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  • ISSN: 2373-9819
    Volume 4, Issue 6
    Case Report
    Rikinder Sandhu, Raquel R Garcia, Nitin Bhanot, Thomas L Walsh, and Zaw Min*
    Invasive meningococcal disease is a serious life-threatening infection. Skin rash is present in about half of the patients with meningococcal infection. However it could be easily missed if no thorough cutaneous examination is performed. Herein, we present a patient with invasive meningococcal serogroup B infection with diffuse cutaneous purplish rash and ecchymoses, suggestive of purpura fulminans. Purpura fulminans is a telltale cutaneous manifestation of disseminated meningococcemia, and it is, unfortunately, an ominous late sign of infection. When present, the prognosis is grim with poor salvageable potential. We also describe how meningococcal serogroup B vaccines were introduced to the United States and their current indications of immunization.
    Omar Hina*, Mills Douglas, and Laurie Timothy
    We present a rare case of disseminated blastomycosis dermatitis causing hepatitis in an immunocompromised patient. A 46-year-old woman with history of crohn's disease presents with one week of fever and right upper quadrant pain. She is found to have elevated liver function tests and normal liver and bile duct imaging. In humans, there is no other published case study in the literature of liver involvement on presentation.
    Tan YP *, Cheong WC, Yusoof HM, Zain MM, Lau IS, and Rosman A
    We report a case of dengue myocarditis involving young male athlete with good recovery. A 14 year-old gentleman presented with a 5-day fever with chest discomfort and typical viral fever presentation. His preliminary diagnosis of dengue fever was confirmed via positive non-structural protein-1 and the ensuing polymerase chain reaction (PCR) confirmed dengue virus serotype DEN 1. He had myocarditis manifested by his electrocardiogram which revealed deepening of T inversion from V1 to V4 with notably biphasic T inversion mimicking Wellen's Syndrome. The T inversion resolved as he recovered. The cardiac enzyme troponin T was positive (0.07 µcg/L; normal < 0.03 µcg/L). The echocardiography done showed normal chambers with no regional wall abnormalities. He recovered with only supportive management and intravenous normal saline hydration.
    Prabhakaran Gopalakrishnan*, Smita Subramaniam, Asha Thomas, and Andrey Manov
    Adult onset Still's disease (AOSD) is a rare inflammatory disorder characterized by daily spiking fevers, arthritis and an evanescent rash, typically affecting young adults. We report a case of AOSD complicated by acute respiratory distress syndrome (ARDS). This uncommon presentation of AOSD has been infrequently described in literature.
    A 33 year old Hispanic male presented with recurrent daily fevers, sore throat and lymphadenopathy. Diagnostic evaluation including lymph node biopsy was negative for infectious causes. His clinical course was complicated by acute respiratory distress syndrome. AOSD was diagnosed based on clinical and laboratory findings. Patient was started on steroids and responded well with resolution of his respiratory failure and fever.
    AOSD is a rare febrile disorder primarily affecting young patients with varied presentations. Diagnosis is clinical and could be easily missed unless the evaluating physician is aware of both the typical as well as atypical presentations such as ARDS, as was found in our patient. Delayed diagnosis or misdiagnosis may lead to recurrent and prolonged hospitalizations in addition to costly and potentially harmful diagnostic workup and therapeutic interventions.
    Case Series
    John A. Lee, Jeffrey S. Larson, and Bruce R. Kava*
    Introduction: Pearly penile papules are common, benign lesions that may be a source of concern and embarrassment for many men. Therapeutic options such as electrodessication, shave excision, cryotherapy, and CO2 laser ablation have demonstrated variable degrees of efficacy, and may result in scarring and hypopigmentation. Holmium: YAG lasers are widely available to most urologists, and have operational characteristics that make them safe for treating cutaneous lesions.
    Aim: We herein describe three Caucasian males with extensive pearly penile papules, treated using the Holmum: YAG laser.
    Methods: Following treatment, patients were followed for 8, 13, and 16 months.
    Results: All patients were treated in the outpatient setting, had an uneventful recovery, did not require complex wound care, and did not develop scarring or hypopigmentation. All three patients were satisfied with their results, which proved to be aesthetically flawless.
    Conclusions: Holmium: YAG laser ablation appears to be a safe and effective option for treatment of pearly penile papules in Caucasian men. Further experience is warranted, particularly in men with different skin colors and tones.
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