1.Cutaneous cytomegalovirus infection presenting as persistent plaque on the nose in an HIV-AIDS patient.
Waskito Mohammad Yoga A. ; Escueta Luella Joy A. ; Dayrit Johannes F
Journal of the Philippine Dermatological Society 2016;25(1):35-37
Cytomegalovirus (CMV) rarely manifests as cutaneous lesions in immunocompromised patients. Only 25 cases have been reported since 1991. It causes latent infection among exposed individuals but reactivation may occur in immunocompromised patients causing encephalitis, pneumonitis, colitis, retinitis and congenital fetal infection. Cutaneous manifestations of CMV infection usually present with various skin lesions such as ulcers, erosions, erythematous morbilliform rash, vesicles and bullae. We report a case of cutaneous CMV infection in an HIV-AIDS patient presenting as a persistent ulcerated plaque on the nose. The lesion slowly evolved into a plaque which partially destroyed the right alar rim. Skin punch biopsy showed perivascular giant cells with large eosinophilic inclusions resembling an owl's eye consistent with CMV infection. He was subsequently diagnosed with CMV retinitis because of blurring of vision and findings of retinal necrosis on fundoscopy. Oral valganciclovir 1800mg/day was given for 21 days. Significant thinning and drying of the plaque with no further progression of ulceration of the alar rim were noted.
Human ; Male ; Adult ; Acquired Immunodeficiency Syndrome ; Blister ; Colitis ; Cytomegalovirus ; Cytomegalovirus Retinitis ; Encephalitis ; Exanthema ; Ganciclovir ; Immunocompromised Host ; Pneumonia ; Strigiformes ; Succinates ; Ulcer
2.Cutaneous metastasis as a diagnostic prelude in a 48-year-old female
Nagatoshi M. Ebisawa ; Isabel G. Palabyab‑Imperial ; Leilani R. Senador ; Luella Joy A. Escueta‑Alcos
Journal of the Philippine Dermatological Society 2023;32(2):107-110
Cutaneous metastasis (CM) describes the spread of a distant primary tumor into the skin. The overall
incidence of CM ranges from 5% to 10% with breast cancer having the highest rate in women. CM of breast
carcinoma origin may manifest as erysipelas-like erythema on the chest, having distinct raised borders and
edema due to lymphatic obstruction termed as carcinoma erysipeloides. In most cases, CM is recognized
after the initial diagnosis of primary internal malignancy. However, in 0.6–1% of cases, CM served as the
first presenting sign of malignancy. A 48-year-old female presented with multiple, erythematous patches,
and plaques with clear-cut raised margins, some topped with violaceous pinpoint papules and nodules
on the chest, abdomen, and back. No palpable breast mass was appreciated. There was noted nipple
retraction and axillary lymphadenopathy. A 4-mm skin punch biopsy revealed nests of large pleomorphic
cells on the papillary dermis admixed with mitotic figures and attempts of ductal formation. CK7 and CEA
were positive. Results of ultrasonography and mammogram were highly suspicious of malignancy. Core
needle biopsy of the breast mass revealed an invasive ductal carcinoma. In the context of an eczematous
presentation on the chest area without palpable nodules or mass on breast examination, a diagnostic
challenge is expected. Interestingly, our patient represents a small group of CM having cutaneous lesions
as their primary manifestation. A high index of suspicion supplemented with proper clinicopathologic and
radiologic correlation is crucial for the diagnosis of CM. A multidisciplinary referral is required for adequate
management and overall survival rate.
Breast Neoplasms