The Dermatologist’s Board Review - March

The contents of these questions are taken from the Galderma Pre-Board Webinar. The Pre-Board Webinar is now an online course. For details, go to www.pre-board.com. The program will be available from April 15, 2016 to November 15, 2016.

1. The most helpful histochemical stain to confirm the diagnosis is: 

3. This condition occurs with increased frequency in HIV-positive patients treated with which antiretroviral drug? 

4. This organism was found in a peripheral blood specimen taken at night from a man with recurrent attacks of lymphangitis associated with lymphedema. The vector is the:

BOARD REVIEW ANSWERS:

1. DERMATOFIBROSARCOMA PROTUBERANS 

The most helpful histochemical stain to confirm the diagnosis is: 

b) CD34

Staining for CD34 (human progenitor cell antigen) suggests the diagnosis of dermatofibrosarcoma protuberans, while staining for factor XIIIa favors benign dermatofibroma. Other characteristic staining patterns include:

• Synaptophysin—Merkel cell tumor • HMB-45—activated melanocytes
• IL-2 receptor—activated T cells

Clarke LE. Fibrous and fibrohistiocytic neoplasms: an update. Dermatol Clin. 2012;30(4):643-656.
Bandarchi B, Ma L, Marginean C, Hafezi S, Zubovits J, Ratsy G. D2-40, a novel immuohistochemical marker in differentiating dermatofibroma from dermatofibrosarcoma protu- berans. Mod Pathol. 2010;23(3):434-438. 

2. LUPUS ANTICOAGULANT SYNDROME 

This patient with systemic lupus erythematosus suffers from recurrent deep venous thromboses, cutaneous infarcts, and cerebro- vascular accidents. The antibody system most directly related to this problem is:

e) Anticardiolipin (antiphospholipid) antibodies 

This condition, which is not restricted to patients with lupus erythematosus, includes a high rate of miscarriage among its complications.The lupus anticoagulant is an immunoglobulin, which interferes with phospholipid dependent coagulation tests; thus, the detection of an- tiphospholipid antibodies is diagnostic. Because cardiolipin is the principle antigen of the VDRL reagent, patients with the lupus anticoagulant may have a false-positive VDRL test.

Reference

Mazodier K,Arnaud L, Mathian A, et al. Lupus anticoagulant-hypoprothrombinemia syndrome: report of 8 cases and review of the literature. Medicine (Baltimore). 2012;91(5):251-260. 

3. HERPES ZOSTER 

This condition occurs with increased frequency in HIV-positive patients treated with which antiretroviral drug? 

e) Indinavir 

The increased incidence of herpes zoster observed after initiation of protease in- hibitor therapy may result from a disproportionate increase in CD8+ cells early in the course of treatment.

References

Nacher M, Basurko C, Adenis A, et al. Predictive factors of herpes zoster HIV-infected patients: another adverse effect of crack cocaine. PLoS One. 2013;8(11):e80187.
Song JY, Lee JS, Jung HW, et al. Herpes zoster among HIV-infected patients in the highly active antiretroviral therapy era: Korean HIV cohort study. J Acquir Immune Defic Syndr. 2010;53(3):417-418. 

4. FILARIASIS

This organism was found in a peripheral blood specimen taken at night from a man with recurrent attacks of lymphangitis associated with lymphedema. The vector is the:

a) Mosquito (genus Culex) (filariasis)

The causative agent, Wuchereria bancrofti, is transmitted most often by the bite of the mosquito, Culex fatigans.The diseases associated with other vectors are also shown. n

Reference

Molyneux DH.Tropical lymphedemas—control and prevention. N Engl J Med. 2012;366(13):1169-1171. 

Bruce Thiers, MD, FAAD, is a professor with the Department of Dermatology and Dermatologic Surgery at the Medical University of South Carolina in Charleston, SC.

The contents of these questions are taken from the Galderma Pre-Board Webinar. The Pre-Board Webinar is now an online course. For details, go to www.pre-board.com. The program will be available from April 15, 2016 to November 15, 2016.

1. The most helpful histochemical stain to confirm the diagnosis is: 

3. This condition occurs with increased frequency in HIV-positive patients treated with which antiretroviral drug? 

4. This organism was found in a peripheral blood specimen taken at night from a man with recurrent attacks of lymphangitis associated with lymphedema. The vector is the:

The contents of these questions are taken from the Galderma Pre-Board Webinar. The Pre-Board Webinar is now an online course. For details, go to www.pre-board.com. The program will be available from April 15, 2016 to November 15, 2016.

1. The most helpful histochemical stain to confirm the diagnosis is: 

3. This condition occurs with increased frequency in HIV-positive patients treated with which antiretroviral drug? 

4. This organism was found in a peripheral blood specimen taken at night from a man with recurrent attacks of lymphangitis associated with lymphedema. The vector is the:

BOARD REVIEW ANSWERS:

1. DERMATOFIBROSARCOMA PROTUBERANS 

The most helpful histochemical stain to confirm the diagnosis is: 

b) CD34

Staining for CD34 (human progenitor cell antigen) suggests the diagnosis of dermatofibrosarcoma protuberans, while staining for factor XIIIa favors benign dermatofibroma. Other characteristic staining patterns include:

• Synaptophysin—Merkel cell tumor • HMB-45—activated melanocytes
• IL-2 receptor—activated T cells

Clarke LE. Fibrous and fibrohistiocytic neoplasms: an update. Dermatol Clin. 2012;30(4):643-656.
Bandarchi B, Ma L, Marginean C, Hafezi S, Zubovits J, Ratsy G. D2-40, a novel immuohistochemical marker in differentiating dermatofibroma from dermatofibrosarcoma protu- berans. Mod Pathol. 2010;23(3):434-438. 

