Norwegian scabies is a crusted rash that's caused by a massive infestation with the mite Sarcoptes scabiei. The characteristic skin lesions of this form are gross scaling and hyperkeratotic plaques, and especially on the hands, feet, face, nails and scalp with varying degrees of pruritus. It is often seen in the individuals with human immunodeficiency virus infection, the elderly, immunocompromised patients and institutionalized persons. We report here on a case of Norwegian scabies on an 86-year-old patient who was living in an eldercare hospital, and the patient presented with localized, pruritic, erythematous patches with thick yelolwish crusts on the scalp.
Aged ; Aged, 80 and over ; Exanthema ; Foot ; Hand ; HIV ; Humans ; Immunocompromised Host ; Institutionalization ; Mites ; Nails ; Pruritus ; Sarcoptes scabiei ; Scabies ; Scalp ; Skin

Radical nephrectomy with tumor thrombectomy for advanced renal cell carcinoma is an oncologically relevant approach that can achieve long-term survival even in the presence of distant metastases. However, the surgical techniques pose significant challenges. The objective of this clinical review was to present technical recommendations for tumor thrombectomy in the vena cava to facilitate surgical treatment. Transesophageal echocardiography is required to prepare for this procedure. Cardiopulmonary bypass should be considered when the tumor thrombus has invaded the cardiac chamber and clamping is not feasible because of the inability to milk the intracardiac chamber thrombus in the caudal direction. Prior to performing a cavotomy, it is crucial to clamp the contralateral renal vein and infrarenal and suprahepatic inferior vena cava (IVC). If the suprahepatic IVC is separated from the surrounding tissue, it can be gently pulled down toward the patient’s leg until the lower margin of the atrium becomes visible. Subsequently, the tumor thrombus should be carefully pulled downward to a position where it can be clamped. Implementing the Pringle maneuver to reduce blood flow from the hepatic veins to the IVC during IVC cavotomy is simpler than clamping the hepatic veins. Sequential clamping is a two-stage method of dividing thrombectomy by clamping the IVC twice, first suprahepatically and then midretrohepatically. This sequential clamping technique helps minimize hypotension status and the Pringle maneuver time compared to single clamping. Additionally, a spiral cavotomy can decrease the degree of primary closure narrowing. The oncological prognoses of patients can be improved by incorporating these technical recommendations.

Mycobacterium (M.) fortuitum is a rapidly growing mycobacterium. It is classified as Runyon's group IV with M. abcessus and M. chelonae that are mostly found in water and soil. M. fortuitum infection usually occurs after trauma, surgery or procedures such as acupuncture that cause cutaneous or soft tissue manifestations. We report a case of cutaneous infection due to M. fortuitum in a 72-year-old woman with erythematous deep-seated nodules on her left hand. She inflicted a minor injury to her left hand in a farm. Culture from skin biopsy specimens on 3% Ogawa medium yielded bacterial colonies after 5 days. The microorganism was subsequently identified as M. fortuitum by PCR-restriction fragment length polymorphism analysis. The skin lesions were improved by antibiotic therapy with clarithromycin for 6 months.
Acupuncture ; Aged ; Biopsy ; Clarithromycin ; Female ; Hand ; Humans ; Mycobacterium ; Mycobacterium fortuitum ; Skin ; Soil

Merkel cell carcinoma is a rare aggressive primary skin cancer which mostly occurs in the elderly on sun-exposed skin. It usually presents as a solitary dome-shaped red or purple nodule on the head, neck and extremities. The mortality rate is higher than the rate for malignant melanoma because its local recurrence is common. Agent Orange, an herbicide widely used as a defoliant in the Vietnam War, contains dioxin contaminants and can cause several dermatoses and skin cancers. We report a case of multiple Merkel cell carcinoma in a 65-year-old male with lesions on the head and neck, who had been exposed to Agent Orange during Vietnam War.
2,4,5-Trichlorophenoxyacetic Acid ; 2,4-Dichlorophenoxyacetic Acid ; Aged ; Carcinoma, Merkel Cell ; Citrus sinensis ; Extremities ; Head ; Humans ; Male ; Melanoma ; Neck ; Recurrence ; Skin ; Skin Diseases ; Skin Neoplasms ; Tetrachlorodibenzodioxin ; Veterans ; Vietnam

