tbuckley/cabot-search huggingface dataset:
DP08 Striking post COVID-19 vaccine aseptic pustular folliculitis, a follicular variant of acute generalized exanthematous pustulosis
Authors: Nikesh Patel, Natalie King-Stokes, Jonathan Carter, Richard Carr
Journal: British Journal of Dermatology (2024)

Abstract This case report documents the unique presentation of a 46-year-old woman who developed a widespread follicular pustular rash, prominently affecting her face, neck, upper chest and back, merely 4 days after receiving the Pfizer–BioNTech COVID-19 vaccine. Laboratory investigations revealed an elevated neutrophil count of 10.6 × 109 L−1 and an increased C-reactive protein level of 96 mg L−1. A skin biopsy showed a striking neutrophilic pustular folliculitis, characterized by the absence of viral inclusions and the presence of neutrophil exocytosis in the adjacent epidermis. A diagnosis of a follicular pustular variant of acute generalized exanthematous pustulosis was proposed. In response to the diagnosis, the patient was initiated on a therapeutic regimen, including prednisolone at 30 mg and topical applications of clobetasol propionate for her body and fusidic acid–betamethasone valerate for her face. The treatment approach aimed at alleviating the inflammatory response associated with the neutrophilic infiltration observed in the skin biopsy. The patient exhibited a slow yet progressive improvement in her rash, which transitioned from a pustular to a nonpustular presentation. This case contributes to the growing body of evidence regarding cutaneous manifestations following COVID-19 vaccination. The association between the patient’s symptoms and the Pfizer–BioNTech vaccine suggests a potential link, emphasizing the importance of vigilance in monitoring adverse events postvaccination. While the specific mechanisms underlying such reactions remain unclear, the prompt initiation of corticosteroid therapy, as demonstrated in this case, appears effective in managing the inflammatory cutaneous manifestations. The patient’s positive response to treatment underscores the clinical significance of recognizing and promptly addressing these rare dermatological side-effects associated with COVID-19 vaccination. In conclusion, this case report sheds light on a distinctive presentation of neutrophilic pustular folliculitis following COVID-19 vaccination, highlighting the importance of dermatological vigilance in the ongoing global vaccination efforts. Further research is warranted to elucidate the underlying pathophysiological mechanisms and establish optimal management strategies for these rare cutaneous reactions.
CPC07 Occupational cutaneous larva migrans presenting as diffuse folliculitis with concurrent helminthiasis
Authors: Kellen Beck-Sander, Alice Coulton, Joanna Cooke, Hywel Cooper
Journal: British Journal of Dermatology (2024)

Abstract Cutaneous larva migrans (CLM) occurs following human skin contact with the larvae of animal hookworms, including the dog hookworm Ancylostoma caninum. To date, these hookworms cannot complete their life cycle in humans. The condition is mostly seen in the tropics or subtropics or in returning travellers; however, cases following local exposure to animal hookworms have been identified. Less than 5% of cases of CLM reported in the literature present as folliculitis. Strongyloidiasis is caused by infection with the soil-transmitted roundworm Strongyloides stercoralis and is seen in areas of poor sanitation. It can complete its life cycle within the human host, and infection can persist asymptomatically for decades. Toxocariasis is infection caused by the larvae of the dog or cat Toxocara spp. roundworm. Human infection occurs through ingestion of eggs, but these roundworms do not complete their life cycle in humans. Infection can be subclinical or present as visceral or ocular larva migrans. A 62-year-old man was admitted to hospital with an un­usual rash and significant metabolic derangement. He had a 4-week history of a diffuse, pruritic, erythematous, papulonodular rash extending from his flanks to his thighs with florid pustular areas on examination. He had no pre-existing medical conditions and denied sexual contact or foreign travel for over a decade. He worked as a cleaner in a large governmental organization with regular exposure to human and animal excrement, although he reported adequate personal protective equipment. Laboratory results revealed a new diagnosis of type 2 diabetes and eosinophils of 0.1 × 109 L−1, and blood culture grew multiple gastrointestinal bacteria. A skin biopsy demonstrated purulent folliculitis, abundant eosinophil infiltration, and multiple rhabditiform larvae within dilated and ruptured follicles. Slides were sent for specialist opinion, and filiform larvae with the characteristic double lateral alae of Ancylostoma spp. were identified. Given the patient’s occupational exposure, the findings were deemed to be compatible with CLM caused by the dog hookworm, A. caninum. Serology also revealed weak-positive Strongyloides, and positive Toxocara antibodies, although two faecal samples were negative for helminths. The patient was treated with a one-off dose of ivermectin and a 7-day course of albendazole. This is a highly unusual case of CLM presenting as fulminant folliculitis secondary to A. caninum, in the absence of foreign travel, and likely contracted through occupational exposure. The possible coinfection with S. stercoralis and Toxocara canis prompts discussion of the transmission, life cycle, diagnostic testing and management of all three helminths.
DS23 Evaluation of American Joint Committee on Cancer and alternative tumour classification systems for primary penile squamous cell carcinoma
Authors: Katie O’Connell, Jacob Thomas, Fadi Murad, Guru Sonpavde, Matthew Mossanen, Timothy Clinton, Antonio Ji- Xu, Phillippe Spiess, Anthony Rossi, Chrysalyne Schmults
Journal: British Journal of Dermatology (2024)

