Introduction: Photocontact dermatitis is a type IV delayed hypersensitivity response to an allergen that is activated by radiation energy. Its incidence is uncertain and only a small number of drugs causing such reaction have been studied. This is a case of a 67-year-old filipino male, diabetic, who presented with scaly, erythematous, and hyperpigmented plaques with areas of desquamation and erosions on sunexposed areas of the skin after taking metformin. Case: Four months prior to consult, the patient was diagnosed with type 2 diabetes mellitus and was started on metformin therapy. Days later, he started noticing scaly, erythematous and hyperpigmented plaques with areas of desquamation and erosions on sun-exposed areas, namely the upper and lower extremities, posterior neck, and forehead. There was notable sparing of areas that are usually covered with clothing such as the torso, inguina and both thighs. There were also no lesions on the scalp, palmar aspect of the hands and plantar surface of the feet. Skin biopsy was considered but was not done per patient’s preference. After discontinuation of metformin and avoidance from sun exposure, the skin lesions gradually improved. Conclusion Metformin is rarely associated with adverse skin reactions. The diagnosis of photocontact dermatitis as a side effect of metformin needs to be considered as a differential diagnosis in patients who present with skin rashes, especially in sun-exposed areas. It is recommended that there should be a high-index of suspicion for adverse drug reactions in such patients. This would reduce medical errors and medical cost and would result to prompt initiation of appropriate treatment.
Metformin ; Dermatitis, Photoallergic ; Diabetes Mellitus, Type 2

Introduction: Before the advent of antibiotics, syphilis was known to be one of the most common infections affecting approximately 10% of the adult population worldwide. One of its devastating complications is neurosyphilis, which has a broad set of manifestations. Some patients may present with blurring of vision in the setting of an ongoing syphilis infection known as ocular syphilis. In the advent of increasing incidence of human immunodeficiency virus (HIV) infection, co-infection with it may further obscure its manifestations or may even cause synergistic effects. Case Presentation: Presenting a case of a 26-year-old male patient who complained of bilateral fronto-occipital headache with progressive blurring of vision and scaly reddish to brown maculopapular lesions affecting the limbs prominently the soles and palms. CT scan showed cerebral atrophy prominently on the temporal lobe bilaterally. Mental status exam was normal. Neurosyphilis was confirmed by CSF studies and patient tested positive for HIV infection. Patient was then started on aqueous crystalline benzathine penicillin G four million units every four hours for ten days and was discharged with improved condition and no neurocognitive deficits. . He was advised to have CD4 count and other work up for his HIV infection as outpatient. Conclusion The reported incidence of neurosyphilis is increasing in the advent of HIV infection. The deficiency of a clear epidemiology, pathophysiology and complications of cerebral atrophy in neurosyphilis patients co-infected with HIV necessitates further studies to elucidate the proper approach to this preventable and treatable disease.
Syphilis ; Neurosyphilis

INTRODUCTION: Primary peritoneal carcinoma (PPC) is an uncommon malignancy and is often misdiagnosed as peritoneal carcinomatosis from metastatic gastrointestinal carcinoma and more frequently from ovarian carcinomas due to a common embryonic origin of the ovary and the peritoneum. Its diagnosis is a challenge for clinicians. Herein, we report a rare case of PPC in a 72-year-old woman who was initially suspected with metastatic ovarian malignancy, and emphasizes points that help differentiate PPC from primary ovarian cancer. CASE: This a case of a 72-year-old female with abdominal discomfort and distension, initially diagnosed with ovarian carcinoma, with abdominal CT scan revealing thickening of the omentum multiple enhancing nodules in the left adnexa, within the pouch of Douglas and subdiaphragmatic region compatible with malignancy such as metastases from carcinoma. Cancer antigen (CA) 125 (3476 u/mL) and CA 15-3 (45.94 u/mL) were elevated. The patient underwent dilation and curettage and diagnostic laparoscopy and biopsy with frozen section, which revealed metastatic clear cell adenocarcinoma, favoring primary ovarian carcinoma. The patient then underwent exploratory laparotomy, total abdominal hysterectomy, bilateral salpingo-oophorectomy with bilateral lymph node dissection, and omentectomy. Further histopathological findings later confirmed that the patient had carcinoma primarily from the peritoneum instead of from the ovary. The patient was discharged, improved and underwent chemotherapy post-operation. CONCLUSION: This report emphasizes how to distinguish primary malignancy from the peritoneum from that in the ovary, preventing misdiagnosis. The emphasis in considering primary peritoneal cancer as a differential diagnosis in patients with abdominal symptoms suspected due to malignancy should be noted.
Peritoneal Neoplasms Carcinoma, Ovarian Epithelial ; Ovarian Neoplasms ; Carcinoma