The COVID-19 pandemic has underscored the vital role of vaccination in mitigating widespread morbidity and mortality. Nevertheless, the global vaccination campaign has also brought to light rare but notable immune-mediated adverse events. Vaccination is inherently immune stimulatory, designed to provoke a robust immune response, and in rare instances, this heightened immune activity may unmask or trigger autoimmunity in genetically predisposed individuals. Proposed mechanisms include molecular mimicry, epitope spreading, and bystander activation, all of which can disrupt immune tolerance and initiate autoreactive responses. This case report explores a potential link between COVID-19 vaccination and the onset of dermatomyositis, adding to the growing body of literature examining the rare but important phenomenon of vaccine-associated autoimmunity.

Human ; Male ; Middle Aged: 45-64 Yrs Old ; Dermatomyositis ; Covid-19 ; Vaccines

Psoriasis vulgaris and vitiligo are chronic autoimmune skin conditions that affect all races and age groups. Psoriasis presents as erythematous plaques with silvery scales, while vitiligo manifests as symmetric depigmented macules. Their co-occurrence, although documented since 1955, remains relatively rare and underreported in Asian populations. We report the case of a 54-year-old Filipino male, with no known comorbidities who presented with both psoriasis and vitiligo. Skin punch biopsies confirmed the diagnoses of both conditions. During treatment, new vitiliginous lesions appeared over psoriatic plaques, suggesting Koebnerization. We review the current literature to explore possible immunologic and genetic overlaps and provide insights to their treatment.

Human ; Male ; Middle Aged: 45-64 Yrs Old ; Vitiligo

Lichen planus (LP) is a chronic inflammatory dermatosis with a prevalence of 0.1%-4%, typically affecting individuals aged 30-60 years. Isolated lip involvement is uncommon, seen in 0.51%-8.9% of cases, predominantly in middle-aged men. We report a 58-year-old male with well-controlled diabetes who developed isolated lower lip LP, initially misdiagnosed as herpes simplex virus infection and unresponsive to oral acyclovir. Dermoscopy and histopathology confirmed the diagnosis. The patient was managed with a novel regimen: Tacrolimus 0.1% ointment (morning) and tretinoin 0.025% cream (night), alongside sunscreen and petroleum jelly. After 4 weeks, marked improvement was observed with flattened lesions and reduced pruritus. This case underscores the potential efficacy of combining a calcineurin inhibitor and a retinoid as a corticosteroid-sparing alternative for localized LP. Clinically, this approach offers a valuable treatment option for patients with lip LP showing suboptimal response to initial corticosteroid therapy, minimizing steroid-related adverse effects and improving therapeutic outcomes.

Human ; Male ; Middle Aged: 45-64 Yrs Old ; Complementary Therapies ; Lichen Planus ; Tacrolimus ; Tretinoin

A 61-year-old woman presented with a 2-month history of non-painful left eye proptosis. Imaging studies showed a superotemporal mass in the left orbit with intracranial extension. Surgical excision of the orbitocranial mass was performed and histopathologic examination revealed metastatic papillary thyroid carcinoma. She subsequently underwent total thyroidectomy. Orbital metastasis from thyroid carcinoma is rare and can be the initial manifestation of occult disease in 63% of cases.

Human ; Female ; Middle Aged: 45-64 Yrs Old ; Thyroid Neoplasms ; Thyroid Carcinoma ; Thyroid Cancer ; Papillary Thyroid Carcinoma ; Thyroid Cancer, Papillary

This is a case of a 55-year-old female, surgical menopause for nine years, not on hormone therapy with one year history of a progressively enlarging left vulvar mass, who sought consult and subsequently underwent excision of mass. Microscopic findings showed alternating hypo- and hypercellular areas composed of plump spindle to epithelioid cells distributed in an edematous stroma with varying amount of collagen. Tumor cells have bland chromatin, inconspicuous nucleoli, and absent mitoses. The cells surround small to medium-sized thin-walled, hyalinized vessels found in hypercellular areas. An adipocytic differentiation of more than fifty percent of tumor is observed further classifying this neoplasm as lipomatous angiomyofibroblastoma, making this an even rarer type of benign mesenchymal tumor of the vulva. Immunohistochemistry stains performed showed positive staining for vimentin, smooth muscle actin, BCL-2, ER, PR, and negative staining for desmin which supports the diagnosis. The clinical presentation, operative findings, histopathologic features and the various considerations are discussed. Literature review of vulvar angiomyofibroblastoma is also presented.

