Nail disorders can arise at any age and are mostly infectious in origin. Other causes include inflammatory, metabolic, malignancies and pigment disturbances. Due to the similarities in presentation, uncertainty is unavoidable. Thus, more accurate diagnostics and targeted treatment plans are needed to ensure the best possible outcomes for patients and to avoid drug resistance. This case describes a a 69-year-old diabetic female who presented with a 10-year history of subungual, lateral and proximal nail fold hyperkeratosis, onycholysis, splinter hemorrhages and yellow-brown nail discoloration of the fingernails and toenails. Histopathologically, the nail matrix of the left middle finger revealed verruca vulgaris.

MMP is a rare blistering disease manifesting with painful erosions or blisters on one or more mucosal surfaces. An estimate of one to two cases per million annually are diagnosed, with females more affected than males.

We present a case of a 73-year-old Filipino female with recurrent multiple mucosal lesions involving the oral mucosa and genitals, ocular symptoms of foreign-body sensation, and erosions on her scalp.

On physical exam, there were multiple well-defined white plaques on an erythematous base on the oral mucosa and the labia minora. There were multiple well-defined erythematous alopecic patches with erosions and milia on the scalp. Histopathology revealed subepidermal split, while DIF findings were consistent with the pemphigoid group. ELISA showed increased anti-BP180, the most common target antigen for MMP. The patient was managed as a case of MMP. Prednisone 25 mg/day was given, which improved her lesions and decreased her MMPDAI score from 44 (moderate) to 10 (mild). She is currently maintained on azathioprine 50 mg/tablet.

Mucous membrane pemphigoid, being rare, is often overlooked as a differential diagnosis. When presented with a patient with predominantly mucosal lesions, it is important to consider MMP to prevent consequences from delayed diagnosis.

Primary cutaneous lymphoma are non-Hodgkin lymphomas with no evidence of extracutaneous disease. Classified into cutaneous T-cell lymphoma and cutaneous B-cell lymphoma from the WHO-EORTC classification 2018. 10 cases per million inhabitants per year worldwide are seen, wherein 20-25% are primary cutaneous B-cell lymphomas, with PCFCL having 12% frequency. Only 17 cases of cutaneous B cell lymphoma are recorded in the Philippines from 2011 to 2023. This rare case will add to the minimal data on the disease in the Philippines.

A 70-year old, Filipino male presenting with nodules, papules and plaques on the nose, forehead, preauricular areas, and temples of the face. Histopathologically, it showed atypical lymphoid follicles which were positive for CD20 and Bcl6 and negative for Bcl2, MUM-1, Cyclin D1, CD10 and CD5. Since there was no extracutaneous involvement, the final diagnosis was Primary Cutaneous Follicle Center Cell Lymphoma. He was treated with external beam radiation therapy with complete response, and no recurrence seven months after radiation therapy.

PFCL presents as papules, plaques, or tumors with a predilection for the scalp, forehead, and posterior torso. On dermoscopy, salmon-colored area and pro-eminent serpentine vessels, some having white circles with scales and arborizing vessels. Histologically, it expresses CD20 and Bcl-6, and predominantly Bcl-2 negative, but some cases show positive cells. Imaging and work-up ruled out systemic involvement Local radiation shows a close to 100% response rate.

PCFCL is still a rare disease nationwide.

Bullous pemphigoid (BP) is an autoimmune blistering disorder characterized by tense vesicles and bullae, primarily affecting the elderly. It results from autoantibodies targeting hemidesmosomal proteins BP180 and BP230, leading to subepidermal blistering. BP often presents with widespread pruritic plaques and blisters on flexural surfaces, and mucosal involvement is rare. While BP typically occurs spontaneously, certain medications, such as linagliptin, have been implicated as triggers. Early diagnosis and treatment with systemic corticosteroids or immunosuppressive agents can significantly reduce morbidity.

After cutaneous and neurological manifestations, bone and joint involvement are the most common manifestations in Hansen’s disease (HD). Sometimes, these are undiagnosed and rarely reported.

A 68-year-old Filipino, male, presented with an 8-month history of digital joint swelling on both hands. He was initially managed by Rheumatology for arthritis, partially responsive to Methotrexate and Prednisone. Immunology and lupus panel tests were unremarkable. Skin biopsy done on a solitary erythematous plaque on the back revealed granulomatous dermatitis, tuberculoid type. Fite-Faraco, AFB, PAS stains were negative. Four weeks later, he developed multiple erythematous papules and plaques on the face, ears, lower back, gluteal area, and lower extremities. Arthritis was persistent but hypoesthesia, hypohidrosis or alopecia were not reported. A repeat skin biopsy showed epithelioid to macrophagic cell granulomatous reaction compatible to HD. AFB stain and slit skin smear were positive. He was managed as a case of Borderline (BB) to Borderline Lepromatous (BL) leprosy and was started on multibacillary drug treatment (MDT) of Rifampicin, Clofazimine and Dapsone. One month later, the patient reported resolution of skin lesions and arthritis.

Approximately 75% of individuals with HD experience arthritis, which can be one of the early signs of disease. A high index of suspicion is required as it closely mimics other rheumatologic conditions.

