Faculty Bibliography

Pseudomelanosis duodeni is a rare medical condition characterized by fine, black "pepper pellet" pigmentation of the duodenal villi observed in endoscopy of the upper gastrointestinal tract. Biopsy reveals pigment-laden macrophages in the lamina propria that stain positive for iron (Pearl's stain). Studies have suggested an association with oral iron ingestion as well as with the use of antihypertensive medications containing a sulfide moiety

Burning mouth syndrome is a debilitating medical condition affecting nearly 1.3 million of Americans. Its common features include a burning painful sensation in the mouth, often associated with dysgeusia and xerostomia, despite normal salivation. Classically, symptoms are better in the morning, worsen during the day and typically subside at night. Its etiology is largely multifactorial, and associated medical conditions may include gastrointestinal, urogenital, psychiatric, neurologic and metabolic disorders, as well as drug reactions. BMS has clear predisposition to peri-/post menopausal females. Its pathophysiology has not been fully elucidated and involves peripheral and central neuropathic pathways. Clinical diagnosis relies on careful history taking, physical examination and laboratory analysis. Treatment is often tedious and is aimed at correction of underlying medical conditions, supportive therapy, and behavioral feedback. Drug therapy with alpha lipoic acid, clonazepam, capsaicin, and antidepressants may provide symptom relief. Psychotherapy may be helpful. Short term follow up data is promising, however, long term prognosis with treatment is lacking. BMS remains an important medical condition which often places a recognizable burden on the patient and health care system and requires appropriate recognition and treatment.

Eczema herpeticum (EH), or Kaposi's varicelliform eruption, is a skin infection with herpes simplex type I virus (HSV-1) that occurs in patients with compromised skin integrity, such as atopic dermatitis (AD). Unrecognized, it may be fatal and viremia in pregnancy may lead to fetal demise and miscarriage. We describe a rare case of EH in pregnancy, eczema herpeticum gravidarum (EHG), which is the third published report in the literature to date.

Acute esophageal necrosis, or black esophagus, is a rare disorder that classically presents with upper gastrointestinal bleeding. Esophagogastroduodenoscopy reveals circumferential black mucosa in the distal esophagus ending at the Z-line that may extend proximally to involve the entire organ. Known risk factors include cardiovascular compromise, ischemia, gastric outlet obstruction, malnutrition, and hypercoagulable status. Biopsy reveals mucosal and submucosal necrosis with local inflammatory cell response. Differential diagnosis includes malignant melanoma, acanthosis nigricans, pseudomelanosis, and melanosis of the esophagus. Overall prognosis is poor, and mortality approaches 30% from the underlying clinical disease

Described by Demetrius Chilaiditi in 1910, this classic type of pseudopneumoperitoneum is characterized by interposition of a bowel loop between the liver and the right diaphragm. This creates an appearance of free air, which can be interpreted as constituting a surgical emergency. However, a close inspection of the X-ray reveals colonic haustral markings in an asymptomatic patient