immunocompromised cutaneous district: A case series

2021 ◽  
Vol 12 (4) ◽  
pp. 406-411
Author(s):  
Ramesh Kumar Kushwaha ◽  
Alpana Mohta ◽  
Suresh Kumar Jain
Keyword(s):  
Case Series ◽  
Anatomical Site ◽  
Immune Control ◽  
Immune Reactions ◽  
Cutaneous Infections ◽  
Atypical Presentations ◽  
Cutaneous Damage

An immunocompromised district is an area of irregular immune control of the skin occurring due to cutaneous damage of any sort conducive to the development of infections, immune reactions, and tumors. Superficial dermatophytoses are one of the most commonly encountered cutaneous infections, which, in some cases, may have various atypical presentations. Herein, we present a series of eleven such cases in which the presentation of a superficial dermatophytosis was altered by the concurrent presence of a different unrelated dermatosis on the same anatomical site.

Unusual non-trophic ulcerations in leprosy: A case series of 17 patients

2021 ◽  
pp. 004947552199849
Author(s):  
Prakriti Shukla ◽  
Kiran Preet Malhotra ◽  
Parul Verma ◽  
Swastika Suvirya ◽  
Abir Saraswat ◽  
...  
Keyword(s):  
Erythema Nodosum ◽  
Case Series ◽  
Lepromatous Leprosy ◽  
Sweet Syndrome ◽  
Erythema Nodosum Leprosum ◽  
Leprosy Patients ◽  
Atypical Presentations ◽  
Neuropathic Ulcers

Non-neuropathic ulcers in leprosy patients are infrequently seen, and atypical presentations are prone to misdiagnosis. We evaluated diagnosed cases of leprosy between January 2017 and January 2020 for the presence of cutaneous ulceration, Ridley–Jopling subtype of leprosy, reactions and histologic features of these ulcerations. Treatment was given as WHO recommended multi-bacillary multi-drug therapy. We found 17/386 leprosy patients with non-neuropathic ulcers. We describe three causes – spontaneous cutaneous ulceration in lepromatous leprosy (one nodular and one diffuse), lepra reactions (five patients with type 1; nine with type 2, further categorised into ulcerated Sweet syndrome-like who also had pseudoepitheliomatous hyperplasia, pustulo-necrotic and necrotic erythema nodosum leprosum) and Lucio phenomenon (one patient). Our series draws attention towards the different faces of non-neuropathic ulcers in leprosy, including some atypical and novel presentations.

scholarly journals Sporotrichoid-Like Spread of Cutaneous Mycobacterium chelonae in an Immunocompromised Patient

2017 ◽  
Vol 2017 ◽  
pp. 1-3
Author(s):  
Daria Marley Kemp ◽  
Anusha G. Govind ◽  
Jun Kang ◽  
Caroline C. Brugger ◽  
Young C. Kauh
Keyword(s):  
Lupus Erythematosus ◽  
Soft Tissues ◽  
Immunocompromised Patient ◽  
Immunocompromised Patients ◽  
Systemic Lupus ◽  
Mycobacterium Chelonae ◽  
Cutaneous Infections ◽  
Subcutaneous Nodules ◽  
Immunosuppressive Medications ◽  
Atypical Presentations

Mycobacterium chelonae is a rapidly growing mycobacterium found in water and soil that can cause local cutaneous infections in immunocompetent hosts but more frequently affects immunocompromised patients. Typically, patients will present with painful subcutaneous nodules of the joints or soft tissues from traumatic inoculation. However, exhibiting a sporotrichoid-like pattern of these nodules is uncommon. Herein, we report a case of sporotrichoid-like distribution of cutaneous Mycobacterium chelonae in a patient with systemic lupus erythematosus on significant immunosuppressive medications. Clinicians treating immunocompromised patients should be cognizant of their propensity to develop unusual infections and atypical presentations.