2. LUPUS ANTICOAGULANT SYNDROME 

This patient with systemic lupus erythematosus suffers from recurrent deep venous thromboses, cutaneous infarcts, and cerebro- vascular accidents. The antibody system most directly related to this problem is:

e) Anticardiolipin (antiphospholipid) antibodies 

This condition, which is not restricted to patients with lupus erythematosus, includes a high rate of miscarriage among its complications.The lupus anticoagulant is an immunoglobulin, which interferes with phospholipid dependent coagulation tests; thus, the detection of an- tiphospholipid antibodies is diagnostic. Because cardiolipin is the principle antigen of the VDRL reagent, patients with the lupus anticoagulant may have a false-positive VDRL test.

Reference

Mazodier K,Arnaud L, Mathian A, et al. Lupus anticoagulant-hypoprothrombinemia syndrome: report of 8 cases and review of the literature. Medicine (Baltimore). 2012;91(5):251-260. 

3. HERPES ZOSTER 

This condition occurs with increased frequency in HIV-positive patients treated with which antiretroviral drug? 

e) Indinavir 

The increased incidence of herpes zoster observed after initiation of protease in- hibitor therapy may result from a disproportionate increase in CD8+ cells early in the course of treatment.

References

Nacher M, Basurko C, Adenis A, et al. Predictive factors of herpes zoster HIV-infected patients: another adverse effect of crack cocaine. PLoS One. 2013;8(11):e80187.
Song JY, Lee JS, Jung HW, et al. Herpes zoster among HIV-infected patients in the highly active antiretroviral therapy era: Korean HIV cohort study. J Acquir Immune Defic Syndr. 2010;53(3):417-418. 

4. FILARIASIS

This organism was found in a peripheral blood specimen taken at night from a man with recurrent attacks of lymphangitis associated with lymphedema. The vector is the:

a) Mosquito (genus Culex) (filariasis)

The causative agent, Wuchereria bancrofti, is transmitted most often by the bite of the mosquito, Culex fatigans.The diseases associated with other vectors are also shown. n

Reference

Molyneux DH.Tropical lymphedemas—control and prevention. N Engl J Med. 2012;366(13):1169-1171. 

Bruce Thiers, MD, FAAD, is a professor with the Department of Dermatology and Dermatologic Surgery at the Medical University of South Carolina in Charleston, SC.

BOARD REVIEW ANSWERS:

1. DERMATOFIBROSARCOMA PROTUBERANS 

The most helpful histochemical stain to confirm the diagnosis is: 

b) CD34

Staining for CD34 (human progenitor cell antigen) suggests the diagnosis of dermatofibrosarcoma protuberans, while staining for factor XIIIa favors benign dermatofibroma. Other characteristic staining patterns include:

• Synaptophysin—Merkel cell tumor • HMB-45—activated melanocytes
• IL-2 receptor—activated T cells

Clarke LE. Fibrous and fibrohistiocytic neoplasms: an update. Dermatol Clin. 2012;30(4):643-656.
Bandarchi B, Ma L, Marginean C, Hafezi S, Zubovits J, Ratsy G. D2-40, a novel immuohistochemical marker in differentiating dermatofibroma from dermatofibrosarcoma protu- berans. Mod Pathol. 2010;23(3):434-438. 

2. LUPUS ANTICOAGULANT SYNDROME 

This patient with systemic lupus erythematosus suffers from recurrent deep venous thromboses, cutaneous infarcts, and cerebro- vascular accidents. The antibody system most directly related to this problem is:

e) Anticardiolipin (antiphospholipid) antibodies 

This condition, which is not restricted to patients with lupus erythematosus, includes a high rate of miscarriage among its complications.The lupus anticoagulant is an immunoglobulin, which interferes with phospholipid dependent coagulation tests; thus, the detection of an- tiphospholipid antibodies is diagnostic. Because cardiolipin is the principle antigen of the VDRL reagent, patients with the lupus anticoagulant may have a false-positive VDRL test.

Reference

Mazodier K,Arnaud L, Mathian A, et al. Lupus anticoagulant-hypoprothrombinemia syndrome: report of 8 cases and review of the literature. Medicine (Baltimore). 2012;91(5):251-260. 

3. HERPES ZOSTER 

This condition occurs with increased frequency in HIV-positive patients treated with which antiretroviral drug? 

e) Indinavir 

The increased incidence of herpes zoster observed after initiation of protease in- hibitor therapy may result from a disproportionate increase in CD8+ cells early in the course of treatment.

References

Nacher M, Basurko C, Adenis A, et al. Predictive factors of herpes zoster HIV-infected patients: another adverse effect of crack cocaine. PLoS One. 2013;8(11):e80187.
Song JY, Lee JS, Jung HW, et al. Herpes zoster among HIV-infected patients in the highly active antiretroviral therapy era: Korean HIV cohort study. J Acquir Immune Defic Syndr. 2010;53(3):417-418. 

4. FILARIASIS

This organism was found in a peripheral blood specimen taken at night from a man with recurrent attacks of lymphangitis associated with lymphedema. The vector is the:

a) Mosquito (genus Culex) (filariasis)

The causative agent, Wuchereria bancrofti, is transmitted most often by the bite of the mosquito, Culex fatigans.The diseases associated with other vectors are also shown. n

Reference

Molyneux DH.Tropical lymphedemas—control and prevention. N Engl J Med. 2012;366(13):1169-1171. 

Bruce Thiers, MD, FAAD, is a professor with the Department of Dermatology and Dermatologic Surgery at the Medical University of South Carolina in Charleston, SC.