Search

Emergent pathogen as Purpureocillium lilacinum are becoming cause of morbidity and mortality in our population, especially in immunocompromised patients. We describe a case of hyalohyphomycosis in a diabetic man under systemic steroid treatment for a bullous pemphigoid. Treatment with different antimycotic drugs were ineffective and infection spread diffusely, leading to deterioration of general conditions and ultimately death. The aim of this article is to increase awareness of clinicians about this uncommon, but frequently fatal refractory mycotic infection.

Objective: Lamotrigine is a new generation anticonvulsant, also used in bipolar type 1 disorders to prevent occurrence of mood episodes not responding to traditional antidepressant, which is an increasing indication worldwide. Skin adverse events occur in 5-10% of patients, but are usually mild and self-limiting. The occurrence of drug-induced lupus erythematosus is an uncommon, but severe condition, usually requiring discontinuation of the drug. Methods: A spontaneous pharmacovigilance case reporting is presented, following the causality assessment criteria, including temporal association with drug exposure, exclusion of other etiologies, dechallenge and rechallenge. Skin biopsy for normal histopathology and direct immunofluorescence was performed to assess the diagnosis of lupus erythematosus. Results: A 77 years old woman was hospitalized in the Dermatology Clinic of Cagliari University for a lamotrigine Induced Subacute Cutaneous Lupus Erythematosus, confirmed by improvement after drug dismission, and immediate recurrence at re-exposure. The last measure was performed on request of the neurologist with the consent of the patient, because of a high suicidal risk, not responding to traditional antidepressants, and well controlled by lamotrigine. Another peculiarity of our observation is a potential dose-related effects, as the patients was assuming lamotrigine from 2 years, and skin manifestations actually began 3 weeks after the dosage was doubled to 100 mg daily. Conclusion: If confirmed by other observation, drug-induced subacute cutaneous lupus erythematosus might be dose-dependent, and careful clinician’s dosage monitoring might prevent occurrence, preserving the lamotrigine use for the many patients who need it. Dermatologist referral is warrant in front of any suspect cutaneous adverse reaction due to psychotropic medications, to provide prompt recognition, adequate assessment and supportive management of such difficult and delicate patients.

Nivolumab is a monoclonal antibody, belonging to the checkpoint inhibitors, recently approved for treatment of recurrent or metastatic non-small cell lung cancer, melanoma, and renal cell carcinoma. Although very efficacious, oncologic immunotherapy is associated with a new spectrum of dermatological adverse events, and spontaneous reporting is advisable to define presentation, prognosis and real-life management. In particular, development of bullous pemphigoid (BP), characterized by pathologic autoantibody formation and complement deposition in the skin. is a rare, but severe event, potentially life-threatening, which requires high doses corticosteroids, or even more aggressive immunosuppression. We describe a 73-year-old Caucasian man, under nivolumab therapy for metastatic renal carcinoma, with 2-month-history of a bullous itching eruption on the trunk and arms, rapidly responding to standard corticosteroids treatment and nivolumab dismission, supporting the decision to taper and completely interrupt steroids. Unfortunately, 3 weeks after complete steroidal washout, the itching bullous eruption relapsed, confirming that the autoimmune disease, once aroused by the drug-induced immune unbalance, has a clinical course superimposable to the idiopathic disease. Prompt referral to the dermatologist is advisable in patients under oncologic immunotherapy, developing pruritus and skin eruptions to address the correct diagnostic workup and management.

Scalp/neck melanomas have a poor prognosis, possibly because of a rich vascular supply that prompts tumor cells' dissemination. METHODS: We compared the accuracy of immunohistochemical (IHC) staining with morphology for the identification of lymphovascular invasion in 156 scalp/neck melanomas. We then analyzed the association of vessel invasion and density with pathological features and survival. RESULTS: IHC-detected lymphatic vessel invasion (LVI) and blood vessel invasion (BVI) were identified in 34.6% and 13.5% of cases, respectively. IHC increased the LVI/BVI detection compared to morphology (40.4% vs 16.6%; p

One-phase, one-pot synthesis of Ag0 nanoparticles capped with alkanethiolate molecules has been optimized to easily achieve a pure product in quantitative yield. We report the synthesis of dodecanethiolate-capped silver particles and the chemophysical, structural, and morphologic characterization performed by way of UV−vis, 1H NMR, and X-ray photoelectron (XPS) spectroscopies, X-ray powder diffraction (XRD) and X-ray absorption fine structure analysis (XFAS), electron diffraction and high-resolution transmission electron microscopy (HR-TEM), and scanning and transmission electron microscopy (SEM and TEM). Depending on the molar ratio of the reagents (dodecylthiosulphate/Ag+), the mean Ag0 particle size DXRD is tuned from 4 to 3 nm with a narrow size distribution. The particles are highly soluble, very stable in organic solvents (hexane, toluene, dichloromethane, etc.), and resistant to oxidation; the hexane solution after one year at room temperature does not show any precipitation or formation of oxidation byproducts.