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Introduction: Allergic drug reactions represent common clinical challenges. Selected allergic drug reactions present with blisters. Case report: A 73 year old female was prescribed levofloxacin injection and trimethoprim/sulfamethoxazole for a urinary tract infection. Subsequently, the patient developed blisters on both of her hands and feet, associated with clinical pruritus. Clinically, bullae were observed on both of her palms and soles, associated with erythema. Methods: Biopsies for hematoxylin and eosin (H&E) examination, as well as for direct immunofluorescence (DIF) were performed. Results: Focal areas of the epidermis displayed diffuse, mild spongiosis. An acute inflammatory process extended into hair follicular units, with focal rupture of these structures. Focal subepidermal vesiculations were also noted in the areas of follicular unit rupture. DIF examination demonstrated faint linear deposits of anti-human fibrinogen at the basement membrane zone of the skin, as well as around several hair shafts. A similar fibrinogen deposition pattern also present around the upper dermal blood vessels. Conclusions: In our practice experience, the most common cause of blistering diseases are allergic drug reactions, in contradistinction to primary autoimmune blistering disorders. Clinical physicians, pathologists and immunodermatologists should be aware that allergic drug reactions can mimic primary autoimmune blistering disorders, both clinically and in selected immunologic aspects.

A 26 year old pregnant female presented with verrucous lesion on nipple and areola of 10 year duration. Histopathology of lesion was consistent with benign pappiloma, which can occur with various clinical differential dignosis which cause clinical picture of hyperkeratosis of nipple and areola. It can occur as isolated entity which is idiopathic or secondary to various causes like epidermal nevus, seborrhoic keratosis, eczema, icthyosis or acanthosis nigricans. Lesion may increase in size in pregnancy and may cause worry to patient regarding nursing the babies in our case. Lesions was removed by radiofrequency cautery. Streszczenie 26-letnia kobieta w ciązy prezentowala brodawkujące zmiany na brodawce sutka i otoczce trwające 10 lat. Histopatologia zmiany byla zgodna z lagodną brodawką, ktora moze sluzyc do diagnostyki roznicowej roznych obrazow klinicznych o charakterze hiperkeratozy na brodawkach i otoczkach sutka. Moze ona wystepowac jako pojedyncza jednostka, ktora jest idiopatyczna lub wtorna z roznych przyczyn, takich jak znamie naskorkowe, rogowacenie lojotokowe, wyprysk, icthyosis lub rogowacenie ciemne. Zmiana moze zwiekszyc rozmiar w ciązy i moze sprawiac zaklopotanie pacjenta w zakresie opieki nad niemowleciem, tak jak w naszym przypadku. Zmiany zostaly usuniete przez przeskorne przyzeganie.

Introduction: Eosinophils are multifunctional cells that play a characteristic role in various diseases of allergic and infective etiology. Eosinophils play an important role in immunity hence eosinophilia occurs in various diseases of skin and systemic allergic disorders. Materials and Methods: One hundred patients admitted to the Dermatology ward with absolute eosinophil count (AEC) above 500 cells per cubic millimeter were included in the study. Detailed history, including, drug history, travel history, history of atopy, and insect bites, was taken. A complete hemogram, stool examination, chest x-ray, and serological test were done to rule out eosinophilia due to other causes. Results: In our study, most of the patients (40%) were between the age group of 40 and 60 years. Fifty-six percent were male patients. Most of the patients (98%) fell in the category of mild-to-moderate eosinophilia. Marked eosinophilia was seen in only 2%. Most common skin conditions were chronic urticaria (28%) followed by generalized pruritus (16%), eczema (10%), drug reaction (10%), psoriasis (7%), bullous diseases (6%), palmoplantar keratoderma (4%), and HIV (4%). Malignancy was seen in 2%. Other conditions constituted 13%. Out of all these, 12% had stool examination positive for ova and cysts. Histopathological examination was done in 22 patients, 12 of whom showed tissue eosinophilia. Conclusion: Peripheral blood eosinophilia and/or infiltration of skin by eosinophils occur in various skin diseases. Coexisting parasitic infestations may be a predominant contributing factor for eosinophilia in tropical countries.