Mutiple epidermal cysts in a hepatocellular carcinoma patient taking Nexavar

( Seuk Hoon Moon ),( So Min Kim ),( Hyeree Kim ),( Hei Sung Kim ),( Sang Hyun Cho ),( Jeong Deuk Lee ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.1

A 63-year-old male with a history of hepatocellular carcinoma presented with asymptomatic, three, 1.0~1.5cm-sized, erythematous, nodulocystic masses on the anterior and posterior neck for 1 month. The lesions appeared within one to two weeks after taking Nexavar (sorafenib; 400mg twice a day), and the patient denied of having any similar skin lesions before. Histopathologic findings showed marked infiltrations of inflammatory cells in the dermis and a keratin-filled cyst lined by squamous epithelium. Based on the clinical and histopathological findings, a diagnosis of ruptured epidermal cysts was made. Sorafenib is a kinase inhibitor, which works by blocking the action of a protein that signals cancer cells to multiply. To our knowledge, common dermatologic side effects of multikinase inhibitors and EGFR inhibitors are maculopapular eruptions, facial and scalp erythema, acral erythrodysesthesia, hand-foot syndrome, alopecia, subungual splinter hemorrhages, and yellow discoloration of the skin. Rare cases of keratoacanthoma and squamous cell carcinoma associated with sorafenib therapy have been reported. Vijendran et al. (2014) suggested that sorafenib can inhibit c-kit or RAF kinase, which may result in keratinocyte injury or proliferation leading to adverse effect like keratosis pilaris, keratoacanthoma, and possibly epidermal cyst. Herein, we report a rare case of mutiple epidermal cysts in a HCC patient taking Nexavar.

Two cases of injection complication following an illegal practice

( Seuk Hoon Moon ),( Mi So Lee ),( Hei Sung Kim ),( Sang Hyun Cho ),( Jeong Deuk Lee ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.1

Illegal filler injection by non-medical personnel has been increasing resulting in numerous side effects. In the literature, bruising, hypersensitivity reaction, infection, as well as granuloma formation and tissue necrosis have been reported. We herein report two cases of filler complication following an illegal practice by non-medical personnel; one case is the development of calcinosis cutis, and the other case is the fat necrosis at the site of injection. The first was a 52-year-old female presenting with firm subcutaneous nodules on the left pelvic area for 1 year. The patient had had injections on the left pelvic area for abdominal lipolysis 1~2 times/month by non-medical personnel. The histopathologic findings showed calcification in the deep dermis. The patient wasdiagnosed as calcinosis cutis. The other patient was a 77-year-old female presenting with skin-colored firm mass on the right cheek for several years. The patient had injection of an unknown material on the face under illegal settings 30 years ago. The histopathologic findings showed fat necrosis. We assumed that the deep portion of the firm mass was not biopsied accurately and may be a foreign body granuloma. Filler injection is a relatively safe aesthetic procedure, but complications can occur, especially if they are injected under illegal settings. Patients need to better understand the risks of an illegal injection.

The efficacy of micropeel in the treatment of lichen amyloidosis

( Seuk Hoon Moon ),( So Min Kim ),( Mi So Lee ),( Hei Sung Kim ),( Sang Hyun Cho ),( Jeong Deuk Lee ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.1

Lichen amyloidosis (LA) is a primary localized cutaneous amyloidosis without systemic involvement and is characterized by pruritic eruption of multiple discrete hyperkeratotic papules. LA causes great cosmetic concern, but its treatment is extremely difficult. Topical corticosteroids or calcipotriol ointment has been used, but provides a poor result. Systemic etretinate appeared to be helpful in reducing severe itching in some, but not all cases. Various laser therapies have also been attempted for cutaneous amyloidosis, and beneficial clinical and histological responses have been reported. Recent reports showed the successful treatment of LA with fractional ablative yttrium aluminum garnet laser treatment and the CO2 laser. Here we report effectiveness of a micropeel laser therapy in patients with LA. The 24-year-old girl presented with multiple brown papules arranged linearly on both shins since she was 5-years-old. A diagnosis of LA was made by the clinical manifestations and histological findings. The histological findings showed hyperkeratosis with dense deposits of homogeneous material in the papillary dermis. First we treated topical retinoid, vascular laser therapy (V-beam), Q-switched Nd:YAG laser and intense pulsed light without dramatic improvement. The patient then underwent micropeel laser therapy. Despite the oozing, erythema and postinflammatory hyperpigmentation lasting for weeks, the lesions have smoothened.

