简介：AbstractThoracic splenosis is the autotransplantation of splenic tissue in the left thoracic cavity as a result of a splenic injury. This rare pathology is usually asymptomatic and may be discovered on incidental imaging, but the diagnosis often requires invasive procedures such as surgery in order to eliminate a neoplasic origin. We report a rare symptomatic case of a 39-year-old man presenting with chest pain and multiple nodules revealed on a computed tomography scan. The patient underwent a surgical exploration and the pathological studies concluded to a thoracic splenosis. Indeed, the previous medical history of the patient revealed a left thoraco-abdominal traumatism during childhood. The aim of this paper is to emphasize that the diagnosis can now be performed using only imaging techniques such as technetium-99 sulfur colloid or labelled heat-denatured red blood cell scintigraphy to avoid unnecessary invasive procedures including thoracotomy.

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简介：AbstractIntroduction:Histiocytoses are localized or systemic diseases that can broadly be classified into Langerhans cell histiocytosis and non-Langerhans cell histiocytosis. Juvenile Xanthogranuloma (JXG) belongs to the latter group, which occurs in around 0.5% population younger than 5 years, and presents as solitary or multiple lesions.Here, we present a case of disseminated JXG in an infant with the lesions regressing spontaneously.Case presentation:A 7-month-old boy presented with multiple erythematous nodular lesions over the body excluding limbs for 3 months. Initial laboratory work up was normal. Skin histopathology showed a dermal nodule with sheets of histiocytes exhibiting grooved vesicular nuclei and pale eosinophilic cytoplasm along with touton giant cells. Immunohistochemistry markers further confirmed the diagnosis. Lesions healed completely with symptomatic relief in 1.5 years and no recurrence occurred.Discussion:Disseminated JXG is a benign childhood disorder that can sometimes be associated with internal organs involvement mainly bones, eyes, and brain. Serious complications may follow in case of extracutaneous spread. Most frequently, JXG follows the occurrence of another neoplastic disorder but can sometimes appear de novo. Skin biopsy is required for the diagnosis and better education of the family.Conclusion:JXG in infancy is a rarity in South Asia. Therefore, along with the clinical judgment, clinicians must also get histological confirmation in order to manage this disorder successfully. Close surveillance for multiorgan involvement is also required to avoid any irreversible sequalae.

简介：AbstractIntroduction:Trichofolliculoma characterized clinically by the presence of acentral dilated pore with tufted hairs and corresponds histologically to a central primary follicle and many secondary vellus hair follicles originating from it. Thus far, dermoscopy description of trichofolliculoma has been lacking.Here, we describe a typical case of trichofolliculoma, particularly the special manifestation under the dermoscopy.Case presentation:A 29-year-old man complained a five-year history of a nodule containing a central whitish hair plug on his left tempus. Dermoscopic examination revealed a well-defined, yellow macule with a central whitish hair plug surrounded by dilated capillaries, and histopathological analysis was consistent with trichofolliculoma.Discussion:The findings of dermoscopy were also vary, which may be affected by the origin of the disease, various phases of the hair cycle, depth of the lesion, and even external stimulus.Conclusion:Diagnosis of trichofolliculoma is sometimes difficult because the presence of the central crater and visible hairs is low, and dermoscopy examination may be a potentially useful diagnostic tool.

简介：SYPHILIS1SCHARACTERIZEDbyseveralclinicalstages:primary,secondary,latentandtertiary.Duetothevarietyoflesionsthatmaypresentduringthesecondstage,syphilishasitsreputationofbeingthe"greatimpostor."Therefore,delaysinitsdiagnosisandtreatmentarecommonlyreported.

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简介：Haemangiopericytoma(HPC)isararevasculartumorwithborderlinemalignancy,considerablehistologicalvariability,andunpredictableclinicalandbiologicalbehavior.HPCcanpresentadiagnosticchallengebecauseofitsindeterminateclinical,radiological,andpathologicalfeatures.HPCgenerallypresentsinadulthoodandisequallyfrequentinbothsexes.HPCcanariseinanysiteinthebodyasaslowlygrowingandpainlessmass.TheprecisecelltypeoriginofHPCisuncertain.OnethirdofHPCsoccurintheheadandneckareas.Exceptionalcasesofhemangioblastomaarisingoutsidetheheadandneckareashavebeenreported,butlittleisknownabouttheirclinicopathologicandimmunohistochemicalfeatures.Thisstudyreportsonacaseofalargesacro-anteriorHPCina65-year-oldmale.

