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- Presentation
Clinicopathologic Self-Assessment at AAD Annual Meeting 2024
Description
During the AAD Annual Meeting 2024, a presentation focused on two intriguing dermatological cases. The first involved a 23-year-old woman with a widespread, pruritic rash that exacerbated following a COVID-19 infection. Initially treated with Prednisone, the rash recurred, revealing multiple erosive lesions amid her tattoos. Biopsies showed a mixed infiltrate of lymphocytes and giant cells, leading to a diagnosis of granulomatous secondary syphilis, a less recognized manifestation often misidentified due to its clinical presentation. The speaker emphasized the importance of maintaining a high index of suspicion for infectious conditions, especially syphilis, given its rising incidence. The second case featured a 21-year-old with unusual growths and crusting lesions in linear arrangements following a shaving injury. Histological analysis revealed features consistent with pemphigus vegetans, a relatively benign variant of pemphigus vulgaris, characterized by vegetative and erosive lesions. The discussion highlighted the necessity of thorough evaluation, including serology and special stains, when encountering atypical dermatological presentations. Ultimately, both cases underscored the complexities of diagnosis and the critical role of histopathology in guiding clinical decisions.
View moreConclusions
- Granulomatous inflammation can manifest in early secondary syphilis and requires a high index of suspicion for diagnosis.
- The case of a 23-year-old with a widespread pruritic rash was ultimately diagnosed as granulomatous secondary syphilis despite initial assumptions of other diagnoses.
- Histological findings in secondary syphilis may not prominently feature plasma cells, which can complicate diagnosis.
- A diagnosis of pemphigus vegetans was established in a 21-year-old patient presenting with unusual skin eruptions and erosions.
- Pemphigus vegetans is a localized form of pemphigus vulgaris that tends to have a benign course and specific clinical features, such as vegetating plaques at sites of erosions.
- Treatment for pemphigus vegetans includes corticosteroids, immunosuppressants, and biologics, but specific agents like Risankizumab are not established treatments.