A case of lupus vulgaris with negative PCR and acid-fast bacilli staining

( Seuk Hoon Moon ),( So Min Kim ),( Dae Hong Kim ),( Hei Sung Kim ),( Jeong Deuk Lee ),( Sang Hyun Cho ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.1

A 72-year-old female patient presented with a 2.0~5.0 cm-sized, irregularly shaped, scaly, pink, firm plaque with well-defined borders on the right mandibular area for 20 years. On diascopy, the infiltrate exhibited a typical apple-jelly appearance. No regional lymphadenopathy was detected. She had no history of tuberculosis. Chest radiography was normal, but the intradermal tuberculin test was positive. Histopathological findings showed lymphohistiocytic infiltration in the superficial dermis and non-necrotizing epitheloid cell granulomas surrounded by lymphocytes in the deep dermis. Acid-fast bacilli (AFB) staining and the polymerase chain reaction (PCR) assay results were negative, but based on the clinical and histopathological findings, a diagnosis of lupus vulgaris was made. A four-drug protocol including isoniazid 5mg/day, rifampin 10mg/day, pyrazinamide 25mg/day, and ethambutol 18mg/kg was started. The cutaneous lesion showed improvement within 6 weeks. Lupus vulgaris is the most common form of cutaneous tuberculosis (CTB). A proper diagnosis of skin tuberculosis requires a good correlation of clinical findings and diagnostic testing, including AFB smears, cultures, PCR and histopathological examination. Our case clearly shows that although the diagnosis of lupus vulgaris is confirmative with AFB staining and PCR, with their low positive rates, the diagnosis is largely based on the clinical and histopathological findings.

Linear porokeratosis superimposed on disseminated superficial porokeratosis

( Seuk Hoon Moon ),( Ki Min Sohn ),( Hei Sung Kim ),( Sang Hyun Cho ),( Jeong Deuk Lee ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.1

Porokeratosis is a group of genetic disease characterized by a clonal proliferation of keratinocytes. To date, 6 different types of porokeratosis have been identified. Disseminated superficial actinic porokeratosis (DSAP) and linear porokeratosis (LP) are included in this group. A 16-year-old female presented with pruritic, multiple, linear and disseminated, annular, brown macules with a peripheral rim arranged on the right lateral side of the upper and lower extremities for 10 years. Histologic findings revealed hyperkeratosis, acanthosis and cornoid lamellae lacking a granular layer, which is suggestive of DSAP. Clinically, some lesions were scattered, and others were arranged on a linear pattern along Blaschko``s lines. With the clinical and histological findings, a diagnosis of linear porokeratosis superimposed on disseminated superficial porokeratosis was made. We attempted treatment with topical tretinoin and Q-switched Nd:YAG laser, but the patient is currently lost for follow up. The coexistence of different forms of porokeratosis in a single person is uncommon, and around 28 cases have been reported so far. Few reports have been made on the association between LP and DSAP. Although several surgical or medical treatments have been tried, none of them have shown consistency and long-term efficacy. Herein, we report an interesting case of linear porokeratosis superimposed on disseminated superficial porokeratosis.

