1/9. erythema ab igne following heating/cooling blanket use in the intensive care unit.erythema ab igne caused by chronic heat exposure presents as a net-like hyperpigmentation of the skin. We report this condition rapidly evolving due to the inadvertent use or dysfunction of an adjustable-temperature blanket in the intensive care unit. The use of heating/cooling blankets, especially in a patient with altered mental status, can result in iatrogenic erythema ab igne.- - - - - - - - - - ranking = 1keywords = unit (Clic here for more details about this article) |
2/9. Cutis tricolor: congenital hyper- and hypopigmented lesions in a background of normal skin with and without associated systemic features: further expansion of the phenotype.The term cutis tricolor describes the uncommon co-existence of congenital hyper- and hypopigmented macules, in close proximity to each other, in a background of normal skin so far seen in a 17-year-old patient with various other congenital defects. The suggested explanation for this phenomenon is allelic twin spotting. We report on two boys, aged 6 and 11 years, with an unusual combination of three different degrees of pigmentation, one of whom had in addition, psychomotor delay, dysmorphic features, musculoskeletal abnormalities and subcortical and periventricular white matter high signal lesions on brain neuroimaging. In both cases a search for mosaicism in peripheral blood lymphocytes and cultured fibroblasts was negative. In contrast to the previously reported case, the two children had large streaks or patches of hyper- and hypopigmented skin lesions, in close proximity to each other, involving large areas of the body. The rest of the skin had a normal intermediate pigmentation. CONCLUSION: This combination of three degrees of pigmentation in association with systemic defects in one child and the lack of such association in the other confirms and further expands the clinical phenotype of cutis tricolor.- - - - - - - - - - ranking = 358.19206161232keywords = streak (Clic here for more details about this article) |
3/9. Green skin discoloration associated with multiple organ failure.OBJECTIVE: To report intense green hyperpigmentation related to FD & C Blue No. 1. DESIGN: Retrospective case review. SETTING: Surgical intensive care unit. PATIENT: A 67-yr-old woman with unstable angina, electrocardiographic S-T segment elevation, and a left ventricle thrombus requiring emergent coronary revascularization surgery. INTERVENTIONS: Postoperative monitoring and treatment for multiple organ dysfunction that included small-bowel tube feeding and propofol sedation. MEASUREMENTS AND MAIN RESULTS: The patient developed an intense green skin color. CONCLUSION: patients with multiple organ failure may be at risk for unusual pigmentation effects from tube feeding dyes.- - - - - - - - - - ranking = 0.2keywords = unit (Clic here for more details about this article) |
4/9. Longitudinal melanonychia of the toenails with presence of Medlar bodies on biopsy.A 9-year-old girl presented with a 2-year history of pigmented streaks on her second right toenail as well as on her fourth and fifth left toenails. The patient was otherwise asymptomatic with no other physical findings. Owing to parental concern, a biopsy was performed, which revealed numerous bacteria as well as Medlar bodies overlying the nail bed with no evidence of a nevomelanocytic lesion. To our knowledge, this is the first report of Medlar bodies causing pigmented streaks in the toenails.- - - - - - - - - - ranking = 716.38412322464keywords = streak (Clic here for more details about this article) |
5/9. The IGF system in a case of costello syndrome.costello syndrome is characterized by facial dysmorphia, hyperpigmented skin, palmar and plantar hyperkeratosis, curly hair, perioral and nasal papillomata (more rarely localized anally and on vocal cords), short stature, mental retardation and sociable personality. Although growth retardation is typical of costello syndrome, its cause is not defined. We report on a 10-yr-old Caucasian girl affected by costello syndrome with fasting hypoglycemia and short stature, associated low circulating levels of acid-labile subunit (ALS), relatively low levels of IGF-I and IGFBP-3, and normal IGF-II, mostly circulating in a binary complex with IGFBP-2 and -6 instead of in a 150 kDa ternary complex. The reduced ALS concentration and the consequent impaired formation of the circulating 150 kDa ternary complex can induce an accelerated clearance rate of IGF peptides and of IGFBP-3, contributing to the decreased IGF-I growth promoting activity in our patient. Moreover, the presence of IGF-II in the binary complex, which has been postulated to increase the insulin-like effects of these peptides, can explain, at least in part, the patient's asymptomatic fasting hypoglycemia.- - - - - - - - - - ranking = 0.2keywords = unit (Clic here for more details about this article) |
