Purpura fulminans (PF) is a severe clinical manifestation of Neisseria meningitides infection that is associated with high mortality rates in children. Survivors are frequently left with debilitating musculoskeletal sequelae. There is a paucity of reports on the musculoskeletal pathology of purpura fulminans. We report on a 2-year-old boy with purpura fulminans due to meningococcemia. The child developed distal gangrene in both the upper and lower limbs. Amputations were done for both lower limbs. Histological examination of the amputated specimens showed an inflammatory process and features of osteonecrosis. The latest follow-up at the age of 6 years showed a right knee valgus due to asymmetrical growth arrest of the proximal tibia. PF and its complications are challenging to treat and may require a multidisciplinary approach to improve patient’s functional ability.

Summary Flagellate erythema is characterized by “whiplike’’ linear streaks, usually following bleomycin chemotherapy or is associated with consumption of shiitake mushrooms, dermatomyositis, adult onset still disease as well as human immunodeficiency disease. Here, we describe a case of bleomycin-induced flagellate erythema in a patient with Hodgkin lymphoma.
Hodgkin Disease--drug therapy

Introduction: Atopic eczema (AE) is a common infammatory skin dermatosis that is increasing in prevalence. However, it can present in various clinical presentations, which leads to challenges in the diagnosis and treatment of the condition, especially in a primary care setting. Te Clinical Practice Guidelines on the Management of Atopic Eczema was developed by a multidisciplinary development group and approved by the Ministry of Health Malaysia in 2018. It covers the aspects of diagnosis, severity assessment, treatment, and referral.

Basal cell carcinoma (BCC) is the commonest skin cancer seen worldwide. This study aims to determine the clinical pattern of BCC in the Department of Dermatology, Hospital Kuala Lumpur, Malaysia

Background: Those with increased dynamic knee valgus are vulnerable to increased risk of non-contact knee injuries. However, studies on the top down kinetic chain of lower limb mechanics during dynamic motions such as single leg squat (SLS) among trained males were scarce. Objective: The objective of the study was to evaluate the relationship between isokinetic hip and knee strength and frontal plane projection angle (FPPA) of the knee joint during SLS. Methods: Thirty-two male junior athletes (twelve cyclists, ten runners and ten squash players) were screened for excessive dynamic knee valgus (DKV) prior to participation. Only those within the normal value of DKV were included. Their hip and knee isokinetic strength in sagittal plane were evaluated at 60º/s of angular velocity for both legs using dynamometer. Two dimensional knee FPPA was evaluated during SLS at 60º of knee flexion. Pearson correlation was evaluated between knee FPPA during SLS and isokinetic leg strength. Results: Correlations between knee FPPA and hip and knee isokinetic strength were not statistically significant except between knee flexion peak torque/body weight (r = -0.35, p = 0.05) and hamstring to quadriceps ratio (r = -0.39, p = 0.03) of non-dominant leg. Conclusions:Isokinetic hip and knee strength and knee FPPA during SLS was correlated only for non-dominant leg during SLS among male junior athletes. DKV during SLS may be reduced through strengthening the muscles around hip and knee joints.

Lymphoma presenting with ulceration is not typical. Wereport a case of relapsed DLBCL in a 73-year-old manpresenting with a chronic non-healing leg ulcer. He hasunderlying varicose veins with recurrent venous ulcers. This patient was diagnosed to have DLBCL six years earlier when he presented with recurrent epistaxis originating from a left nasal cavity nodule. Complete resolution was achieved after eight cycles of R-CHOP and intrathecal methotrexate. For this current problem, this patient was treated with rituximab combined with chemotherapy which resulted in healing of the ulcer.

Adult-onset metachromatic leukodystrophy is often a diagnostic challenge to many clinicians. It may be presented with psychiatry symptom before other evidences of leukodystrophy are uncovered. We report a 53-year-old patient who presented with 7-year history of manic-like presentation in addition to progressive neurocognitive deterioration. Diagnosis was made eventually with neuroimaging. Mutational analysis showed compound heterozygous of ARSA gene. This case demonstrated the challenge in diagnosing this condition due to its complex neuropsychiatric presentation.
Leukodystrophy, Metachromatic

Background: Patients with severe psoriasis, namely those requiring phototherapy or systemic treatment, have an increased risk of death. The aim of this study was to determine the prevalence, aetiology and risk factors for mortality among adult patients aged 18 years and above with psoriasis in Malaysia. Methods: This was a retrospective study involving adult patients notified by dermatologists to the Malaysian Psoriasis Registry between July 2007 and December 2013. Data were cross-checked against the National Death Registry. Patients certified dead were identified and the cause of death was analysed. Multivariate analysis using multiple logistic regression were conducted on potential factors associated with higher risk of mortality. Results: A total of 419 deaths were identified among the 9775 patients notified. There were four significant risk factors for higher mortality: age>40 years (age 41-60 years old, Odds Ratio (OR) 2.70, 95%CI 1.75, 4.18; age>60 years OR 7.46, 95%CI 4.62, 12.02), male gender (OR 1.72, 95%CI 1.33,2.22), severe psoriasis with body surface area (BSA) >10% (OR 1.52, 95%CI 1.19, 1.96) and presence of at least one cardiovascular co-morbidity (OR 1.67, 95% CI 1.30, 2.14). Among the 301 patients with verifiable causes of death, the leading causes were infection (33.9%), cardiovascular disease (33.6%) and malignancy (15.9%). Conclusion: Infection was the leading cause of death among psoriasis patients in Malaysia. Although cardiovascular diseases are well-known to cause significant morbidity and mortality among psoriasis patients, the role of infections and malignancy should not be overlooked.
Psoriasis