Syphilid has been called the "great imitator" of skin disease, and it can have protean clinical manifestations and it may present with unusual lesions. Annular syphilid, which can mimic sarcoid, granuloma annulare, Sweet syndrome or tinea corporis, is a rare variant of syphilid. We report here on a case of annular syphilid that mimicked tinea corporis in a 29-year-old female who showed a three month history of multiple, pruritic, well-demarcated annular scaly erythematous patches with central clearing and an elevated border on the trunk and both upper extremities. Direct mycological examination and culture did not result in finding any fungal elements, and annular syphilid was confirmed according to the histopathologic and serologic findings. She and her boyfriend were treated with benzathine penicillin G, and the skin lesions disappeared completely.
Adult ; Ethylenediamines ; Female ; Granuloma Annulare ; Humans ; Hydrazines ; Penicillin G Benzathine ; Skin ; Skin Diseases ; Sweet Syndrome ; Syphilis, Cutaneous ; Tinea ; Upper Extremity

Anesthegiologists commonly use arterial cannulation for both close blood pressure monitoring and repeated blood sampling for gas analysis. Radial artery cannulation is generally thought of as a safe and uncomplicated procedure, however, some possible complications have been reported. These include bleeding, hematoma, infection, pseudoaneurysm and thromboembolism, which do not usually result in any serious clinical problems. Although it is not common, thromboembolism could be serious because it can lead to digital ischemia and necrosis. We report here a case of finger necrosis following radial artery cannulation in a patient who underwent radical hysterectomy under general anesthesia.
Aneurysm, False ; Arteries ; Blood Pressure Monitors ; Catheterization ; Fingers ; Hematoma ; Hemorrhage ; Humans ; Hysterectomy ; Ischemia ; Necrosis ; Radial Artery ; Thromboembolism

Nocardiosis is an uncommon, potentially life-threatening infectious disease caused by several species of the genus Nocardia, which are Gram-positive branched bacilli. Most infections enter through the respiratory tract and then disseminate systemically but rarely has a primary infection occurred resulting from direct inoculation. Isolation of Nocardia from clinical specimens and identification of species is difficult and require a specialized microbiologist. We report a case of primary cutaneous nocardiosis caused by N. brasiliensis in a 68-year-old man who was diagnosed by bacterial culture and 16S ribosomal RNA sequencing. The skin lesions improved with trimethoprim- sulfamethoxazole antibiotic therapy for 6 months.
Aged ; Communicable Diseases ; Humans ; Nocardia ; Nocardia Infections ; Respiratory System ; RNA, Ribosomal, 16S ; Skin ; Sulfamethoxazole

Porokeratosis is a genodermatosis that is characterized by abnormal epidermal keratinization with the histologic finding of a cornoid lamella. Linear porokeratosis is an uncommon variant that presents a characteristic linear nevoid distribution along the Blaschko's lines and linear porokeratosis has the highest potential for malignant degeneration of all the porokeratoses. Many treatment modalities have been used, but the treatment outcomes are variable and the treatments are poorly standardized. We report here on a case of linear porokeratosis in a 48-year-old female who showed localized, linear, brownish macules with a well-demarcated hyperkeratotic border on the left lower abdomen and back.
Abdomen ; Female ; Humans ; Keratins ; Middle Aged ; Porokeratosis

We report a case of rosacea-like tinea faciei in a 62-year-old female. The lesions were manifested by 2.0x2.0 cm and 2.0x2.0 cm-sized, two, pruritic, well-demarcated, erythematous macules on the nose and left ala nasi. Histopathologic examination of the skin lesion showed chronic dermal inflammation with presence of fungal hyphae in the honey layer of the epidermis. Fungal culture of the biopsy specimen grew out typical white cottony colonies of Trichophyton rubrum. The patient was treated with 250 mg of terbinafine daily for 1 month and topical lanoconazole application. Skin lesions improved one month after the treatment, and recurrence has not been observed.
Biopsy ; Epidermis ; European Continental Ancestry Group ; Female ; Honey ; Humans ; Hyphae ; Imidazoles ; Inflammation ; Middle Aged ; Naphthalenes ; Nose ; Recurrence ; Skin ; Tinea ; Trichophyton

Exercise-induced anaphylaxis (EIA) is a medical emergency in that it derives from a physical allergy. We reported a case of food-independent EIA based on history and laboratory data. A 40-year-old male patient was presented with generalized urticaria, angioedema, and syncope after jogging. He had suffered from allergic rhinitis for 25 years. Increased level of serum tryptase was noted. Mast cell activation might be suggested in the pathophysiologic mechanism of EIA.
Adult ; Anaphylaxis* ; Angioedema ; Emergencies ; Humans ; Hypersensitivity ; Jogging ; Male ; Mast Cells ; Rhinitis ; Syncope ; Tryptases* ; Urticaria