Rare atypical presentations in Type 2 lepra reaction: a case series

2013 ◽  
Vol 53 (3) ◽  
pp. 323-326 ◽  
Author(s):  
Pragasam Vijendran ◽  
Rajesh Verma ◽  
Biju Vasudevan ◽  
Debdeep Mitra ◽  
Ambresh Badad ◽  
...  
Keyword(s):  
Case Series ◽  
Atypical Presentations

Mycobacterial Infections of the Hand

Hand ◽  
2020 ◽  
pp. 155894472094006
Author(s):  
Vivek K. Bilolikar ◽  
Asif M. Ilyas
Keyword(s):  
Case Reports ◽  
Case Series ◽  
Signs And Symptoms ◽  
Joint Space ◽  
Cutaneous Infections ◽  
Mycobacterial Infections ◽  
Resistant Tuberculosis ◽  
Resistance Patterns ◽  
New Diagnosis ◽  
Resistance Rates

Background Hand infections caused by mycobacteria are relatively uncommon compared to infections caused by other pathogens; therefore, much of the available literature consists of case reports and limited case series. Broadly categorized into tuberculous and nontuberculous mycobacterial (NTM) infections, both tuberculous and NTM infections are typically insidious with long incubation periods and with the ability to remain dormant for prolonged periods. Methods We reviewed the most current literature on the epidemiology, presentations, treatment methods, and resistance patterns of mycobacterial infections of the hand focusing on the indications and outcomes of nonoperative as well as operative interventions. Results The worldwide burden of tuberculosis remains high and while the overall rate of new diagnosis drug resistant tuberculosis has been on the decline some regions of the world have demonstrated staggeringly high resistance rates to first-line tuberculosis therapies. Signs and symptoms of mycobacterial hand infection are typically inconsistent, and highly dependent on the specific structures of the hand that are affected; therefore, these infections may mimic other infections of the hand like tenosynovitis, joint space infections, and cutaneous infections. The main stay of treatment remains antimycobacterial therapies including but not limited to rifampin, isoniazid, pyrazinamide, and ethambutol. Conclusions The complications associated with mycobacterial hand infections can be significant. Prompt evaluation, including a thorough history to evaluate for potential exposures to infectious sources, followed by appropriate antibiotic choice and duration, with surgical management as needed, is key to reducing the chance that patients experience lasting effects of the infection.

Diagnosis and Management of Precocious Puberty in Atypical Presentations of McCune-Albright Syndrome: A Case Series Review

2012 ◽  
Vol 25 (1) ◽  
pp. e9-e13 ◽  
Author(s):  
Jennifer L. Bercaw-Pratt ◽  
Tracy Patel Moorjani ◽  
Xiomara M. Santos ◽  
Lefkothea Karaviti ◽  
Jennifer E. Dietrich
Keyword(s):  
Precocious Puberty ◽  
Case Series ◽  
Mccune Albright Syndrome ◽  
Diagnosis And Management ◽  
Albright Syndrome ◽  
Atypical Presentations ◽  
Mccune Albright

scholarly journals Coccidioidomycosis in Nonhuman Primates: Pathologic and Clinical Findings

2018 ◽  
Vol 55 (6) ◽  
pp. 905-915 ◽  
Author(s):  
Keith Koistinen ◽  
Lisa Mullaney ◽  
Todd Bell ◽  
Sherif Zaki ◽  
Aysegul Nalca ◽  
...  
Keyword(s):  
Vertebral Column ◽  
Nonhuman Primates ◽  
Case Series ◽  
Granulomatous Inflammation ◽  
Clinical Findings ◽  
Review Of The Literature ◽  
Endemic Region ◽  
Cutaneous Infections ◽  
Abdominal Organs ◽  
Disseminated Disease

Coccidioidomycosis in nonhuman primates has been sporadically reported in the literature. This study describes 22 cases of coccidioidomycosis in nonhuman primates within an endemic region, and 79 cases of coccidioidomycosis from the veterinary literature are also reviewed. The 22 cases included baboons ( n = 10), macaques ( n = 9), and chimpanzees ( n = 3). The majority died or were euthanized following episodes of dyspnea, lethargy, or neurologic and locomotion abnormalities. The lungs were most frequently involved followed by the vertebral column and abdominal organs. Microscopic examination revealed granulomatous inflammation accompanied by fungal spherules variably undergoing endosporulation. Baboons represented a large number of cases presented here and had a unique presentation with lesions in bone or thoracic organs, but none had both intrathoracic and extrathoracic lesions. Although noted in 3 cases in the literature, cutaneous infections were not observed among the 22 contemporaneous cases. Similarly, subclinical infections were only rarely observed (2 cases). This case series and review of the literature illustrates that coccidioidomycosis in nonhuman primates reflects human disease with a varied spectrum of presentations from localized lesions to disseminated disease.

