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Molluscum contagiosum is a viral infection of the skin. It may occur anywhere on the skin surface but is most common in skinfolds, on the face, and in the genital region. Atypical presentations are usually seen in conditions with altered immunity, but they may occur in immunocompetent patients as well. We present a case of an unusual presentation of molluscum contagiosum lesions (multiple normal and one giant) on the plantar area of the foot in an adult.
Metastatic Melanoma of a Metatarsal
A Case Report
A 53-year-old woman presented with painful swelling of the right forefoot presenting clinically as a metatarsal stress fracture. Radiographs showed destructive changes, and diagnostic imaging revealed an aggressive neoplasm. The lesion was biopsied, and the pathologic diagnosis was metastatic melanoma. A thorough physical examination and advanced imaging did not reveal a primary tumor. Ray resection was performed with en bloc resection of the neoplasm. The patient continues to receive long-term immune stimulation chemotherapy 34 months after the ray resection.
Cutaneous adverse drug reactions make up 1% to 2% of all adverse drug reactions. From these adverse cutaneous drug reactions, 16% to 21% can be categorized as fixed drug reactions (FDR). Fixed drug reactions may show diverse morphology including but not limited to the following: dermatitis, Stevens-Johnson syndrome, urticaria, morbilliform exanthema, hypersensitivity syndrome, pigmentary changes, acute generalized exanthematous pustulosis, photosensitivity, and vasculitis. An FDR will occur at the same site because of repeated exposure to the offending agent, causing a corresponding immune reaction. There are many drugs that can cause an FDR, such as analgesics, antibiotics, muscle relaxants, and anticonvulsants. The antibiotic ciprofloxacin has been shown to be a cause of cutaneous adverse drug reactions; however, the fixed drug reaction bullous variant is rare. This case study was published to demonstrate a rare adverse side effect to a commonly used antibiotic in podiatric medicine.
Streptococcus anginosus (SAG) is a known human pathogen and member of the Streptococcus milleri group. SAG is a known bacterial cause of soft-tissue abscesses and bacteremia and is an increasingly prevalent pathogen in infections in patients with cystic fibrosis. We describe a rare case of SAG as an infectious agent in a case of nonclostridial myonecrosis with soft-tissue emphysema. This is the only case found in the literature of SAG cultured as a pure isolate in this type of infection and was associated with a prolonged course of treatment in an otherwise healthy patient.
Recalcitrant Verrucous Lesion
Verrucous Hyperplasia or Epithelioma Cuniculatum (Verrucous Carcinoma)
A 37-year-old woman originally presented in May 2003 with a nonhealing, painless ulcer on the plantar surface of her right foot that had been slowly increasing in size for the previous 1.5 years. Two weeks before presentation, a biopsy of the lesion, performed at another institution, had indicated a probable verrucous carcinoma. After preoperative workup, the patient underwent resection of the lesion, with clear margins and full-thickness skin grafting. The final pathologic findings were not consistent with verrucous carcinoma. A recurrent lesion was noted during a follow-up visit, and a second biopsy revealed a hyperkeratotic papillomatous verrucous lesion, type unclassified. No viral particles were isolated in the random biopsy samples. This recurrent lesion was refractory to treatment with topical acyclovir. Subsequent treatments consisted of imiquimod and CO2 laser ablation, which succeeded in reducing the lesion. Verrucous lesions can be frustrating, and the diagnosis of epithelioma cuniculatum can be difficult to prove. We report a case highly suggestive of but not definitively diagnosed as epithelioma cuniculatum and summarize the literature on this entity. (J Am Podiatr Med Assoc 96(2): 148–153, 2006)
This article reports on a 45-year-old woman who presented with pruritus and was diagnosed as having chigger mite infestation, a rare condition. The chigger mite larvae were encountered while the patient was traveling in South America. A small erythematous area with a well-circumscribed papule in the sulcus of the second digit of the right foot was incised and drained. Follow-up examination showed relief of all symptoms, including pain and pruritus. This unusual case presentation underscores the need for all podiatric physicians to obtain a comprehensive history, including history of travel, along with performing a thorough physical examination. (J Am Podiatr Med Assoc 93(5): 399-401, 2003)
Giant cell tumor of the tendon sheath (GCTTS) in the foot is a rare pathology and is involved in the differential diagnosis of soft-tissue tumors of the foot and ankle. Although it can affect any age group, GCTTS mainly occurs at the 3rd and 5th decade and is more common in females. Histopathologic examination is a major definitive method for diagnosis, although physical examination and radiologic imaging are helpful in reaching a diagnosis preoperatively. Many treatment options exist but marginal excision is the most commonly used treatment. We describe the case of a 26-year-old pregnant woman with a multi-fragmented mass extending from the first web space to the plantar aspect of the metatarsophalangeal joint (MTP) of the left great toe associated with flexor hallucis longus tendon after trauma. She had pain that worsened with activity and wearing shoes. After pregnancy, a marginal excision with dorsal longitudinal incision in the first web space was performed under spinal anesthesia. The lesion was diagnosed as a localized type tenosynovial giant cell tumor. At the last follow-up appointment in the 23rd month, the patient was doing well and there was no recurrence of the lesion. GCSST should be considered in the differential diagnosis of plantar masses of foot. Although, GCTTS is frequently seen in females, it has not been previously reported in a pregnant woman with an extremely rare condition after trauma.
Polyarteritis nodosa is a progressive, often life-threatening, vasculitis affecting multiple organs, including the skin and peripheral nerves. We report a patient presenting with systemic features of the disease and with characteristic lesions in the feet 3 weeks after vaccination against hepatitis B virus infection.
Tenosynovial giant cell tumor, also known as giant cell tumor of the tendon sheath (GCT-TS), is a solitary, nodular, firm, benign, soft-tissue tumor that arises from the synovial lining of a tendon. The etiology is unknown. It is a rare soft-tissue tumor, with an overall incidence of one in 50,000 individuals, and usually affects people aged between 30 and 50 years. Magnetic resonance imaging tends to be the imaging modality of choice, used for surgical preparation. Widely accepted treatment involves local excision with or without radiotherapy. The author presents a case study involving a patient with an abnormally large, longstanding GCT-TS, diagnosed with clinical examination and imaging modalities, surgically excised, and further confirmed by pathology reports. Topic of discussion includes a review of GCT-TS.
Psoriatic Onychopachydermoperiostitis (POPP)
A Perplexing Case Study
The following case of a 37-year-old male describes a very rare form of psoriasis known as psoriatic onychopachydermoperiostitis. There have been fewer than 20 cases reported worldwide. (J Am Podiatr Med Assoc 99(2): 140–143, 2009)