Abstract Survivorship overlap exists among patients classified according to the American Joint Committee on Cancer (AJCC) 8th edition tumour (T) staging system for penile squamous cell carcinoma (PSCC). At present, the AJCC 8th edition guidelines for PSCC stratify T1 tumours by the presence or absence of perineural invasion (PNI) and lymphovascular invasion, and the degree of differentiation. T2 and T3 tumours are stratified based on the anatomical depth of invasion into the corporal structures, with T4 tumours invading into the scrotum, prostate or pubic bone. This study evaluates the current performance of PSCC AJCC T staging and compares it to an alternative. Different combinations of tumour risk factors were evaluated in terms of distinctiveness (prognostic groupings without overlapping confidence intervals) to determine a new system with the best risk stratification. These characteristics have been set forth by the AJCC to describe the ideal staging system. An alternative staging system was developed from a previously published cohort of 265 patients with PSCC. Tumours were staged via the alternative and AJCC T staging systems. Predictions of metastasis and disease-specific death (DSD) were compared. The alternative and AJCC systems were compared regarding distinctiveness, homogeneity and monotonicity. Three independent predictors of poor outcomes were included in the alternative PSCC T staging system: PNI, poor differentiation, and invasion into corporal structures. In the alternative system, T1 represents 0 risk factors (RF), T2 is 1 RF, T3 is 2 RF, and T4 is 3 RF. The alternative system was superior to AJCC staging in detecting tumours at risk for metastasis (C-statistic: alternative 67% vs. AJCC 63%) and DSD (C-statistic: alternative 74% vs. AJCC 72%). Homogeneity and monotonicity were similar. For alternative T1 disease, the 5-year cumulative incidence of metastasis was 9% and risk of death 5%. The risk of metastasis climbed to 24%, 42% and 74% for alternative T2, T3 and T4 cases, respectively, and 21%, 33% and 60% for DSD. The alternative PSCC T staging system appears to have superior distinctiveness. External validation of the alternative staging system against the AJCC stage should be undertaken. Alternative T1 N0 disease may benefit from nodal staging given the 9% risk of metastasis. Alternative T2/T3/T4 N0 PSCC carries a significant risk of metastasis and death and merits further study for optimal management.
DS25 Complications after skin surgery
Authors: Rubiana Sarto, Anitha Balagopalan, Saadia Naseem, Josephine Sanapala, Emma Pynn
Journal: British Journal of Dermatology (2024)