6/9. dyskeratosis congenita or chronic graft-versus-host disease? A diagnostic dilemma in a child eight years after bone marrow transplantation for aplastic anemia.A 12-year-old boy had striking reticulate hyperpigmentation of the neck and upper chest, dystrophic nails, patchy alopecia, and a white streak on the buccal mucosa. He was diagnosed as having chronic graft-versus-host disease (GVHD) based on clinical findings, skin biopsy findings, and his history of a bone marrow transplantation for aplastic anemia eight years earlier. dyskeratosis congenita (DC) was not a diagnostic consideration, although the clinical findings and history of aplastic anemia made it a compelling possibility. This case highlights the clinical similarities between DC and chronic GVHD and the difficulty in arriving at an unequivocal diagnosis.- - - - - - - - - - ranking = 358.19206161232keywords = streak (Clic here for more details about this article) |
7/9. focal dermal hypoplasia (Goltz syndrome): an adult case with multisystemic involvement.focal dermal hypoplasia (Goltz syndrome) is a rare congenital syndrome with suspected X-linked transmission that is characterized by a wide range of mesoectodermal defects. We describe a 39-year-old woman who had a peculiar phenotype and asymmetry of the body. Examination revealed atrophic erythematous and hyperpigmented linear streaks following Blaschko's lines, some of which were in a reticular or cribriform arrangement. Yellow, soft nodules caused by fat herniation were visible mainly in skin folds. The patient had multiple bone anomalies, including longitudinal striation of long bones (osteopathia striata). She had several ocular, dental, and kidney defects. Histopathologic examination showed a markedly thinned dermis that was replaced by adipose tissue.- - - - - - - - - - ranking = 358.19206161232keywords = streak (Clic here for more details about this article) |
8/9. Malignant melanoma in situ arising in the nail unit of a child.A very rare case of malignant melanoma in situ of the nail unit of a child is presented. Clinically, a pigmented streak was present on the finger nail of a 3-year-old girl, and the lesion increased in size and in darkness of the color associated with periungual pigmentation in the following two years. Histopathologically, sections showed proliferation of atypical melanocytes, arranged mostly in single units but some in nests, in and above the basal layer of the epithelium and admixed with long dendrites and a few mitotic figures. Pigmented lesions of nail units of children often show fading or loss of pigmentation clinically; however, a biopsy should be done when they show augmentative changes which clinically suggest malignancy, because subungual malignant melanoma can exist even in children, and proper biopsy can detect it in its early stages.- - - - - - - - - - ranking = 359.59206161232keywords = streak, unit (Clic here for more details about this article) |
9/9. Pigmented and nested sebomatricoma or seborrheic keratosis with sebaceous differentiation?Recently, the term sebomatricoma has been proposed as the most appropriate denomination to avoid controversial and confusing terms and to encompass all benign neoplasms with sebaceous differentiation. We report on two specimens that may be interpreted as examples of two new histopathologic patterns in sebomatricoma, namely, pigmented and nested sebomatricoma, or as seborrheic keratosis with sebaceous differentiation. The first case consisted of a neoplasm composed of basaloid immature cells with features of sebaceous differentiation in the form of clusters of sebocytes and sebaceous ducts, in addition to the proliferation of dendritic melanocytes arranged as solitary units scattered through the neoplastic aggregations of immature germinative sebaceous cells. The second case, in addition to the proliferation of single dendritic melanocytes as the first case, showed well-defined nests of basaloid and heavily pigmented germinative sebaceous cells connected to the skin surface and numerous sebaceous ducts. In the first case, the pigmented nature of the lesion was the most striking histopathologic characteristic, whereas the nested pattern was remarkable in the second one. Immunohistochemical investigations demonstrated positivity of cytokeratin MNF116 in neoplastic aggregations of germinative sebaceous cells, whereas the clusters of mature sebocytes and sebaceous ducts expressed epithelial membrane antigen positivity. S-100 protein made evident the scattered dendritic melanocytes, but neoplastic cells resulted negative.- - - - - - - - - - ranking = 0.2keywords = unit (Clic here for more details about this article) |