Human ; Female ; Middle Aged: 45-64 Yrs Old ; Vulva

Mycosis fungoides (MF) is the predominant type of primary cutaneous lymphoma, accounting for at least 40%. It usually occurs in middle to late adulthood with the average age of diagnosis between 55 and 60 years. Folliculotropic MF is a variant that clinically presents with patches, plaques, and unusual hair loss within lesions. It predominantly involves the head and neck region. This usually presents with intense pruritus and commonly with secondary bacterial infection. Cutis verticis gyrata is a rare skin condition characterized by thickening and folding of the scalp, resulting in a furrowed or ridged appearance, and rarely associated with mycosis fungoides. A 46-year-old male, Filipino, presented with a 1-year history of generalized follicular papules, erythematous plaques, and subsequently presented with cutis verticis gyrata. Histopathological examination revealed findings consistent with folliculotropic MF. This was further confirmed by CD3, CD4, CD5 which revealed strongly positive immunohistochemical staining. To the best of our knowledge, there is currently only one published case of folliculotropic MF that presented with cutis verticis gyrata and only four cases of cutis verticis gyrata published locally.

Human ; Male ; Middle Aged: 45-64 Yrs Old ; Mycosis Fungoides

BACKGROUND

Mycetoma is a chronic, progressively destructive granulomatous infection caused by fungi (eumycetoma) or bacteria (actinomycetoma). It is recognized by the WHO as a neglected tropical disease. Despite its presence globally, the incidence and burden in the Philippines remain poorly documented.

OBJECTIVES

To determine the prevalence, clinicodemographic profile, and outcomes of mycetoma diagnosed at the Jose R. Reyes Memorial Medical Center - Department of Dermatology from January 2014 to December 2024.

METHODS

A retrospective chart review was conducted among patients diagnosed clinically and confirmed either microbiologically and/or histopathologically with mycetoma. Data collected included age, sex, occupation, risk factors, lesion characteristics, causative agent, diagnostic method, treatment, and outcomes.

RESULTS

Four cases of actinomycetoma were identified, all with pedal involvement. The majority were male (75%) and over 40 years old. One patient had an agricultural occupation. Most were from outside Metro Manila. Histopathologic confirmation was present in all cases. Three patients were lost to follow-up. Only the patient treated for over 12 months achieved clinical improvement.

CONCLUSION

Mycetoma remains a rare but significant disease in the Philippines. Findings support existing literature on male predominance, pedal localization, and the importance of prolonged antimicrobial treatment. Greater surveillance, early diagnosis, and follow-up strategies are essential.

Human ; Male ; Female ; Middle Aged: 45-64 Yrs Old ; Adult: 25-44 Yrs Old ; Mycetoma ; Actinomycetoma

BACKGROUND

Cervical cancer, caused by human papillomavirus (HPV), is the second most common cancer among Filipino women. Despite vaccine availability, the Philippines has a low 60% immunization rate, driven by hesitancy and poor public awareness.

AIMS AND OBJECTIVES

This study assessed how 100 women (ages 18–45) in Quezon City understood HPV and their willingness to vaccinate.

MATERIALS AND METHODS

Researchers used a pre–post interventional study and purposive sampling and Cochran’s formula for size calculation. Participants completed a pretest, a Department of Health/World Health Organization/Centers for Disease Control and Prevention-based digital educational intervention, a posttest, and a satisfaction survey. Data were gathered confidentially under informed consent.

