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A case of cutis verticis gyrata developing in a patient with primary scarring alopecia: A unique presentation of a rare disorder [Case Report]

Buontempo, Michael G; Alhanshali, Lina; Shapiro, Jerry; Klein, Elizabeth J; Oh, Christina S; Kim, Randie H; Rodriguez, Eduardo A; Lo Sicco, Kristen
PMCID:10338184
PMID: 37448472
ISSN: 2352-5126
CID: 5537842

Pruritic Rash in a Woman With Endometrial Cancer

Liang, Sydney E; Kim, Randie H
PMID: 36753090
ISSN: 2168-6084
CID: 5447982

Diagnostic work-up and treatment in patients with pyoderma gangrenosum: retrospective analysis of US insurance claims-based data

Shaigany, Sheila; Wong, Priscilla W; Caplan, Avrom; Kim, Randie H; Femia, Alisa
Pyoderma gangrenosum (PG) is a rare, and often challenging to diagnose, inflammatory disorder with relatively high rates of morbidity and mortality. Central to the diagnosis of PG is histologic evaluation and exclusion of other entities. Large-scale studies investigating the proportion of patients receiving a thorough diagnostic work-up, as well as prevalence studies regarding comorbidities and systemic treatment in PG using claims-based data, are sparse. Our objective was to identify patients diagnosed with PG and describe the diagnostic work-up and prevalence of common comorbidities and therapies in this population using claims-based data in a retrospective cohort study. In order to better understand practices of diagnostic work-up, we captured rates of skin biopsy, tissue culture, and/or surgical debridement prior to initial diagnosis. We also identified the prevalence of PG-associated comorbidities and initial immunosuppressive therapy given for PG. Of the 565 patients diagnosed with PG, 9.4% underwent skin biopsy, 8% tissue culture, and 1.4% both skin biopsy AND tissue culture prior to diagnosis. Inflammatory bowel disease was the most prevalent comorbidity (16.3%). The most common treatment administered was systemic corticosteroids (17%). Although practice guidelines explicitly delineate histology and exclusion of infection as important diagnostic criteria, only a minority of patients in this study underwent skin biopsy and/or tissue culture prior to receiving a diagnosis of PG, suggesting that patients may receive a diagnosis of PG without having tissue evaluation. Such discordance between practice guidelines and "real-world" practice inevitably increases the risk for misdiagnosis of PG and misdirected treatment with immunosuppressants for presumptive PG in cases of PG mimickers. Moreover, comorbidities associated with PG may occur, or be identified in, a lower proportion of patients as compared with what is reported in the existing literature. Study limitations include a population restricted to < 65 years with commercial insurance and the reliance upon ICD diagnostic coding to capture the population.
PMID: 34714405
ISSN: 1432-069x
CID: 5042872

Eosinophil-rich linear IgA bullous dermatosis induced by mRNA COVID-19 booster vaccine [Case Report]

Nahm, William J; Juarez, Michelle; Wu, Julie; Kim, Randie H
We present a case of eosinophil-rich linear IgA bullous disease (LABD) following administration of an mRNA COVID-19 booster vaccine. A 66-year-old man presented to the Emergency Department with a 3-week history of a pruritic blistering rash characterized by fluid-filled bullae and multiple annular and polycyclic plaques. He was initially diagnosed with bullous pemphigoid based on a biopsy demonstrating a subepidermal blister with numerous eosinophils. However, direct immunofluorescence studies showed linear IgA and IgM deposition along the basement membrane zone with no immunoreactivity for C3 or IgG. Additionally, indirect immunofluorescence was positive for IgA basement membrane zone antibody. The patient was subsequently diagnosed with LABD and initiated on dapsone therapy with resolution of his lesions at three-month follow-up. This case illustrates the growing number of autoimmune blistering adverse cutaneous reactions from vaccination. Dermatopathologists should be aware that features of autoimmune blistering diseases can overlap and may not be distinguishable based on these histopathological findings alone. Confirmation with direct immunofluorescence and/or serological studies may be necessary for accurate diagnosis. This article is protected by copyright. All rights reserved.
PMID: 35922892
ISSN: 1600-0560
CID: 5288132

