A 70-year-old female was referred for brown-to-gray colored papules and nodules on her lower legs. She had been diagnosed with diffuse large B-cell lymphoma (DLBCL) in her stomach, and myelodysplastic syndrome (MDS) by bone marrow biopsy. Three years after complete remission of DLBCL, she experienced DLBCL recurrence in her small bowel and was hospitalized. MDS had been stationary, but during the treatment of DLBCL, her laboratory findings suggested signs of leukemia. Bone marrow biopsy was done, and acute monoblastic leukemia (AMoL) was diagnosed. After 1 cycle of chemotherapy for AMoL, skin lesions developed, and her skin biopsy showed cutaneous T-cell lymphoma (CTCL). Terminal deoxynucleotidyl transferase staining and CD123 staining were negative, and bone marrow re-biopsy conducted after the skin lesion developed still showed monoblastic proliferation. Whether the CTCL represented with an AMoL lineage switch could not be completely proved due to the absence of molecular or clonal marker evaluations, but the possibility of coexistence of three different malignancies was higher. During treatment, a neutropenic fever developed, and the patient died due to sepsis. We herein report a rare case of CTCL accompanied by AmoL and DLBCL.

Background: An evident relationship has been shown between psoriasis and metabolic comorbidities. However, the results in pediatric psoriasis vary from study to study, and no meta-analysis exists on the association of metabolic comorbidities with pediatric psoriasis. Objective: To evaluate the association between psoriasis and metabolic comorbidities in pediatric patients. Methods: We searched articles published in PubMed, EMBASE, and Cochrane Library databases from inception to April 30, 2019. All observational studies reporting the prevalence of obesity or metabolic comorbidities in pediatric patients with psoriasis were included. Results: The meta-analysis included 16 unique studies meeting the inclusion criteria. The pooled odds ratios in pediatric patients with psoriasis was 2.40 (95% confidence interval [CI], 1.60∼3.59) for obesity (13 studies), 2.73 (95% CI, 1.79∼ 4.17) for hypertension (8 studies), 2.01 (95% CI, 1.09∼3.73) for diabetes mellitus (8 studies), 1.67 (95% CI, 1.42∼1.97) for dyslipidemia (7 studies), and 7.49 (95% CI, 1.86∼30.07) for metabolic syndrome (4 studies). Conclusion Pediatric patients with psoriasis showed a significantly higher prevalence of obesity, hypertension, diabetes, dyslipidemia, and metabolic syndrome. Adequate monitoring and timely management of metabolic comorbidities should be considered in these patients.

Background: An evident relationship has been shown between psoriasis and metabolic comorbidities. However, the results in pediatric psoriasis vary from study to study, and no meta-analysis exists on the association of metabolic comorbidities with pediatric psoriasis. Objective: To evaluate the association between psoriasis and metabolic comorbidities in pediatric patients. Methods: We searched articles published in PubMed, EMBASE, and Cochrane Library databases from inception to April 30, 2019. All observational studies reporting the prevalence of obesity or metabolic comorbidities in pediatric patients with psoriasis were included. Results: The meta-analysis included 16 unique studies meeting the inclusion criteria. The pooled odds ratios in pediatric patients with psoriasis was 2.40 (95% confidence interval [CI], 1.60∼3.59) for obesity (13 studies), 2.73 (95% CI, 1.79∼ 4.17) for hypertension (8 studies), 2.01 (95% CI, 1.09∼3.73) for diabetes mellitus (8 studies), 1.67 (95% CI, 1.42∼1.97) for dyslipidemia (7 studies), and 7.49 (95% CI, 1.86∼30.07) for metabolic syndrome (4 studies). Conclusion Pediatric patients with psoriasis showed a significantly higher prevalence of obesity, hypertension, diabetes, dyslipidemia, and metabolic syndrome. Adequate monitoring and timely management of metabolic comorbidities should be considered in these patients.

Friction melanosis (FM) is an acquired pigmented disease that is caused by recurrent mechanical stress. There is no previous report explaining the presence of tiny brown-colored particles confined to the corneal layer. We describe a case of a rare form of FM of the finger that showed a relatively transient clinical course. A 17-year-old Korean female presented with a 5-month history of an asymptomatic localized hyperpigmented patch on the tip of the right index finger. The dermoscopic examination revealed homogenous globular pattern, which favored pigmentation over hemorrhage. Histopathologically, hyperkeratosis and acanthosis with lymphohistiocytic infiltration of the superficial dermis were noted on hematoxylin and eosin staining; however, there was neither a definite increase in melanophages in the upper dermis nor melanocytic proliferation in the basal layer. Per high-power field, multiple brown-colored tiny particles were scattered in the corneal layer. The particles were not dyed by Fontana-Masson stain, iron stain, and S-100. We questioned the patient about the presence of irritation and found that she had bought new shoes at the time of the onset. She was habituated to placing her fingers in her shoes while wearing them because they were slightly tight. The lesion disappeared spontaneously a week after the cause of friction was eliminated.Altogether, we encountered a rare form of FM that occurred in a rare location with a transient clinical course. Further cases on pigmentation restricted to finger tips might reveal the origin of the particles.

