Multiple intracranial aneurysms are not uncommon in patients with cerebral aneurysms, however, studies relating to its natural history, symptomatology and management have not been extensively explored especially in the local setting. The case presented is that of a 42-year-old hypertensive female with a three-day history of sudden severe throbbing headache. The patient had three intracranial saccular aneurysms, two on the middle cerebral artery and one on the anterior cerebral artery. The three intracranial aneurysms were clipped through a right pterional approach in one operative procedure. The surgical and postoperative courses were unremarkable. The patient recovered well with no neurologic deficits and was subsequently discharged after three weeks. Single-stage clipping can be performed in the presence of multiple intracranial aneurysms.

CYLD cutaneous syndrome (CCS) encompasses numerous inherited skin adnexal tumor syndromes, such Brooke–Spiegler Syndrome (BSS), familial cylindromatosis (FC), and multiple familial trichoepitheliomas (MFT). These syndromes arise from germline pathogenic variants in the tumor suppressor gene CYLD that show variable expressivity. With merely 115 cases documented worldwide and a singular reported incidence among Filipinos, they are exceptionally rare. We present two cases of trichoepitheliomas in Filipino patients, encompassing their clinical, histopathological, and genetic findings.

Our first case is of a 22-year-old male presenting with an 8-year history of asymptomatic skin-colored papules on the nasolabial folds. He was initially diagnosed with milia and underwent electrocauterization; however, recurrence was observed shortly thereafter. No family history exhibited similar lesions.

The second case involves a 43-year-old female with a 31-year history of asymptomatic skin-colored papules on the nose that progressively disseminated to her forehead and ears that started to obstruct the patient’s airway, prompting her to seek consultation.

Genetic testing conducted on affected patients and their relatives identified mutations in the CYLD gene. The first case underwent CO2 laser treatment, while the second patient underwent excision with reconstructive surgery.

Given the rarity of these disorders and their diverse clinical manifestations, genetic testing serves as an invaluable instrument for the purpose of accurate diagnosis, proactive disease progression surveillance, and family planning efforts. This can also contribute to a more comprehensive understanding of the syndrome and the development of new therapeutic strategies.

Central centrifugal cicatricial alopecia (CCCA) is the most common form of primary cicatricial alopecia in women of African descent but has rarely been reported from other parts of the world. It is also rarely reported in the Philippines hence there is a need to investigate this condition. Distinguishing this from other scarring alopecia is important to be able to give the proper treatment and intervention. A 28-year-old Filipino male presented at an outpatient dermatology clinic in the Philippines with a two-years history of erythematous bump with bald spot on the vertex area of the scalp associated with 8/10 itch and 2-4/10 tenderness. He denied any burning or decrease in sensation on the affected area as well as previous history of bald spot or trauma to the scalp. He did not notice any similar lesion on other parts of the body. There is no family history of alopecia. There were no history of hair treatments or hair dye use, however admits to occasional application of hair gel and use of a cap. Clinical, trichoscopy, and histologic findings confirmed the diagnosis of CCCA. There are no clear guidelines that exist for the management of CCCA. However, early intervention reduces the chance of disease progression. The use of anti-inflammatory therapy is considered the first-line treatment such as topical steroids or intralesional triamcinolone acetonide.

Psoriasis is a chronic immunologically-mediated inflammatory disease characterized by scaly, erythematous plaques, primarily affecting the extensor surfaces and involving the IL-23/Th17 pathway. It is associated with increased risks for arthritis, cardiovascular issues, and other autoimmune disorders.

This case discusses a 27-year-old Filipino female with a 7-year history of psoriasis, initially treated with clobetasol ointment, methotrexate, and narrowband UVB phototherapy. Due to worsening of lesions, patient eventually developed erythrodermic psoriasis and was treated with secukinumab, an IL-17 inhibitor. While on biologic treatment, patient experienced weight loss, diarrhea, hand tremors, palpitations, and fatigue. Patient was worked up, showing elevated FT3, FT4, and TSH receptor antibody leading to a diagnosis of Graves’ Disease.

Research shows increased risk of thyroid dysfunction in psoriasis patients, with greater association with Hashimoto Thyroiditis than Graves’ Disease. The highest ratio of thyroid involvement concerning dermatologic subtypes was 59% for erythrodermic psoriasis.

The connection between psoriasis and Graves’ Disease may stem from a shared T-helper 1 response and IL-17 involvement in the IL-23/Th17 axis. Research indicates an elevated Th17 proportion in Graves’ patients, suggesting that blocking IL-17 might reduce inflammation. However, in this case, contrary to this, a new onset autoimmune condition developed despite the use of an IL-17 inhibitor.

This case underscores the need for a multidisciplinary approach in managing chronic immunologic disorders like psoriasis, which can impact multiple organ systems beyond the skin. This case may help explore the connection of psoriasis with other autoimmune conditions.