Atypical Presentation of Fulminating Subacute Sclerosing Panencephalitis: A Case Series

2020 ◽  
Author(s):  
Pranab K. Dey ◽  
Arindam Ghosh
Keyword(s):  
Measles Virus ◽  
Subacute Sclerosing Panencephalitis ◽  
Case Series ◽  
Acute Disseminated Encephalomyelitis ◽  
Initial Symptom ◽  
Gait Abnormality ◽  
First Case ◽  
History Of ◽  
Atypical Presentations ◽  
Fulminant Type

AbstractSubacute sclerosing panencephalitis (SSPE) is a rare and progressive inflammatory disease of central nervous system due to aberrant measles virus with an outcome that is nearly always fatal. In acute fulminant SSPE, the disease rapidly evolves leading to death within 3 months of the diagnosis. We report here four cases of fulminant SSPE with atypical presentations, two of them presented at very early age with history of congenital measles infection in first case and gait abnormality as initial symptom in second case; acute disseminated encephalomyelitis (ADEM) with refractory seizures in third case, unilateral myoclonus with hemiparesis in fourth case at the onset of disease, respectively. The typical periodic electroencephalographic (EEG) complexes, elevated cerebrospinal fluid (CSF), and serum antimeasles antibodies in our patients led to the diagnosis of SSPE. A high index of clinical suspicion in fulminant type with awareness of atypical features, EEG, and CSF studies are of paramount importance in establishing its diagnosis.

scholarly journals COVID-19 Pandemic in the Disguise of Multi System Inflammatory Syndrome in Children: A Case Series

2021 ◽  
Author(s):  
Anahita Sanaei Dashti ◽  
Kamyar Ebrahimi ◽  
Reza Shahriarirad ◽  
Shabnam Hajiani Ghotbabadi ◽  
Shiva Aminnia
Keyword(s):  
Tertiary Care ◽  
Case Series ◽  
Organ Damage ◽  
The Novel ◽  
Number Of Children ◽  
Public Crisis ◽  
Novel Coronavirus ◽  
Atypical Presentations ◽  
Inflammatory Syndrome

Abstract Although nearly a year has passed since the emerge of the SARS-CoV-2 virus, with it, a serious and novel pediatric condition called children's multisystem inflammatory syndrome (MIS-C) has subsequently emerged. In order to achieve a better understanding and management of the disease, documentation and reporting of atypical cases is justified, particularly with the growing number of children with inflammatory syndrome with clinical features simulating MIS during the ongoing COVID-19 pandemic. Based on similar reports from numerous countries with temporal relation to COVID-19 infection in the community, it is essential for general pediatricians to be on alert for such atypical presentations and early referral to tertiary care should be considered as appropriate. Here we four cases of Multisystem Inflammatory Syndrome (MIS) during the COVID-19 pandemic. Early diagnosis and treatment of patients meeting full or partial criteria for MIS are critical to preventing end-organ damage and other long-term complications, especially during times of public crisis and global health emergencies, such as the novel coronavirus pandemic.

scholarly journals Factors Contributing to Diagnostic Discordance Between Store-and-Forward Teledermatology Consultations and In-Person Visits: Case Series

10.2196/24820 ◽  
2021 ◽  
Vol 4 (1) ◽  
pp. e24820
Author(s):  
Michelle S Lee ◽  
Robert Stavert
Keyword(s):  
Differential Diagnosis ◽  
Clinical Diagnosis ◽  
Case Series ◽  
Retrospective Chart Review ◽  
Cost Effective ◽  
Academic Community ◽  
Diagnostic Uncertainty ◽  
Store And Forward ◽  
Diagnostic Concordance ◽  
Atypical Presentations