A case of adult-onset urticaria pigmentosa

( Seuk Hoon Moon ),( Hyeree Kim ),( Hei Sung Kim ),( Sang Hyun Cho ),( Jeong Deuk Lee ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.1

Mastocytosis is a neoplastic disease characterized by the accumulation of mast cells in various tissues. Two main variants of the disease are recognized by the WHO: cutaneous mastocytosis and systemic mastocytosis. Cutaneous mastocytosis typically presents as urticaria pigmentosa, and systemic mastocytosis is characterized by neoplastic mast cell infiltrates in extracutaneous tissues like the bone marrow, GI tract, liver, kidney, and central nervous system. Urticaria pigmentosa, the most common skin manifestation of mastocytosis, often presents as erythematous to brownish macules and patches, typically on the trunk usually in childhood. A 27-year-old male presented with asymptomatic, multiple, 0.2~0.5cm-sized, brown macules and papules on the trunk and both upper extremities for several months. He did not show any other symptoms such as hot-flushing, dyspnea, palpitation, gastrointestinal symptoms, and splenomegaly. Laboratory findings were non-specific. Histopathologic findings revealed perivascular and interstitial lymphohistiocytic and mast cell infiltration and increased epithelial melanin pigments. We diagnosed our patient as urticaria pigmentosa and referred him to the hematologic department for systemic evaluation. Herein, we report a rare case of adult-onset urticaria pigmentosa.

Cerebriform nevus sebaceous

( Seuk Hoon Moon ),( Hyeree Kim ),( Hei Sung Kim ),( Sang Hyun Cho ),( Jeong Deuk Lee ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.1

A 12-year-old girl presented with a pruritic, 7.0 cm x 4.0 cm-sized, skin-colored plaque with a cerebriform surface on the scalp since birth. The lesion gradually increased in size. There were no associated skin lesions, signs of asymmetry, deafness, or signs of neurologic dysfunction. Histologic findings revealed papillomatosis, hyperplastic sebaceous glands, and primitive hair follicles without evidence of malignant change. From the clinical and histological findings, a diagnosis of cerebriform nevus sebaceous was made. Nevus sebaceous is an epidermal nevus, a sebaceous harmartoma with an estimated incidence of 0.3% in neonates. It is usually located on the head and neck as a solitary lesion and often presents at birth as a single hairless yellowish plaque with a smoothvelvety surface. Widespread nevus sebaceous may be part of a complex syndrome, known as linear nevus sebaceous syndrome, which encompasses skeletal, ocular, and neurological abnormalities, etc. In such cases, there is a risk of malignant transformation, and regular follow up isnecessary. Wide excision remains the treatment of choice. Cerebriform nevus sebaceous is a rare variant of nevus sebaceous, and only 5 cases have been reported so far. The etiology of the cerebriform nevus sebaceous is still unknown, but treatment and prognosis is thought to be similar with classical nevus sebaceous. Herein, we report a rare case of cerebriform nevus sebaceous.

Renal Dysfunction Induced by Bacterial Infection other than Spontaneous Bacterial Peritonitis in Patients with Cirrhosis: Incidence and Risk Factor

( Jong Hoon Kim ),( June Sung Lee ),( Seuk Hyun Lee ),( Won Ki Bae ),( Nam Hoon Kim ),( Kyung Ah Kim ),( Young Soo Moon ) 대한소화기기능성질환·운동학회 2009 Gut and Liver Vol.3 No.4

Background/Aims: Deterioration of renal function in cirrhotic patients with spontaneous bacterial peritonitis (SBP) is a predictor for in-hospital mortality; however, the clinical significance of renal dysfunction during bacterial infection other than SBP is unknown. The aim of this study was to investigate the prevalence and clinical significance of renal dysfunction due to bacterial infections other than SBP in patients with liver cirrhosis. Methods: Retrospective data from inpatients with bacterial infections other than SBP were analyzed. Results: Eighty patients were recruited for the analysis. The types of infections included that of urinary tract (37.5%), pneumonia (23.8%), biliary tract (20%), cellulitis (12.5%), and bacteremia of unknown origin (6.3%). Renal dysfunction developed in 29 patients (36.3%), of which 11 patients had irreversible renal dysfunction. The initial MELD score, neutrophil count, albumin, and blood pressure were significant risk factors in the univariate analysis, whereas only the MELD score was an independent risk factor for the development of renal dysfunction (p<0.001) after multivariate analysis. Conclusions: The prevalence of renal dysfunction during bacterial infection other than SBP in patients with liver cirrhosis was 36.3%, and its development was related to the severity of the liver disease. Occurrence of irreversible renal dysfunction seemed to affect the prognosis of these patients. (Gut and Liver 2009;3:292-297)

