Breast Mass with Bloody Discharge: A Case of Idiopathic Granulomatous Mastitis

One of the rare identity of breast diseases is Idiopathic Granulomatous Mastitis (IGM), a chronic inflammatory breast condition that can mimic advanced breast cancer. The case came with nipple discharge and mass with skin changes, which was definitively diagnosed following core-cut biopsy of the mastitis group idiopathic granulomatous.

Comparison of Anterior Nares Viral Loads in Asymptomatic and Symptomatic Individuals Diagnosed with SARS-CoV-2 in a University Screening Program

RT-qPCR has been used as the gold standard method for detecting SARS-CoV-2 since early in the pandemic. At our university based high throughput screening program, we test all members of our community weekly. RT-qPCR cycle threshold (CT) values are inversely proportional to the amount of viral RNA in a sample, and thus are a proxy for viral load. We hypothesized that CT values would be higher, and thus the viral loads at the time of diagnosis would be lower in individuals who were infected with the virus but remained asymptomatic throughout the course of the infection. We collected the N1 and N2 CT values from 1633 SARS-CoV-2 positive RT-qPCR tests of individuals sampled between August 7, 2020, and March 18, 2021, at the BU Clinical Testing Laboratory. We matched this data with symptom reporting data from our clinical team. We found that asymptomatic patients had CT values significantly higher than symptomatic individuals on the day of diagnosis. Symptoms were followed by the clinical team for 10 days post the first positive test. Within the entire population, 78.1% experienced at least one symptom during surveillance by the clinical team (n=1276/1633). Of those experiencing symptoms, the most common symptoms were nasal congestion (73%, n=932, 1276), cough (60.0%, n=761/1276), fatigue (59.0%, n=753/1276), and sore throat (53.1%, n=678/1276). The least common symptoms were diarrhea (12.5%, n=160/1276), dyspnea on exertion (DOE) (6.9%, n=88/1276), foot or skin changes (including rash) (4.2%, n=53/1276), and vomiting (2.1%, n= 27/1276). Presymptomatic individuals, those who were not symptomatic on the day of diagnosis but became symptomatic over the following 10 days, had CT values higher for both N1 (median= 27.1, IQR 20.2- 32.9) and N2 (median=26.6, IQR 20.1-32.8) than the symptomatic group N1 (median= 21.8, IQR 17.2- 29.4) and N2 (median= 21.4, IQR 17.3- 28.9) but lower than the asymptomatic group N1 (median=29.9, IQR 23.6-35.5) and N2 (median= 30.0, IQR 23.1- 35.7). This study supports the hypothesis that viral load in the anterior nares on the day of diagnosis is a measure of disease intensity at that time.

Triggers and markers of skin aging in women with menopausal syndrome

Introduction. External manifestations of aging, and especially skin aging are the most important for modern women.Aim. The aim of our study was to identify a set of adverse factors that effect on the skin of women in menopausal transition (MP) and in postmenopause (PM), and to identify markers of skin aging in this category of women.Materials and methods. The study included 36 women in MP and PM suffering from MS. At the first stage, anamnesis was collected, anthropometric data and severity of MS were evaluated, and the hormonal profile of patients was determined. At the second stage, computer mapping of the skin was performed using the digital video camera Aramo SG with the skin XPpro program. Statistic analysis was performed using the SPSS v13.0 program. Spearman’s analysis was used to determine the relationship between anthropometric, clinical and anamnestic data and the measurements of skin condition of women in MP and PM. Results. According to the obtained data, the main triggers of skin aging of women in MP and PM are: the presence of metabolic disorders (obesity, metabolic syndrome), decrease of estradiol and progesterone levels in blood serum as well as increase of prolactin level and rhythm disturbance of melatonin secretion. Markers of skin aging in women with menopausal syndrome are decreased moisture, increased oiliness in T-zone, increased of skin pigmentation and enlarged pore size.Conclusions. The obtained data are useful for management involuting skin changes of women in PM and MP suffering from MS. The data justifies the relevancy to normalization not only the estradiol level, but other sex steroids, melatonin, as well as correction of metabolic endocrine processes, and treatment of MS.