OBJECTIVE: Neuroimaging in headache patients identifies clinically significant neurological abnormalities and plays an important role in excluding secondary headache diagnoses. We performed a systematic review and meta-analysis of the existing guidelines and studies surrounding neuroimaging in headache patients. METHODS: The research question involved determining the prevalence of detecting clinically significant neurological abnormalities using neuroimaging in patients suspected of primary headache. Searches of the PubMed and Embase databases were conducted on English-language studies published from 1991 to 2016, and the reference lists of the retrieved articles were also checked manually. All headache subtypes and patients aged ≥15 years were included in the analysis. RESULTS: Ten studies met the selection criteria. The pooled prevalence of detecting clinically significant abnormalities in the neuroimaging of headache patients was 8.86% (95% confidence interval: 5.12–15.33%). Subsequently, diverse subgroup analyses were performed based on the detection method, headache type, study type, study region, age group, and disease type. CONCLUSION: The present findings indicate that limited neuroimaging methods should be carefully considered for headache diagnostic purposes when there are red flag symptoms. Limitations and suggested directions for future studies on neuroimaging in headache patients are described.
Diagnosis ; Headache ; Humans ; Magnetic Resonance Imaging ; Methods ; Neuroimaging ; Patient Selection ; Prevalence ; Tomography, X-Ray Computed

PURPOSE: To evaluate the diagnostic utility and predictors for determinate results of an enzyme-linked immunospot assay using induced sputum cells (IS ELISPOT) for a rapid diagnosis of pulmonary tuberculosis (TB). MATERIALS AND METHODS: Subjects suspected of pulmonary TB who had either sputum acid fast bacilli smear-negative or not producing sputum spontaneously were prospectively enrolled. ELISPOT assay was performed using cells from induced sputum. RESULTS: A total of 43 subjects, including 25 with TB (TB group) and 18 with non-TB disease (non-TB group) were enrolled. Results of IS ELISPOT were determinate in only 17/43 (39%) subjects, but all of determinate results were consistent with the final diagnosis. Of the 43 sputum samples, 11 (26%) were inadequate to perform IS ELISPOT. Of 32 adequate sputum samples, the proportion of determinate results was significantly higher in the TB group (75%, 15/20) than in the non-TB group (17%, 2/12) (p=0.002). The status of active TB was a unique predictor but smear positivity was not a significant predictor for determinate results. In addition, sensitivity of IS ELISPOT (75%, 9/12) in smear negative TB was higher than that of TB-polymerase chain reaction (25%, 3/12). CONCLUSION: IS ELISPOT showed relatively high diagnostic value and accuracy in the TB group, independent of smear positivity. IS ELISPOT may provide additional diagnostic yield for microbiological tools in the rapid diagnosis of smear-negative TB.
Adult ; Aged ; *Enzyme-Linked Immunospot Assay ; Female ; Humans ; Immunologic Tests/*methods ; Male ; Middle Aged ; Mycobacterium tuberculosis/*isolation & purification ; Predictive Value of Tests ; Prospective Studies ; Reproducibility of Results ; Risk Factors ; Sensitivity and Specificity ; Sputum/*microbiology ; Tuberculosis, Pulmonary/*diagnosis/microbiology

Onychomycosis is a fungal nail infection caused mainly by dermatophytes. Non-dermatophytes such as yeasts, Acremonium, Aspergillus, and Fusarium species account for only 10% of onychomycosis, and Fusarium species are relatively common amongst these pathogens. However, the main Fusarium species pathogens are Fusarium solani and Fusarium oxysporum. Fusarium proliferatum is a rare pathogen in onychomycosis, and only a few cases have been reported worldwide. We report a case of a 68-year-old woman presenting with a white- to yellow-colored patch on her left third fingernail plate, which was diagnosed by fungus culture and sequencing as onychomycosis caused by Fusarium proliferatum.

No abstract available.
Diagnosis, Differential ; Nevus ; Scalp

Non-Hodgkin's lymphoma presented as a malignancy of the uterine cervix is exceedingly rare disease and accounts for approximately only 0.12-0.6% of extranodal lymphomas. Most reported cases were B-cell lymphomas and there is no consensus on the management and prognosis of the disease because of its extreme rarity. Primary T/natural killer (NK)-cell lymphoma arising from the uterine cervix is scarcely encountered that, in the review of literature, only 1 case has been reported by Mhawech et al. We encountered a woman with T/NK-cell lymphoma involving the uterine cervix that initially presented with severe vaginal bleeding. Therefore, we report the case with a brief review of literature.
Cervix Uteri* ; Consensus ; Female ; Humans ; Lymphoma* ; Lymphoma, B-Cell ; Lymphoma, Non-Hodgkin ; Prognosis ; Rare Diseases ; Uterine Hemorrhage

BACKGROUND: Obstructive sleep apnea (OSA) is a common disease, but there are few studies about the quality of life (QOL) of Korean patients with OSA. The aims of the present study were compare the QOL of patients with OSA and healthy controls, and to determine the factors that influence the QOL in these patients. METHODS: This was a casecontrol study comparing the QOL of 136 OSA patients and 126 healthy controls. For all of the subjects, QOL and the severity of subjective symptoms were evaluated using various questionnaires, including the Korean versions of the Medical Outcome Study Short Form-36 (SF-36), the Pittsburg Sleep Quality Index (PSQI-K), the Epworth Sleepiness Scale (KESS), the Insomnia Severity Index (ISI), the Beck Depression Inventory (KBDI)-2, and the Hospital Anxiety Scale (HAS). RESULTS: The QOL was worse in patients with OSA than in the controls, but there was no association between the severity of OSA and the degree of worsening of QOL. Multiple stepwise regression analysis revealed that the strongest associations were found between QOL and HAS, ISI and BDI-2 scoring in OSA patients. CONCLUSIONS: These findings demonstrate that OSA represents a considerable burden on the QOL of Koreans, and suggest that the impairment in QOL of Koreans with OSA is related to the degree of anxiety, insomnia and depression that they suffer.
Anxiety ; Depression ; Humans ; Outcome Assessment (Health Care) ; Quality of Life* ; Surveys and Questionnaires ; Sleep Apnea, Obstructive* ; Sleep Initiation and Maintenance Disorders