간농양으로 발현한 간의 원발 신경내분비암종 1예

이석현 ( Seuk Hyun Lee ),김경아 ( Kyung Ah Kim ),이준성 ( June Sung Lee ),오동훈 ( Dong Hoon Oh ),배원기 ( Won Ki Bae ),김남훈 ( Nam Hoon Kim ),문영수 ( Young Soo Moon ),김한성 ( Han Seong Kim ) 대한소화기학회 2006 대한소화기학회지 Vol.48 No.4

Primary hepatic neuroendocrine cell carcinoma is a very rare tumor. We experienced a 75-year-old woman with primary hepatic neuroendocrine carcinoma presenting with pyogenic liver abscess. Abdominal CT scan revealed a multiseptated liver abscess and an enlarged lymph node in portocaval portion. We performed percutaneous drainage of the liver abscess, but the amount of drained pus did not decrease after 20 days. The follow-up abdominal CT scan showed that the cystic portion of liver abscess had been replaced by the solid tumor. Microscopic examination of the tumor tissue showed nests of epithelial cells with uniform round hyperchromatic nuclei and high nuclear to cytoplasmic ratio, Immunohistochemical staining was strongly positive for synaptophysin and chromogranin A. (Korean J Gastroenterol 2006;48:277-280)

The Association Between the Serum Sodium Level and the Severity of Complications in Liver Cirrhosis

( Jong Hoon Kim ),( June Sung Lee ),( Seuk Hyun Lee ),( Won Ki Bae ),( Nam Hoon Kim ),( Kyung Ah Kim ),( Young Soo Moon ) 대한내과학회 2009 The Korean Journal of Internal Medicine Vol.24 No.2

Background/Aims: Dilutional hyponatremia associated with liver cirrhosis is caused by impaired free water clearance. Several studies have shown that serum sodium levels correlate with survival in cirrhotic patients. Little is known, however, regarding the relationship between the degree of dilutional hyponatremia and development of cirrhotic complications. The aim of this study was to evaluate the association between the serum sodium level and the severity of complications in liver cirrhosis. Methods: Data of inpatients with cirrhotic complications were collected retrospectively. The serum sodium levels and severity of complications of 188 inpatients were analyzed. Results: The prevalence of dilutional hyponatremia, classified as serum sodium concentrations of ≤135 mmol/L, ≤130 mmol/L, and ≤125 mmol/L, were 20.8%, 14.9%, and 12.2%, respectively. The serum sodium level was strongly associated with the severity of liver function impairment as assessed by Child-Pugh and MELD scores (p<0.0001). Even a mild hyponatremia with a serum sodium concentration of 131-135 mmol/L was associated with severe complications. Sodium levels less than 130 mmol/L indicated the existence of massive ascites (OR, 2.685; CI, 1.316-5.477; p=0.007), grade III or higher hepatic encephalopathy (OR, 5.891; CI, 1.490-23.300; p=0.011), spontaneous bacterial peritonitis (OR, 2.562; CI, 1.162-5.653; p=0.020), and hepatic hydrothorax (OR, 5.723; CI, 1.889-17.336; p=0.002). Conclusions: Hyponatremia, especially serum levels ≤130 mmol/L, may indicate the existence of severe complications associated with liver cirrhosis. (Korean J Intern Med 2009;24:106-112)