AAD
Author: Willhemenia Loremipsum Special session: Lorem ipsum dolor sit amet Category: Lorem ipsum View all results

Please login or create an account. If you do not have access to this content, you will be shown a 30 second preview and licensing options.

  • Presentation

You May Not Have Seen It, but It Has Seen You: Commonly Missed Diagnoses in Dermatology

Description

This dermatology presentation discusses commonly missed diagnoses, primarily focusing on adult-onset Still's disease (AOSD) and other complex dermatological cases. The first case illustrates a 30-year-old male with symptoms of fever, elevated white cell counts, and a specific rash characterized by flagellate hyperpigmented papules, ultimately diagnosed as AOSD, confirmed by high ferritin levels. The talk further explains the two forms of AOSD, detailing the classic urticarial rash and the atypical form characterized by persistent rashes. The second case involves a 61-year-old female with linear lichenoid papules diagnosed as scleromyxedema, linked to a monoclonal gammopathy often seen in such patients. The third case highlights hypochromic vitiligo, emphasizing its differentiation from related conditions. A 45-year-old male with facial nodules was eventually diagnosed with chronic herpes due to a biopsy revealing multinucleated keratinocytes, stressing the need for accurate diagnosis in HIV-positive patients. Finally, a 47-year-old female presenting with painful ulcers was diagnosed with an atypical mycobacterial infection, emphasizing the significance of accurate biopsies in identifying the infection type. The session concluded with intriguing insights into how specific immune responses may lead to atypical presentations of common conditions, enhancing clinical awareness among dermatologists.

View more

Conclusions

  • Adult-onset Still's disease (AOSD) can present with distinctive dermatological manifestations, including persistent pruritic papules and plaques.
  • AOSD is linked to high ferritin levels, inflammatory cytokines, and specific histopathological findings such as neutrophilic infiltrate and apoptosis of keratinocytes.
  • Delays in the diagnosis of AOSD can occur due to negative cultures and atypical presentations that can mimic other conditions.
  • Scleromyxedema is often associated with monoclonal gammopathy and can present with systemic complications, highlighting the need for careful monitoring.
  • The skin lesions of hypochromic vitiligo, a distinct entity, are well-demarcated, stable, and more common in richly pigmented skin, necessitating awareness among dermatologists.
  • Chronic herpetic infections in immunocompromised individuals can lead to atypical presentations, including ulcerative and wart-like lesions.
  • Acyclovir resistance is a concern in chronic herpes simplex infections, requiring alternative dosing strategies and therapies such as imiquimod or cidofovir.
  • Environmental exposure can lead to atypical mycobacterial infections, particularly in patients with a history of trauma or compromised skin integrity.
  • Damevska K, França K, Nikolovska S, Gucev F. Adult-onset Still's disease as a cutaneous marker of systemic disease. Clin Dermatol. 2019 Nov.
  • Lee JY, Yang CC, Hsu MM. Histopathology of persistent papules and plaques in adult-onset Still's disease. J Am Acad Dermatol. 2005.
  • Vora P, Kunzler E, Dominguez AR, Vandergriff T, Harris-Tryon T. Atypical Adult-onset Still's disease with flagellate morphology in a patient with skin of color. JAAD Case Rep.
  • Lee JY, Yang CC. Onset Still Disease Presenting With Dermatomyositis-Like Persistent Pruritic Lesions. The American Journal of Dermatopathology 41(11):p 851-854, November 2019. 10.1097/DAD.0000000000001447
  • Sun NZ, Brezinski EA, Berliner J, Haemel A, Connolly MK, Gensler L, McCalmont TH, Shinkai K. Updates in adult-onset Still disease: Atypical cutaneous manifestations and associations with delayed malignancy. J Am Acad Dermatol. 2015 Aug;73(2):294-303. doi: 10.1016/j.jaad.2015.04.063.
  • Wouters J M, van der Veen J, van de Putte L B, de Rooij D J. Adult onset Still's disease and viral infections. Ann Rheum Dis. 1988 Sep;47(9):764-7. doi: 10.1136/ard.47.9.764.
  • McNish A, Ho JD. Water-exacerbated Pruritus and a Flagellate Eruption: Adult-onset Still's Disease Occurring in Association with Influenza A Virus Infection. Clin Dermatol. 2021;6(2):15. DOI: 10.23880/cdoaj-16000245.
  • Gonzalez-Santiago TM, Drage LA. Nontuberculous Mycobacteria Skin and Soft Tissue Infections. Dermatol Clin. 2015;33(3):556-577.
  • Röltgen K, Pluschke G. Epidemiology and disease burden of Burull ulcer: a review. Res Rep Trop Med. 2015;6:59-73.
  • Castelo-Soccio L, Bernardin R, Stern J, Goldstein SA, Kovarik C. Successful treatment of acyclovir-resistant herpes simplex virus with intralesional cidofovir. Arch Dermatol. 2010 Feb;146(2):124-6. doi: 10.1001/archdermatol.2009.363.