Polyorchidism is a very rare congenital anomaly, which is defined as having more than 2 testicles in a human male. To date, there are only a number of cases reported worldwide and most of them are published as case reports. Most cases of polyorchidism are associated with other male genitourinary anomalies such as varicoceles, hydroceles, inguinal hernias, and testicular malignancies. Even much more rarer are accessory spleens located intrascrotally, with only a handful of case reports in the last 80 years. Reported here is a case of a 33-year old male presenting with symptoms of intermittent scrotal pain for 2 years and extratesticular mass on ultrasound. Surgical management for this patient was done, removing one of the accessory testicles. Histopathology showed as an accessory spleen. Since this is a rare occurrence, the authors aimed to present splenunculus as a differential for patients with polyorchidism.

Objective: To report a case of a 42-year-old male who developed bilateral solar retinopathy from two-decade history of religious sun gazing. Methods: This is a case report. Conclusion We report a rare case of a 42-year-old male with subtle findings solar retinopathy. Careful examination and high index of suspicion are needed for correct diagnosis. Avoiding direct sun-gazing, use of protective UV filters, and remote observation thru videography and the like are recommended.
Human ; Male ; Adult: 25-44 Yrs Old

Asherman’s syndrome is a global disease with a significant impact on the reproductive career among women. Its exact prevalence is quite difficult to ascertain as there are different methods to diagnose and several classifications being used. Its increasing incidence has been credited to a great number of uterine surgeries and improved accuracy of imaging studies. The clinical manifestations of this condition range from secondary amenorrhea, hypomenorrhea, dysmenorrhea, infertility, and recurrent pregnancy loss. Hysteroscopy played an important role in its diagnosis and management.

Fibromuscular dysplasia (FMD) is a rare non-inflammatory, non-atherosclerotic arterial diseasecharacterized by abnormal cellular proliferation and distorted architecture. It commonly affects therenal and extracranial carotid and vertebral arteries, but nearly all arterial beds may be affected,and multivessel involvement is common. We report a rare case of a 31-year-old Filipino femalewho presented with a rapidly enlarging right anterior axillary mass. Initial consideration was ableeding soft tissue sarcoma as seen on chest CT scan, while whole abdominal CT scan withIV contrast revealed incidental findings of multiple aneurysms in the superior mesenteric artery,both renal arteries and right common iliac artery, suggestive of fibromuscular dysplasia. Furthervascular imaging studies showed a looped left internal carotid, and a tortuous left brachial arterywith beading pattern.

Unilateral rosacea is a rare type of rosacea that affects only one side of the face. Limited literature exists on this condition which resembles classic rosacea with persistent erythema, papules, or pustules but shows an unusual asymmetric pattern. The cause is unclear though localized triggers or vascular differences may be involved, complicating diagnosis due to similarities with other conditions.

This is a case of a 42-year-old male who presented with a 4-year history of few ill-defined erythematous patches topped with yellowish papules on the right side of his face and neck. On initial consult, he was noted to have a history of prolonged esun exposure. A skin punch biopsy was done and revealed basal layer hyperpigmentation, pigment incontinence and lymphohistiocytic cell aggregates in the dermis, consistent with granulomatous dermatitis. There was no Demodex infestation. Based on clinical and histopathological data, the diagnosis was unilateral rosacea. Treatment in this case included topical Azelaic Acid cream and frequent sunscreen application along with physical photoprotection, avoidance of unnecessary and prolonged sun exposure.

First reported in 1989 by Shelley et al., unilateral rosacea is underreported, making it challenging to estimate its prevalence. It affects middle-aged adults and can be confused with other unilateral skin conditions. However, no specific data or large-scale studies have been dedicated solely to unilateral cases and it may be mistaken for other unilateral skin conditions making the diagnosis challenging. Treatment generally follows the rosacea protocols like topical therapies, oral medications and lifestyle modification.

Pemphigus erythematosus is an autoimmune chronic bullous disease involving the skin and mucous membranes. It is a variant of Pemphigus foliaceus with features of both pemphigus and lupus erythematosus, clinically presenting as flaccid bullae with crusted erosions in a seborrheic distribution, at times concurrent with more lupus-like discoid lesions. Several case reports have documented that Pemphigus erythematosus may have atypical presentation, mimicking contact dermatitis, small plaque parapsoriasis, or even seborrheic keratosis. This is a case of a 27-year old Filipino Female who presented with erythematous, non-blanching macules, patches, and plaques after intake of anti-TB medications. ANA immunofluorescence, anti-dsDNA, and anti-histone IgG were high while complement C3 was low. Histopathology was consistent with leukocytoclastic vasculitis. However, there was also noted subtle acantholysis with subcorneal blister. Direct immunofluorescence (DIF), on the other hand, showed granular intercellular deposits of IgG, granular intercellular deposits of lgA, and strong granular vascular deposits of fibrinogen. Due to financial constraints, ELISA Desmoglein 1 and 3 were done one month after starting the patient on systemic corticosteroids, giving a negative result. Still, coupling the histopathology and DIF result, the patient was diagnosed as a case of Pemphigus erythematosus with connective tissue-associated vasculitis. The patient was given systemic and topical corticosteroids with noted 90% improvement of erythematous patches and plaques after two weeks. This case demonstrated that pemphigus erythematosus may present with atypical lesions such as vasculitis. Careful examination and correlation of clinical features, laboratories, and histopathology is fundamental to arrive at a correct diagnosis.