Blood Flow Analysis of the Great Saphenous Vein in the Su-Pine Position in Clinical Manifestations of Varicose Veins of Different Severities: Application of Phase-Contrast Magnetic Resonance Imaging Data

The progression of clinical manifestations of lower-limb varicose veins remains unclear. This study investigated changes in lower-limb venous blood flow using phase-contrast magnetic resonance angiography. Data were collected on veins from 141 legs. We compared legs with and without varicose veins and related symptoms and examined varying levels of varicose vein symptom severity. Legs without varicose veins exhibited a lower absolute stroke volume (ASV, p < 0.01) and mean flux (MF, p = 0.03) for the great saphenous vein (GSV) compared with legs with symptomatic varicose veins. Legs with asymptomatic varicose veins exhibited lower MF for the GSV (p = 0.02) compared with legs with symptomatic varicose veins. Among legs with varicose veins, asymptomatic legs exhibited lower ASV (p = 0.03) and MF (p = 0.046) for the GSV compared with legs that exhibited skin changes or ulcers; however, no significant differences were observed between legs presenting with discomfort or edema and legs with skin changes or ulcers, and between legs presenting with discomfort or edema and asymptomatic legs. In conclusion, in the supine position, increased blood flow rate and blood flow volume in the GSV were associated with symptomatic varicose veins and increased symptom severity.

Erythema nodosum leprosum (type 2 reaction) in a patient with neurofibromatosis type 1

Being a region endemic for leprosy, clinical practitioners in India often encounter myriad manifestations and diverse complications of the disease. However, the masking of the obvious clinical presentations due to the coexistence of a closely resembling unrelated disorder, a ‘mimicker’, would indeed pose a serious diagnostic predicament unless a high degree of clinical suspicion is maintained. Leprosy, also known as Hansen’s disease is a chronic infectious disease caused by Mycobacterium leprae complex that involves the skin and peripheral nerves. Neurofibromatosis type 1 (NF1) also known as von Recklinghausen’s disease is an autosomal dominant genetic disorder that presents with skin changes and benign peripheral nerve sheath tumours called neurofibromas. Here, we present the case of a 35-year-old man with NF1 who presented with type 2 lepra reaction (erythema nodosum leprosum, ENL) and the skin biopsy unmasked ENL nodule among the group of NF1 nodules.

Rabson-Mendenhall syndrome: a rare case of severe insulin resistance

Insulin resistance syndromes are a heterogeneous group of disorders with variable clinical phenotypes, associated with increased blood glucose and insulin levels. A 20-year-old female, diabetic for 12 years, reported with hyperglycemia not responding to high dose of insulin; therefore, insulin dosage was increased but did not lead to appropriate glycemic control. Investigations revealed hyperglycemia (random blood glucose 23 mmol/L) glycosylated hemoglobin (HbA1c) 9.2%. Ultrasonogram of the abdomen showed prominent ovaries with fatty liver. Echocardiography revealed mild mitral, pulmonary and tricuspid regurgitation and pulmonary hypertension. Based on the clinical features, skin changes and the onset of type 2 diabetes mellitus, Rabson-Mendenhall syndrome (RMS) was considered. In last admission, she was admitted for hyperglycemic control and treated with intravenous fluids, insulin infusion, metformin, pioglitazone, linagliptin, hydroxychloroquine, sulphonylurea, antibiotics. There is no complete cure for the condition and the current treatments are difficult and not very promising. BIRDEM Med J 2022; 12(1): 83-87

Analyses and Correlation of Pathologic and Ocular Cutaneous Changes in Murine Graft versus Host Disease

