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.

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.

Otorrheacan result from middle ear discharge with tympanic membrane perforation, external ear canal pathology, skull injury and other serious diseases in trauma and immunocompromised patients.1Thorough investigation is warranted in cases without improvement after treatment. We present a case where fibrous dysplasia was the underlying cause and discuss its treatment.

CASE REPORT
A 41-year-old farmer man consulted at our ENT Outpatient Clinic with a 1-year history of clear, non-foul-smelling discharge from his left ear, associated with intermittent pounding ear pain. A hard immobile nontender prominence was noted over the patient’s left temporal area. (Figure 1) He was initially treated for chronic suppurative otitis media for 3 months. Severe ear pain was noted,
10/10 on pain scale, squeezing in character, radiating to the left temporal and parietal area associated with progressive hearing loss and ear fullness. Plain CT scans revealed a combined lytic and ground glass expansile lesion involving the left occipital, mastoid, and petrous temporal bone and portion of the parietal bone obliterating the external auditory canal and middle ear. (Figure 2)

On physical examination, a hard immobile nontender prominence was noted over the patient’s left temporo-parietal area. No facial asymmetry or numbness was noted. On otoscopy, there was a skin-colored round smooth hard immobile nontender mass in the external auditory canal with non-foul smelling whitish to yellowish purulent discharge. A Weber tuning fork test lateralized to the left and a Rinne test revealed air conduction < bone conduction on the left, and air conduction > bone conduction on the right.

The patient was admitted with an impression of chronic suppurative otitis media, left; to consider fibrous dysplasia vs. tuberculosis. Aerobic culture of ear discharge revealed no growth. Canal down mastoidectomy was done. Intraoperative findings revealed granulomatous and cartilaginous lesions on the mastoid and temporal bone. (Figure 3) There were aural polyps and cholesteatoma with the ossicles apparently eroded by the lesion. (Figure 4) Temporal bone fluid was sent for GeneXpert MTB/RIF while the surgical specimen was sent for histopathology. GeneXpert MTB/RIF revealed negative results for tuberculosis. Final histopathology results showed fibrous dysplasia.

Nodular syphilis with a granulomatous inflammatory histopathologic pattern is an uncommon cutaneous presentation of secondary syphilis which could pose a diagnostic challenge for clinicians and pathologists alike.

A 33-year-old male diagnosed with HIV presented with a 5-week history of asymptomatic generalized erythematous papules and nodules with overlying scales, with involvement of the palms and soles. Histopathologic examination of a nodule from the forearm revealed non-caseating granulomas in a background of a mixed cell inflammatory infiltrate composed of lymphocytes, epithelioid and foamy histiocytes, plasma cells, neutrophils, and multinucleated giant cells. Warthin-Starry Stain revealed spirochetal organisms, while Fite-Faraco and Periodic Acid-Schiff stains were negative for acid-fast bacilli and fungal elements, respectively. Rapid plasma reagin (RPR) was reactive (1:256). Patient was given a single dose of benzathine penicillin G 2.4 million units intramuscularly, with noted complete resolution of skin lesions as well as an 8-fold decrease in RPR titers.

Nodular lesions are an uncommon cutaneous manifestation of secondary syphilis, and the associated histopathologic finding of granulomatous inflammatory pattern is also unusual, posing a diagnostic challenge. With the increasing prevalence of syphilis, especially among HIV patients, dermatologists, dermatopathologists, internists, and infectious disease specialists should be aware of such presentations of syphilis.

Pyoderma gangrenosum (PG) is a chronic inflammatory neutrophilic dermatosis often presenting as a solitary enlarging painful ulcer with red to violaceous undermined borders. This report delves into the role of doxycycline in the treatment of PG in a 44-year-old male COVID-19 positive patient who has concomitant active tuberculosis infection and end-stage kidney disease, for which both first-line treatments (systemic corticosteroid and cyclosporine) are contraindicated. After three months on doxycycline and topical corticosteroids, there was resolution of the ulcers and no note of recurrence up to three months from completion of the treatment regimen.