Mohs micrographic surgery reduces the need for a repeat surgery for primary Merkel cell carcinoma when compared to wide local excision: A retrospective cohort study of a commercial insurance claims database

Tran, Duy C; Ovits, Channa; Wong, Priscilla; Kim, Randie H
PMCID:9558042
PMID: 36248207
ISSN: 2666-3287
CID: 5360152

Scaly Plaques on the Foot: Answer

Roman, Jorge; Kim, Randie H; Marji, Jackleen S
PMID: 36122340
ISSN: 1533-0311
CID: 5333052

Scaly Plaques on the Foot: Challenge

Roman, Jorge; Kim, Randie H; Marji, Jackleen S
PMID: 36122344
ISSN: 1533-0311
CID: 5333062

Dermatomal Granulomatous Dermatitis and Vasculitis Following Herpes Zoster Ophthalmicus [Case Report]

Martinez, Michael; Kim, Randie; Zampella, John
Cutaneous granulomatous dermatoses are uncommon sequelae of herpes zoster (HZ) infection that have been documented in the literature, with granulomatous vasculitis described in rare cases. Here, we report a patient with HZ ophthalmicus who developed edematous plaques with central scarring in a V1 dermatomal distribution with histopathological changes of a granulomatous dermatitis including features of granulomatous vasculitis. J Drugs Dermatol. 2022;21(10):1127-1128. oi:10.36849/JDD.6749.
PMID: 36219054
ISSN: 1545-9616
CID: 5356612

Urticarial dermatitis herpetiformis: A rare presentation of an uncommon disorder [Case Report]

Sally, Rachel; Kim, Randie; Lo Sicco, Kristen; Caplan, Avrom S
PMCID:9294481
PMID: 35865727
ISSN: 2352-5126
CID: 5279382

Deep learning and pathomics analyses reveal cell nuclei as important features for mutation prediction of BRAF-mutated melanomas

Kim, Randie H; Nomikou, Sofia; Coudray, Nicolas; Jour, George; Dawood, Zarmeena; Hong, Runyu; Esteva, Eduardo; Sakellaropoulos, Theodore; Donnelly, Douglas; Moran, Una; Hatzimemos, Aristides; Weber, Jeffrey S; Razavian, Narges; Aifantis, Iannis; Fenyo, David; Snuderl, Matija; Shapiro, Richard; Berman, Russell S; Osman, Iman; Tsirigos, Aristotelis
Image-based analysis as a method for mutation detection can be advantageous in settings when tumor tissue is limited or unavailable for direct testing. Here, we utilize two distinct and complementary machine learning methods of analyzing whole slide images (WSI) for predicting mutated BRAF. In the first method, WSI of melanomas from 256 patients were used to train a deep convolutional neural network (CNN) in order to develop a fully automated model that first selects for tumor-rich areas (Area Under the Curve AUC=0.96) then predicts for mutated BRAF (AUC=0.71). Saliency mapping was performed and revealed that pixels corresponding to nuclei were the most relevant to network learning. In the second method, WSI were analyzed using a pathomics pipeline that first annotates nuclei and then quantifies nuclear features, demonstrating that mutated BRAF nuclei were significantly larger and rounder nuclei compared to BRAF WT nuclei. Lastly, we developed a model that combines clinical information, deep learning, and pathomics that improves the predictive performance for mutated BRAF to AUC=0.89. Not only does this provide additional insights on how BRAF mutations affect tumor structural characteristics, machine learning-based analysis of WSI has the potential to be integrated into higher order models for understanding tumor biology.
PMID: 34757067
ISSN: 1523-1747
CID: 5050512