An atypical presentation of lupus vulgaris
An atypical presentation of lupus vulgaris | A 25-year-old man was referred to the dermatology clinic with a nonhealing ulcer. Examination showed a 2.5 × 2 cm violaceous-bordered ulceration (first image). Five weeks later, the culture results returned positive for Mycobacterium tuberculosis. Four-drug antituberculosis therapy started. The ulcer resolved after six months (second image). Lupus vulgaris, the most common variant, is chronic and progressive.
Mycobacterium marinum infection with sporotrichoid spread from fish tank exposure
An immunocompetent 52-year-old man presented with lesions and inflammation on his left arm after lacerating his index finger while cleaning a fish tank ([Figure 1]). The lesions appeared at the laceration site two weeks after the injury and continued to progress for five months. He had no fever
Acute coral contact dermatitis
A 45-year-old woman sought treatment for a pruritic rash — acute coral contact dermatitis — that developed on her arm within minutes after accidentally brushing against a coral while snorkelling in the Mediterranean Sea. She had an erythematous and serpiginous plaque on her left forearm. Superficial crusts and scaly dermatitis are observed. Full article (subscription required): www.cmaj.ca/lookup/doi/10.1503/cmaj.151370
Metastatic pulmonary calcification in end-stage renal failure
A 37-year-old man with progressive chronic renal failure (which started in the first year after a kidney transplant 15 years earlier) presented for evaluation of a nonproductive cough. There was no history of dyspnea. The patient was taking calcitriol, prednisone, cyclosporine and azathioprine.
Raynaud phenomenon causing lingual pallor and dysarthria
Raynaud phenomenon causing lingual pallor and dysarthria | Figure 1: (A) Raynaud phenomenon affecting the patient’s fingers (pallor phase). (B) Nailfold capillaroscopy showing dilated capillary loops. (C) Normal appearance of the patient’s tongue. (D) Blanched white tongue during an episode of lingual Raynaud phenomenon.
Treatment of severe frostbite with iloprost in northern Canada
Treatment of severe frostbite with iloprost in northern Canada following Yukon Arctic Ultra race | Key points: Current standard of care for severe frostbite is rapid rewarming, débridement/aspiration of clear blisters & application of dry bulky dressings; May be insufficient to prevent necrosis, with amputation often only solution; Studies show decreased amputation with use of vasodilators & thrombolytics; Administration of iloprost is feasible in community hospital setting.
Giant bilateral sporadic renal angiomyolipoma
A 64-year-old man presented to our hospital with a 15-year history of slow, progressive distension of the abdomen. On physical examination, palpable masses in both flanks were noted ([Figure 1]). Results of serum creatinine and urinalysis testing were normal. Contrast-enhanced computed tomography
Pustules of the fingers: acrodermatitis continua
Pustules of the fingers: acrodermatitis continua | Right thumb of a woman in her fifties showing well-defined, erythematous, scaly plaque over the palmar aspect of the distal phalanx. Note the remnant of pustules in the centre of the plaque. Full article (subscription required): www.cmaj.ca/lookup/doi/10.1503/cmaj.150955
Treatment of severe frostbite with iloprost in northern Canada
Usual approach to treating severe frostbite may be insufficient to prevent necrosis, with amputation often the only solution. Authors describe two cases that occurred during the Yukon Arctic Ultra race, in which iloprost, a vasodilator, was used to treat severe frostbite with good results. Case 1, 46-yr-old man with grade 3 frostbite on his right hand. Case 2, a 43-yr-old man with grade 3 frostbite on his right foot. Full article (sub. required): www.cmaj.ca/lookup/doi/10.1503/cmaj.151252
Biliary obstruction caused by the liver fluke, Fasciola hepatica
Biliary obstruction caused by liver fluke, Fasciola hepatica | Brown, leaf-shaped parasite extracted from common bile duct of 20-year-old man (A). Photomicrographs of the specimen showing the oral (black arrow) and ventral (black broken arrow) suckers (× 40) (B), branching intestines (× 100) (C) and spiked integument (× 200) (D). Using patient’s immigration history from North Africa, specimen was identified as Fasciola hepatica. The size and lack of eggs indicate immature adult form.
Mycoplasma pneumoniae–associated mucositis
Mycoplasma pneumoniae –associated mucositis | Bilateral conjunctivitis with severe subconjunctival hemorrhage and erythematous lips in a 35-year-old man. First published February 29, 2016, doi: 10.1503/cmaj.151017
Hydroxychloroquine-related skin discoloration
Hydroxychloroquine-related skin discoloration | Hydroxychloroquine-related hyperpigmentation on the face (A) and areas of previous bruising on the arm (B) of a 48-year-old man with systemic lupus erythematosus. First published February 22, 2016, doi: 10.1503/cmaj.150622
Blue man syndrome
Blue man syndrome | (A) Photograph of a 73-year-old man presenting with a bluish-grey skin discolouration, predominantly in sun-exposed areas. (B) Near-complete resolution of the discolouration was seen one year after amiodarone was stopped. First published February 8, 2016, doi: 10.1503/cmaj.150393
Evidence for transmissibility of Alzheimer disease pathology: Cause for concern?
Evidence for transmissibility of Alzheimer disease pathology: Cause for concern? | Photomicrographs of neocortex tissue in degenerative proteinopathies (black bars represent 100 μm). Immunohistochemical staining (brown) was used to show (A) misfolded prion protein, with fine, granular (“synaptic”) deposits throughout the neuropil; and (B) amyloid-β, with amyloid angiopathy in blood vessel walls in the arachnoid and superficial neocortex. Feb 1, 2016, doi: 10.1503/cmaj.151257
Cutaneous sarcoidosis at insulin injection sites
Cutaneous sarcoidosis at insulin injection sites | Fig. 1: Confluent brownish-red papules and plaques distributed symmetrically at the abdominal insulin injection sites of a 49-year-old woman with diabetes. Fig. 2: Histologic specimen from a lesion on the patient’s abdomen, showing noncaseating, microorganism-negative granulomas with focal foreign-body giant cell reaction to nonpolarizable foreign material. Hematoxylin and eosin stain. First published January 18, 2016, doi…
Wellens syndrome | (A) Electrocardiogram showing the Wellens pattern (black arrows) in the precordial leads of a 70-year-old woman who presented to the emergency department with intermittent pain in the left arm over the preceding 24 hours. (B) Coronary angiogram showing 90% stenosis of the proximal left anterior descending artery (white arrow). First published January 11, 2016, doi: 10.1503/cmaj.150550