Lupus vulgaris is a form of cutaneous tuberculosis (CTB) caused by Mycobacterium tuberculosis (MTB). It is characterized by a usually solitary, long-lasting skin lesion that most commonly develops on the head or neck, especially the nose, cheek, earlobe, or scalp.

A 69-year-old elderly, Filipino female presented with a 20-year history of progressively growing erythematous ulcerative plaques on the right arm and ear, with associated mild pruritus and pain. She appeared to be immunocompetent and had no clinically apparent underlying focus of TB infection. Tuberculin skin test (TST) showed a positive reaction and histopathologic examination revealed a chronic granulomatous dermatitis that is focally positive for acid-fast bacilli (AFB). She was given anti-koch’s therapy with subsequent resolution of the lesions.

The case report presents a rare instance of lupus vulgaris (LV) in a Filipino woman, characterized by large, ulcerative plaques on her body with no apparent infection source, emphasizing the need for early detection and Quantiferon-TB Gold (QFT-G) testing for diagnosis.

Cutaneous squamous cell carcinoma (cSCC) is one of the most common skin cancers, with an increasing incidence worldwide. Chronic sun exposure is a major risk factor and lesions are usually seen on sun-exposed areas such as the face, neck, scalp, and hands. Imiquimod cream, an immune response modifier, has shown promising results in the management of SCC.

A 70-year-old, Filipino male presented with 3-year history of a slow growing erythematous plaque on the abdomen. Physical examinaPon done showed a solitary, well- defined, erythematous plaque measuring 5cm on the leR lower quadrant of the abdomen. Histopathologic examination revealed SCC. In an initial attempt to decrease the size of the tumor, Imiquimod 5% cream 2x a week was initiated. However with continuous use for 24 weeks the patient achieved complete clinical resolution which was confirmed with biopsy.

This case report showcases imiquimod cream as a valuable therapeutic option for giant (5cm)cutaneous squamous cell carcinoma, offering a non-surgical alternative with promising outcomes. This treatment approach has the potential to expand the management options for cSCC and benefit patients who may not be suitable candidates for conventional surgical excision.

BACKGROUND: Cardiac Amyloidosis is a disorder of protein misfolding and metabolism in which insoluble fibrils are deposited in the myocardial extracellular matrix causing organ dysfunction and eventually death. It can exhibit cardiac signs and symptoms, or it can be identified through screening in patients who exhibit extracardiac symptoms of amyloidosis. As there were no clear clinical signs of cardiac amyloidosis and a biopsy is required to show amyloid deposition, the condition has been historically challenging to diagnose. Thus, a high index of suspicion based on the clinical presentation and the outcomes of the preliminary testing arecrucial to determine the approach to diagnosis. CASE SUMMARY: We outline a case of 75-year-old Filipino male who was admitted due to progressive exertional dyspnea. Cardiac Amyloidosis was considered due to evaluation findings of heart failure with preserved ejection fraction with restrictive type of cardiomyopathy. This was subsequently confirmed through extracardiac fat pad biopsy, echocardiographic strain analysis and Technetium (99mTc) Pyrophosphate (PYP) single photon emission computed tomography scan (SPECT). CONCLUSION This case report discussed the red flags of clinical manifestations of cardiac amyloidosis and highlighted the use of non-invasive diagnostic modalities to diagnose the disease. Cardiac amyloidosis remains a rare entity and with emerging therapies that have the potential to improve patient outcomes, early diagnosis is really important. Having high index of suspicion based on signs and symptoms can lead to early detection and an increased number of patients being referred for treatment.
Human ; Male ; Aged: 65-79 yrs old ; Coronary Artery Disease

Knee pain secondary to knee osteoarthritis is one of the most common reasons for consultation in patients 50 years old and above. Due to limitations of current management options for knee osteoarthritis, studies seeking alternative treatment techniques have emerged, including procedures targeting knee innervation. The effectiveness of nerve hydrodissection for managing neuropathies such as carpal tunnel syndrome has been demonstrated but has not been applied to nerves that innervate the knee to manage osteoarthritis. This article discusses the potential application of ultrasound-guided nerve hydrodissection to the anterior innervation of the knee, known as the genicular nerves, for pain management in patients with osteoarthritis.

Acral lentiginous melanoma (ALM) is a rare subtype of cutaneous melanoma, primarily affecting individuals with darker skin. This case series presents four unique instances of nodular ALM, highlighting the association of trauma with disease progression, a factor underreported in existing literature.

We report four patients aged 30 to 72 years, each presenting with nodular masses that evolved from stable pigmented lesions. Notably, all cases followed a history of trauma, resulting in significant clinical features such as rapid lesion growth and associated lymphadenopathy. Histopathological evaluations confirmed atypical melanocyte nests and pagetoid spread in all cases, reinforcing the diagnosis of nodular melanoma.

This series underscores the importance of recognizing the nodular presentations of ALM, particularly in patients with a history of trauma, which may lead to misdiagnosis and delayed treatment. The findings reveal a younger demographic, with an average age of 55.3 years, challenging prior assumptions about ALM’s typical patient profile. The critical takeaway is the necessity for heightened awareness and thorough diagnostic evaluation in similar cases to ensure timely intervention and improved patient outcomes. Our observations advocate for further research to elucidate the relationship between trauma and ALM progression.