简介：AbstractThe Hoffa fracture is an uncommon fracture. There is a lot of confusion about its diagnosis and management with several conflicting reports in literature. We reported a 25-year-old patient with non-union of Hoffa fracture, and meanwhile tried to develop an algorithm-based treatment for Hoffa fractures. A systematic review of the available literature was performed. Medline, Embase, the Cochrane Library and PubMed were searched for relevant articles. Fifty-five articles were reviewed, and the clinical knowledge base was summarized. The understanding of the mechanism of trauma has become more nuanced. The literature has also evolved to classify the fracture with the purpose of surgical management in mind. This can be used to plan approach and fixation with preservation of blood supply. Classification can also prognosticate the outcomes in Hoffa fracture.

简介：AbstractPerimesencephalic subarachnoid hemorrhage (P-SAH) is a benign subset of subarachnoid hemorrhage. Only two cases of P-SAH during pregnancy have been reported in the literature. We describe a case of P-SAH detected at 29 weeks’ gestation, arose with severe bilateral frontal headache, neck rigidity, and vomiting. A diagnosis of P-SAH was confirmed on magnetic resonance angiography with no evidence of vascular malformation or bleeding sources and conservatively treated. Hemorrhage, vasospasm, and cerebellar edema observed on initial magnetic resonance angiography resolved after two months. The clinical course of P-SAH during pregnancy appears to be favorable. Our case shows for the first time in literature that magnetic resonance angiography is a valid diagnostic test for P-SAH during pregnancy that circumvents radiological risk associated with conventional imaging.

简介：Objective:Theototoxicityofpovidone-iodinehasbeendocumentedinanimalstudies.However,thereislimitedevidenceoftheseototoxiceffectsinhumans.Thisisthefirstreporttoshowtheototoxiceffectsofpovidoneiodineinahumansubject.Patient:A36-year-oldwomancametoourhospitalcomplainingofleftunilateralpersistenthearingloss.Onemonthbeforepresentation,herchildhadaccidentallystruckheronherleftear.Sheappliedapproximatelythreedropsofpovidone-iodine(10%weight/volume)intoherleftauditorycanal.Immediatelyafterapplication,shefeltseverepainandvertigo.Anaudiogramrevealedsevereleftunilateralsensorineuralhearingloss.Magneticresonanceimagingshowedmildenhancementoftheleftvestibuleandbasalturnoftheleftcochlea.Conclusions:Evenasingleapplicationofpovidone-iodinecouldcausesignificanthearinglossanddisequilibrium.Itshould,therefore,beusedwithcaution.

简介：ＡＣＡＳＥＲＥＰＯＲＴＯＦＰＲＩＭＡＲＹＳＱＵＡＭＯＵＳＣＡＲＣＩＮＯＭＡＯＦＴＨＥＥＮＤＯＭＥＴＲＩＵＭＨｅＷｅｎｃｕｉ何文翠；ＷｕＪｉｎｇ吴静；ＣｈａｎｇＪｉｅ唱捷；（ＴｈｅＳｅｃｏｎｄＡｆｆｉｌｉａｔｅｄＨｏｓｐｉｔａｌ，Ｘｉ’ａｎＭｅｄｉｃａ...

简介：ＡＤＵＬＴＭＥＳＥＮＣＨＹＭＡＬＨＡＭＡＲＴＯＭＡＯＦＴＨＥＬＩＶＥＲ：ＡＣＡＳＥＲＥＰＯＲＴＷａｎｇＸｉａｎｇｈｕｉ王湘辉ＣｈａｉＦｕｌｕ柴福录ＤｏｎｇＬｉａｎｇ董亮ＬａｎｚｈｏｕＧｅｎｅｒａｌＨｏｓｐｉｔａｌｏｆＰＬＡ，Ｌａｎｚｈｏｕ７３００５０...

简介：AbstractHarlequin ichthyosis is a severe autosomal recessive skin disorder. Most deaths occur within the first few days after birth, and the survivors still have severe chronic skin disease throughout their lives. Almost all cases were associated with a pathogenic variant of adenosine triphosphate binding cassette transporter, subfamily A, member 12 (ABCA12) gene. We described a case of HI diagnosed by ultrasound examination during the second-trimester and genetic diagnosis reveal two novel heterozygous ABCA12 mutations c.2563-2570delinsGGCAATT, p.(Leu855Glyfs*13), and c.6116delT, p.(Met2039Argfs*8) by the next-generation DNA sequencing, which further enriched our understanding of the pathogenic variation of ABCA12 gene.

简介：DiabetesMellitus(DM)isametabolicdisorderresultingfrommanyfactorsandcharacterizedbychronicelevatedbloodsugar.DM'scausesarenownotabsolutelyknown,butitisknownasasyndromeassociatedwithheredity,self-immuneandenvironmentalfactors.IntraditionalChinesemedicine,DMbelongstothecategoryof"XiaoKe"andistypedinto"ShangXiao',"ZhongXiao"and"XiaXiao"inthelightofthediseasedlocation.