Background Use of asynchronous store-and-forward (SAF) teledermatology can improve access to timely and cost-effective dermatologic care and has increased during the COVID-19 pandemic. Previous research has found high diagnostic concordance rates between SAF teledermatology and face-to-face clinical diagnosis, but to our knowledge, none have used specific cases to illustrate factors contributing to diagnostic discordance. Objective To identify and illustrate characteristics that may have contributed to diagnostic discordance between store-and-forward teledermatology and in-person clinical diagnosis in a series of patients. Methods We identified 7 cases of diagnostic discordance between teledermatology and in-person visits where the favored diagnosis of the in-person dermatologist was not included in the differential diagnosis formulated by the teledermatologist. Cases were identified from a previously published retrospective chart review of 340 SAF teledermatology consultations, which was previously performed at an academic community health care system in the greater Boston area, Massachusetts, from January 1, 2014, through December 31, 2017. Of 99 patients who completed an in-person dermatology appointment after their teledermatology consultation, 7 had diagnostic disagreement between the teledermatologist and in-person dermatologist where the diagnosis in the in-person consultation was not included in the differential diagnosis in the original teledermatology consult. These 7 cases were examined by 2 author reviewers to identify factors that may have contributed to diagnostic discordance. Results Factors contributing to diagnostic discordance between SAF teledermatology consultations and in-person visits included poor image quality, inadequate history or diagnostic workup, inability to evaluate textural characteristics, diagnostic uncertainty due to atypical presentations, and evolution in appearance of skin conditions over time. Conclusions We identified multiple factors that contributed to diagnostic discordance. Recognition and mitigation of these factors, when possible, may help to improve diagnostic accuracy and reduce the likelihood of misdiagnosis. Continuing education of referring providers and implementation of standardized guidelines for referrals may also be helpful in reducing the risk of misdiagnosis due to inherent limitations of teledermatology services.

scholarly journals The Etiologies of Isolated Fourth Cranial Nerve Palsy: A 10-Year Review of 158 Cases

2021 ◽  
Author(s):  
Apatsa Lekskul ◽  
Wadakarn Wuthisiri ◽  
Phantaraporn Tangtammaruk
Keyword(s):  
Nerve Palsy ◽  
Demographic Data ◽  
Closed Head Injury ◽  
Clinical Signs ◽  
Case Series ◽  
Signs And Symptoms ◽  
Rapid Progression ◽  
Clinical Signs And Symptoms ◽  
Atypical Presentations ◽  
Fourth Nerve Palsy

Abstract MethodsPatients diagnosed with isolated fourth nerve palsy from January 1, 2009, through July 31, 2020 in Ramathibodi Hospital, were included in this retrospective, observational case series. The demographic data of patients, age at presentation, the etiologies of isolated fourth nerve palsy and neuroimaging results (if indicated) were recorded.ResultsWe identified 153 unilateral and 5 bilateral cases of isolated fourth nerve palsy. Mean age at presentation was 38.89 ± 25.71 years old. Most of the unilateral cases were congenital (58.17%), with vasculopathy (27.45%), intracranial neoplasm (8.5%) and other etiologies. Trauma with closed head injury was the most common etiology of bilateral cases (60%), followed by ruptured arterovenous malformation (20%) and vasculopathy (20%). Twenty-one of the 43 (48.84%) patients with vasculopathy-associated fourth nerve palsy underwent neuroimaging, with normal findings, and all patients’ symptoms resolved within 6 months of symptom onset.ConclusionsIn our series, most of the isolated fourth nerve palsy cases were congenital, followed in frequency by vasculopathy and intracranial tumor, as in many studies. In cases of vasculopathy, the clinical signs and symptoms resolved within 6 months in all cases: observation was sufficient, with no necessity for neuroimaging. However, neuroimaging should be considered in cases with atypical presentations, such as headache, periorbital pain, ataxia with positive cerebellar signs, or if there is rapid progression or no recovery.

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