RESULTS

Results showed significant improvement in knowledge and willingness to vaccinate (P < 0.001), with almost all respondents expressing willingness. The intervention received high satisfaction ratings, proving the digital tool was effective and well-received.

CONCLUSION AND RECOMMENDATION

In conclusion, this study demonstrated that a structured digital educational tool effectively bridges knowledge gaps and addresses vaccine hesitancy in a community setting. Findings emphasize the importance of targeted, community-level initiatives to reduce cervical cancer risk. Future research should include teens and males and use a larger randomized sample for definitive evidence.

Human ; Female ; Adolescent: 13-18 Yrs Old ; Young Adult: 19-24 Yrs Old ; Adult: 25-44 Yrs Old ; Middle Aged: 45-64 Yrs Old ; Uterine Cervical Neoplasms ; Human Papillomavirus Viruses ; Vaccination ; Women

BACKGROUND

Large-vessel arterial thromboembolism is a rare initial presentation of acute myelogenous leukemia (AML). Aortoiliac occlusion is exceptionally uncommon and has not been previously reported in association with acute myelomonocytic leukemia (AML-M4).

CASE PRESENTATION

We present the first documented case of a 55-year-old female with AML-M4 who initially presented with recurrent respiratory infections and acute left leg ischemia, which responded to intravenous heparinization and femoropopliteal thromboembolectomy. However, progressive bilateral lower extremity ischemia revealed extensive thromboembolism involving the aortoiliac and bilateral femoropopliteal regions, requiring repeat thromboembolectomy and retrograde kissing balloon aortic angioplasty. Flow cytometry confirmed AML-M4 with CD13, CD33, CD11C and myeloperoxidase positivity. Her condition deteriorated due to multiple acute cerebrovascular infarcts, acute coronary thrombosis and sepsis, leading to her demise.

METHODS

A literature search of PubMed and Google Scholar (1980–2025) identified 51 cases of arterial thrombosis in AML.

RESULTS

Most patients were male (66%), with lower limb vessels (44%) as the most frequently affected sites. Acute promyelocytic leukemia (AML-M3) was the most common subtype. Management varied, including chemotherapy, anticoagulation and surgical or endovascular interventions.

CONCLUSION

The management of arterial thrombosis in AML is complex due to the competing risks of thrombosis, hemorrhage and infection. Early leukemia identification and timely chemotherapy initiation must be carefully balanced against the risks of cytopenias and immunosuppression in these critically ill patients.

Human ; Female ; Middle Aged: 45-64 Yrs Old ; Leukemia, Myeloid, Acute ; Aorta

OBJECTIVE

To present a rare case of nine syndrome in a middle-aged patient with stage IV chronic kidney disease presenting with hypertensive emergency at a tertiary government hospital, and to discuss its clinical presentation, diagnostic approach, and management within the realities of limited-resource settings.

METHODS

This is a case report.

RESULTS

A 45-year-old woman with uncontrolled hypertension and stage IV chronic kidney disease came to the emergency department with acute dizziness and vomiting. On neurologic examination, she had left horizontal conjugate gaze palsy and an adduction deficit of the left eye with intact abduction and an abducting nystagmus of the right eye consistent with one-and-a-half syndrome. In addition, she had left-sided facial weakness and right lower limb weakness suggesting nine syndrome. Brain imaging confirmed a left posterior pontine infarct. Treatment for neuroprotection and blood pressure control led to significant improvement in ocular symptoms and muscle strength.

CONCLUSION

This report describes a rare case of nine syndrome. Careful bedside neuro-ophthalmologic examination, supported by MRI, enabled accurate localization to the paramedian pons. Early recognition allowed timely stroke management and initiation of secondary management, even in a resource-limited setting.

Human ; Female ; Middle Aged: 45-64 Yrs Old ; Hypertensive Emergency ; Hypertensive Crisis