Clinical and Histopathological Spectrum of Delayed Adverse Cutaneous Reactions Following COVID-19 Vaccination
BACKGROUND:As more people become vaccinated against the SARS-CoV-2 virus, reports of delayed cutaneous hypersensitivity reactions are beginning to emerge. METHODS:In this IRB-approved retrospective case series, biopsies of potential cutaneous adverse reactions from the Pfizer-BioNTech or Moderna mRNA vaccine were identified and reviewed. Clinical information was obtained through the requisition form, referring clinician, or medical chart review. RESULTS:Twelve cases were included. Histopathological features from two injection site reactions showed a mixed-cell infiltrate with eosinophils and a spongiotic dermatitis with eosinophils. Three biopsies came from generalized eruptions that demonstrated interface changes consistent with an exanthematous drug reaction. Three biopsies revealed a predominantly spongiotic pattern, consistent with eczematous dermatitis. Small vessel vascular injury was seen in two specimens, which were diagnosed as urticarial vasculitis and leukocytoclastic vasculitis, respectively. There were two cases of new-onset bullous pemphigoid supported by histopathological examination and direct immunofluorescence studies. Eosinophils were seen in 10 cases. CONCLUSIONS:Dermatopathologists should be aware of potential cutaneous adverse reactions to mRNA-based COVID-19 vaccines. Histopathological patterns include mixed-cell infiltrates, epidermal spongiosis, and interface changes. Eosinophils are a common finding but are not always present. Direct immunofluorescence studies may be helpful for immune-mediated cutaneous presentations such as vasculitis or bullous pemphigoid. This article is protected by copyright. All rights reserved.
Assessment of Functionality in Elderly Patients When Determining Appropriate Treatment for Nonmelanoma Skin Cancers
BACKGROUND:The treatment of nonmelanoma skin cancer (NMSC) in the elderly population is a source of significant debate. Mohs micrographic surgery (MMS) is a highly effective treatment option yet not every patient with a cutaneous malignancy that meets appropriate use criteria (AUC) should be treated with surgery. OBJECTIVE:The purpose of this study was to use the Karnofsky Performance Status (KPS) scale to categorize the functional status of patients aged 75 years and older who required treatment of NMSC. The authors wanted to see whether functionality played a role on the treatment selection. METHODS:Patients aged 75 years and older presenting for biopsy of a suspected NMSC that met AUC for MMS were included in the study. Trained medical assistants used the KPS scale to assess patient functionality. Treatment modality was recorded once the biopsy confirmed the NMSC. RESULTS:A cohort of 203 subjects met inclusion criteria for the study. There was a statistically significant difference in utilization of surgical treatments between high and low functionality patients (p = .03). CONCLUSION/CONCLUSIONS:Dermatologists consider patient functionality when selecting a treatment for NMSC and use less invasive modalities for patients with poor functional status, even when the tumor meets AUC.
Blaschkoid lichen planus: Throwing a "curve" in the nomenclature of linear lichen planus [Case Report]
Fibroadenoma of ectopic breast tissue masquerading as an axillary lipoma [Meeting Abstract]
Fibroadenoma of the breast is the most common benign breast condition found in up to 33% of women aged 35-50. Clinically, these are firm, mobile growths within the breast measuring 1-2 cm. The differential diagnosis include cysts, tubular adenoma and phyllodes tumors. The American College of Obstetricians and Gynecologists (ACOG) notes that fibroadenoma of the breast is associated with an elevated risk factor of 1.76 for future breast cancer. The clinician can differentiate between these growths using mammography and ultrasound. Therapy is based upon the findings of this work up. We present a 31-year-old woman with a new painful growth in the left axilla for several months. She had a history of cysts and methicillin sensitive S. aureus infections; past medical and family history were noncontributory. Physical examination of the left axilla revealed a subcutaneous tumor that was soft, mobile, tender and measured 5 x 5 cm. A punch biopsy taken featured neoplastic mature adipocytes consistent with the diagnosis of lipoma. Given the discomfort of the lesion, she opted for excision. We excised the tumor without complication. Microscopic examination revealed a relatively well circumscribed neoplasm comprised of discrete aggregates of glandular spaces lined by cuboidal cells with round uniform nuclei with peripheral myoepithelial cells within the deep dermis. The glands were set within a fibromyxoid stroma with surrounding fibrosis. These findings were consistent with the diagnosis of fibroadenoma of ectopic breast tissue. This discrepancy in diagnosis may be due to the limited depth of the specimen from the initial punch biopsy. Breast tissue is not strictly localized to the pectoral space and can appear anywhere along "milk lines" spanning from the axilla to the groin. These ectopic breast tissues are susceptible to the same neoplastic processes that affect normally distributed breast tissue and can mimic conditions such as lymphadenopathy or as in our case, a lipoma. In one case, a fibroadenoma of breast tissue was found in the vulva. Although a handful of cases exist in literature, this case underscores the importance of including ectopic breast tissue disorders in the differential diagnosis when evaluating new axillary growths in women. Furthermore, this case shows the inherent limitation of punch biopsies and the need for subsequent microscopic examination status post complete excision of suspicious lesions.
Kaposi's varicelliform eruption in a patient with Grover's disease [Case Report]
Kaposi's varicelliform eruption is a secondary herpes simplex virus infection that affects patients in the setting of primary dermatologic conditions. It occurs with a variety of skin diseases, although association with Grover's disease has never been reported in the literature. This report describes the manifestations and clinical course. A review of the literature on Kaposi's varicelliform eruption includes disease associations, pathogenesis, and treatment
Philadelphia : Lippincott Williams & Wilkins, 2001
Urticaria pigmentosa presenting with massive peripheral eosinophilia [Case Report]
A 5-month-old Hispanic boy had a diffuse eruption and massive peripheral eosinophilia. Mastocytosis was diagnosed by skin biopsy and Giemsa stain. Other causes of eosinophilia were ruled out by bone marrow examination and negative cultures. The patient's course improved with antihistamines and the removal of mast cell degranulating agents. Clinicians need to be aware that mastocytosis should be considered in the differential diagnosis of eosinophilia