Graft versus host disease (GVHD) is initiated by donor allo-reactive T cells activated against recipient antigens. Chronic GVHD (cGVHD) is characterized by immune responses that may resemble autoimmune features present in the scleroderma and Sjogren’s syndrome. Unfortunately, ocular involvement occurs in approximately 60–90% of patients with cGVHD following allo-hematopoietic stem cell transplants (aHSCT). Ocular GVHD (oGVHD) may affect vision due to ocular adnexa damage leading to dry eye and keratopathy. Several other compartments including the skin are major targets of GVHD effector pathways. Using mouse aHSCT models, the objective was to characterize cGVHD associated alterations in the eye and skin to assess for correlations between these two organs. The examination of multiple models of MHC-matched and MHC-mismatched aHSCT identified a correlation between ocular and cutaneous involvement accompanying cGVHD. Studies detected a “positive” correlation, i.e., when cGVHD-induced ocular alterations were observed, cutaneous compartment alterations were also observed. When no or minimal ocular signs were detected, no or minimal skin changes were observed. In total, these findings suggest underlying cGVHD-inducing pathological immune mechanisms may be shared between the eye and skin. Based on the present observations, we posit that when skin involvement is present in aHSCT patients with cGVHD, the evaluation of the ocular surface by an ophthalmologist could potentially be of value.

Persistent Atraumatic Knee Pain in a Teenage Female with Bony Protuberance Secondary to Hook-Shaped Osteochrondroma

A 13-year-old female presented at her pediatrician’s office with a complaint of sharp, intermittent, right-sided knee pain that had been present for the previous three days without any known trauma and no association with activity. Her medical history was significant for fractures, and on physical exam, there was a hard mass palpated on the medial aspect of her distal thigh that was nontender, nonmobile, and without overlying skin changes. The plain radiograph findings were consistent with a hook-shaped osteochondroma of the right medial distal metaphysis. Orthopedics recommended conservative management with continued ibuprofen for pain and six-week follow-up with repeat radiograph to evaluate for progression. The follow-up radiograph showed no interval growth. However, due to continued pain, the patient had surgical excision of the osteochondroma six months after initial presentation, allowing her to finish her current soccer season. The surgery was successful, and the patient did well after operation with no residual pain.

Influence of combined use of gas-liquid peeling and PDT on quality of life of patients with visible signs of involutive skin changes

Objective of the study. To develop a questionnaire to determine the quality of life of a patient with visible signs of involutive skin changes. To determine the effect of the combined use of gas-liquid peeling and PDT on the quality of life of patients with visible signs of involutive skin changes.Materials and methods. The study involved 50 patients aged 35 to 45 years. The state of the emotional sphere was assessed before and after the course of treatment using the following methods: a scale for assessing discomfort; ‘The Scale of States’ methodology by А. B. Leonova, Hospital Anxiety and Depression Scale (HADS), Dermatological Life Quality Index (DLQI). The condition was assessed before and after treatment (gas-liquid peeling and photodynamic therapy).Results. The use of the questionnaire developed by us made it possible to determine the index for assessing the quality of life in persons with agerelated skin changes and to reveal the influence of the latter on the emotional sphere and behavior of the respondents. A clear positive trend was observed when comparing indicators of discomfort, anxiety, depression, quality of life. The data obtained make it possible to recommend an assessment of the dermatological index of the quality of life in patients with age-related skin changes as a criterion for the effectiveness of the therapy, and also focus on the need for further study and correction of factors that cause deterioration in life in this category of women.

Jadassohn anetoderma: clinical observation

The article presents a clinical observation of a rare dermatosis - Jadassohn anetoderma. The described case demonstrates the important role of differential diagnostic in patients with atrophic skin changes, paying attention to the possibility of rare dermatoses. Difficulties in diagnosing such diseases are largely due not only to the low frequency of occurrence in the practice of a dermatologist, but also to the sometimes-untimely treatment of patients due to the lack of subjective sensations, especially when the rashes are located in places inaccessible for self-examination. At the same time, despite the fact that the exact pathophysiological mechanisms of the development of anetoderma remain unknown, a number of studies indicate the possibility of autoimmune diseases of the connective tissue, antiphospholipid syndrome and an increased risk of thromboembolic complications in such patients. This fact convincingly proves that the timely diagnosis of anetoderma not only makes it possible to form the correct approach to the management of such patients, but also to provide vigilance regarding the development of autoimmune pathology of the connective tissue.