Dapsone Induced Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) Syndrome - A Case Report

A 50-year-old male Sudanese patient presented with a three-week history of jaundice, high-grade fever, and mucocutaneous eruption. For last months he was on compound therapy for leprosy, which had been confirmed recently. The patient’s face was prominent, along with the erythematous dusky morbilliform rash covering all the body. On examination, we detected hepatosplenomegaly and generalized lymphadenopathy. Laboratory investigations revealed hepatorenal impairment, and hematological analysis revealed leukocytosis mainly due to eosinophilia. The clinical and laboratory findings interpretation ranked DRESS or Drug-Induced Hypersensitivity Syndrome (DIHS) on top of possible causes before Dapsone Hypersensitivity Syndrome (DHS) and lepra reactions. We promptly discontinued MDT, admitted him to the dermatological ward. Two skin biopsies were sent to two different histopathologists, MF was suggested by one and Sezary syndrome by the other one. Besides the general conservative measures and vital functions monitoring, he received systemic and topical steroids. However, unfortunately, within the next three weeks, his condition deteriorated, and passed away from multi-systems failure.

Prevalence and Pattern of Skin Manifestations in COVID-19 Patients; A Cross-Sectional Observational Study in Saudi Arabia

Background: Although COVID-19 is known to cause fever and an array of respiratory symptoms, the disease has recently been reported to be associated with dermatological symptoms. It is crucial to identify the frequency and the nature of these symptoms to facilitate the early detection and the efficient management of the disease. Methods: A cross-sectional observational survey study that was carried out in Saudi Arabia Previously-infected adult residents with COVID-19 were considered. Sociodemographic characteristics, concomitant medications, medical history, and the occurrence of skin manifestations while having COVID-19 infection were collected. Data were represented in the form of frequencies (number of responders) and valid percentages for categorical variables. ANOVA test was utilized to compare means between different subgroups. All P values < 0.05 were considered statistically significant. Result: A total of 464 participants were included. Gender distribution was almost equal. Out of them, 54.1% aged from 21 to 40 years old and 65.9% hold a university degree. Skin symptoms were reported in 9.1% respondents. The most common locations were all-over the body (1.5%), arms (1.3%), face or upper body (1.3%) and fingers (1.3%). Participants experienced morbilliform rash (3.5%), maculopapular rash (1.3%), urticaria (0.9%), livedo reticularis (0.2%) while 5.4% experienced miscellaneous skin symptoms. Conclusion: More research studies investigating the prevalence and patterns of skin symptoms accompanying COVID-19 infection are suggested.

GENERALIZED URTICARIA AS A VASCULITIC MANIFESTATION IN A PATIENT WITH SARS-CoV-2 INFECTION: A CASE REPORT IN COLOMBIA

Skin manifestations have been reported in up to 20% of cases of SARS-CoV-2 infection, including morbilliform rash (22%), pernio-like acral lesions (18%), urticaria (16%), and macular erythema (13%). It is believed that in the case of SARS-CoV-2 infection, the mechanism involved is an inflammatory response that generates immune dysregulation, vascular congestion, vasculitis, vascular thrombosis, or neoangiogenesis. This case study, present the case of a patient with no previous history of urticarial reactions, autoimmune diseases, or exposure to medications who develops generalized urticaria lasting more than 24 hours and who was diagnosed with SARS-CoV-2 infection by RT-PCR with a nasopharyngeal swab. We suggest in this patient vasculitic urticaria as a manifestation of SARS-CoV-2 infection.

Cutaneous chemotherapy-induced radiation recall reaction

An 80 year old man with metastatic castrate-resistant prostate cancer was treated with multiple systemic agents but after carboplatin/paclitaxel, developed a morbilliform rash conforming precisely to a skin site of previous palliative radiotherapy, a so-called radiation recall reaction.

Skin Manifestations Associated with COVID-19: Current Knowledge and Future Perspectives

<b><i>Background:</i></b> Coronavirus disease-19 (COVID-19) is an ongoing global pandemic caused by the “severe acute respiratory syndrome coronavirus 2” (SARS-CoV-2), which was isolated for the first time in Wuhan (China) in December 2019. Common symptoms include fever, cough, fatigue, dyspnea and hypogeusia/hyposmia. Among extrapulmonary signs associated with COVID-19, dermatological manifestations have been increasingly reported in the last few months. <b><i>Summary:</i></b> The polymorphic nature of COVID-19-associated cutaneous manifestations led our group to propose a classification, which distinguishes the following six main clinical patterns: (i) urticarial rash, (ii) confluent erythematous/maculopapular/morbilliform rash, (iii) papulovesicular exanthem, (iv) chilblain-like acral pattern, (v) livedo reticularis/racemosa-like pattern, (vi) purpuric “vasculitic” pattern. This review summarizes the current knowledge on COVID-19-associated cutaneous manifestations, focusing on clinical features and therapeutic management of each category and attempting to give an overview of the hypothesized pathophysiological mechanisms of these conditions.

Aseptic Syphilitic Meningitis in an HIV-Negative Patient with Concomitant Primary and Secondary Syphilis

Background: Syphilis is a sexually and vertically transmitted disease caused by the Treponema pallidum species. Aseptic syphilitic meningitis (ASM) is a subcategory of neurosyphilis. Neurosyphilis is typically considered a tertiary manifestation of syphilis; however, ASM typically occurs within 6 months of exposure and may be concurrent with the rash of secondary syphilis. Case Presentation: A 58-year-old immunocompetent male presented to the dermatology clinic with an erythematous morbilliform rash that involved his trunk and upper extremities. He was prescribed benzonatate 100 mg 3 weeks prior for cough and was diagnosed with a drug-induced morbilliform rash. The patient was seen 1 month later by urology for a penile ulcer. At his urology appointment, an RPR test was done and resulted positive with a titer of 1:256. He was referred to dermatology again and was noted to have a diffuse, copper-colored maculopapular rash involving the palms and soles. During this appointment, the patient complained of a 4-week headache and was found to have nuchal rigidity. He was admitted for neurosyphilis work up, including CSF and CSF-VDRL examination. His neurologic symptoms improved on IV Penicillin G. Repeat RPR testing at 6 months follow up confirmed adequate treatment and his RPR declined from 1:256 to 1:4. Conclusion: We present a case of ASM in an immunocompetent individual with concomitant primary and secondary syphilis. Dermatologists are trained to recognize the cutaneous manifestations of syphilis, but also should be familiar with the variable presentations of the disease, including the early neurological findings of ASM.