简介：AbstractIntroduction:Pemphigoid nodularis is a rare clinical variant of bullous pemphigoid characterized by both prurigo nodularis-like lesions and pemphigoid-like blisters.Herein, we report a case of pemphigoid nodularis in a cognitively-impaired patient who has been managed as extensive prurigo nodularis with neurotic exocriations for many years.Case presentation:A 72-year-old Chinese man has been on follow-up at an outpatient Dermatology unit for extensive prurigo nodularis for past 4 to 5 years until an inpatient stay when he was admitted for labile mood and erratic behavior due to the intense pruritus and skin lesions. During the admission, the inpatient team noticed tense hemorrhagic blisters on his right thigh for which histological examination confirmed the diagnosis of bullous pemphigoid. He was treated with oral prednisolone, doxycycline, and nicotinamide, which led to clinical improvement.Discussion:Pemphigoid nodularis can be easily misdiagnosed as prurigo nodularis. We discuss clinical clues that can raise the suspicion of an underlying immunobullous disorder, including erythematous nodules with a much larger surface area affected by central erosions and ulceration. Pruritus associated with larger areas of erosions and ulceration is clues that lesions can be more than mere excoriations.Conclusion:It is important for clinicians to be aware of the presentation of prurigo nodularis in association with bullous pemphigoid such that effective treatment can be promptly instituted. This is especially illustrated in this case, as the treatment of bullous pemphigoid not only improved his skin condition but it also improved his psychological health and behavior with the resolution of itch.

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简介：AbstractIntroduction:Nail psoriasis has a profound negative influence on quality of life and has a more closely relationship with psoriatic arthritis. However, patients with nail changes only were often overlooked with the diagnosis of psoriasis. It is necessary to pay more attention to nail psoriatic changes.Herein, we report a 24-year-old male patient with nail changes as the initial sign of psoriasis who was finally diagnosed with nail psoriasis.Case presentation:The nails presented with white streaks, deformations, and had been missed for 8 months. Physical examination further revealed one erythematous scaly plaque on the buttock, anusand scalp respectively with positive Auspitz sign. Combined with the negative fungal microscopic, dermoscopic results and pathological results, the diagnosis of nail psoriasis was made. Oralacitretin (30 mg/day) and topical calcipotriene liniment was prescribed for 3 months followed with etanercept (50 mg once per week), and the nail symptoms were well controlled.Discussion:Nail psoriasis is usually noticed after the occurrence of skin lesions, but may occur simultaneously with or before skin psoriasis. Occasionally, nail involvement is the only manifestation of psoriasis. Nail lesions maybe one of the strongest clinical predictors of psoriatic and it has a profound negative influence on quality of life, so that timely recognition and proper treatment are improtant.Conclusion:Nail psoriasis can cause substantial physical and psychological impairment. However, nail involvement is an often overlooked feature of psoriasis. More attention should be paid to nail psoriatic changes and the administration of appropriate treatment.

简介：AbstractSubcutaneous emphysema is commonly associated with infection caused by gas-producing organisms. In this case report, we describe a rare instance of traumatic subcutaneous emphysema of the hand and forearm caused by a puncture injury to the first web space of the hand. Our objective is to increase awareness of the potential for seemingly minor trauma to cause entrapment of significant air in subcutaneous tissues, thereby decreasing the likelihood that a clinically benign-appearing patient will be started down an unnecessarily aggressive treatment pathway.A 16-year-old, otherwise healthy white female, presented to the pediatric emergency room with an impressive amount of subcutaneous emphysema that developed over a 12-h period after sustaining an accidental laceration to the first web space of her right hand. She appeared nontoxic and had a clinically benign presentation. A comprehensive work-up was performed. She was splinted by the orthopedic surgery resident on call, and was admitted to the Pediatric Intensive Care Unit for overnight monitoring. She received tetanus vaccination and broad-spectrum antibiotics. The patient was discharged 2 days after admittance, with a splint applied to her right hand and forearm. She undertook home-based physical and occupational therapy. She had a pain-free range-of-motion in the right wrist, elbow and shoulder. The swelling in the right hand subsided completely.Although initially alarming, traumatic subcutaneous emphysema in an otherwise healthy patient from minor wounds (as featured in this case) does not necessarily mean one ought to proceed down an aggressive treatment algorithm. Careful evaluation of the patient's history, clinical examination findings, and determination of the Laboratory Risk Indicator for Necrotizing Fasciitis score can help guide physicians in the management of traumatic subcutaneous emphysema and potentially avoid unnecessary and costly interventions.