Abstract Dermatological surgery is associated with a low incidence of postprocedural complications (Amici JM, Rogues AM, Lasheras A et al. A prospective study of the incidence of complications associated with dermatological surgery. Br J Dermatol 2005; 153: 967–71). However, they can have a significant impact on healing, patient experience and cosmetic outcome. Our aim was to assess our incidence of postprocedural complications and to review associated risk factors, potentially enabling us to improve clinical practice and patient outcomes. Over a 2-week period in December 2023, all patients undergoing excision with primary closure, at any surgical site, were invited to take part. Twelve operators across three outpatient locations recorded operative details and gave out information sheets. Patients were surveyed 2 weeks after surgery through an online form or by phone regarding bleeding, antibiotic requirement, dehiscence and other issues. Case records were reviewed to obtain demographics and details of medications. In total 78 patients agreed to participate, of whom 70 responded to the survey: 71% were above 65 years old, and 51% were male. Thirteen patients (19%) reported postprocedural complications, most of whom (77%) were above the age of 65 years. The face was the most frequent site (38%). Bleeding was the most common complication, seen in seven participants (10%); only one was anticoagulated and four were treated for postoperative infection, which may have been the primary issue. Two experienced slight bleeding, whereas five (7%) needed further medical input. Five (71% of those with a bleed) had a recorded history of increased alcohol consumption, compared with 14% of those who did not bleed. Fifteen patients (21%) received prophylactic antibiotics, and five different individuals (7%) required postprocedural antibiotics in the community. Interestingly, four of these five (80%) reported concurrent bleeding. Dehiscence was described by five patients (7%), 23% of whom were smokers. Six patients were recorded as having ulcerated lesions, four of whom were given prophylactic antibiotics; of the other two, one developed dehiscence and one infection. Our study identified bleeding as the most common postprocedural complication, with significant events in 7%. The most frequent documented risk factor was not anticoagulation as expected but alcohol intake; however, high use of antibiotics in this group suggests association with or primary diagnosis of infection. Limited by our relatively small sample size, we would like to expand this study to a larger group to further explore the clinical significance of these risk factors. We advocate continuing to educate patients regarding risk of bleeding postprocedure, with awareness of the potential effect of alcohol.
DP16 Nicolau syndrome (embolia cutis medicamentosa) due to glatiramer acetate (Copaxone) injection: a case report
Authors: Sadaf Mukhtar, Sahrish Rashid, Rand Hawari
Journal: British Journal of Dermatology (2024)

Abstract Nicolau syndrome (NS) is a rare cutaneous drug reaction that occurs at the site of an intramuscular drug or intra-articular injection. NS has been reported with the administration of various other drugs such as penicillins {Modzelewska I, Dawidowicz-Szczepanowska A. [Nicolau syndrome following administration of procaine penicillin]. Wiad Lek 1980; 33: 231–3 (in Polish)}, local anaesthetics, corticosteroids (Cherasse A, Kahn MF, Mistrih R et al. Nicolau’s syndrome after local glucocorticoid injection. Joint Bone Spine 2003; 70: 390–2) and nonsteroidal anti-inflammatory drugs. Patients experience extremely severe pain around the injection site of the drug immediately after injection, followed by rapid development of erythema, a livedoid reticular patch or a haemorrhagic patch. It may result in necrosis and ulceration of the skin. We report the case of 50-year-old woman who presented with areas of skin discoloration over her left axilla and left arm after an injection of Copaxone (glatiramer acetate) for her multiple sclerosis. It was painful and swollen. She has a past medical history of multiple sclerosis, epilepsy and an underactive thyroid. She has been on glatiramer acetate injections for multiple sclerosis for more than 3 years but has never had any reaction. Drug history included glatiramer acetate, levothyroxine, pregabalin, udenafil, propranolol, levetiracetam and docusate. There was no known drug allergy. She was seen by an on-call dermatologist. On examination there were bruise-like patches on her left lateral arm and left axilla, with some livedoid pattern. Bloods and medical photographs were taken. Incisional biopsy was done. On review after a few days, the swelling had decreased but the skin discoloration persisted and the skin was tender. Skin bacteriology swab was taken. Blood showed a slightly deranged clotting profile and raised creatinine kinase. Autoimmune screen was negative. Skin biopsy showed necrosis of the squamous epithelium, fibrinoid thrombi in superficial and mid-dermal blood vessels, and occasional eosinophils. This was suggestive of NS. Over time the rash evolved into indurated ulcerated plaques with a necrotic surface. Oral doxycycline 100 mg once daily was started, as a swab showed a heavy growth of Staphylococcus aureus. Glatiramer acetate injection was discontinued. She was treated with AQUACEL (silver-containing) dressing, clobetasol propionate cream for the surrounding skin, and surgical debridement. The skin healed completely within 20 weeks with scarring. NS is an important cause for morbidity and also of mortality in severe cases. There is no specific therapy. Conservative treatment with debridement, pain control and dressings are the mainstays of therapy. This case highlights the need for awareness about this rare condition.
Disitamab vedotin, a HER2‐directed antibody‐drug conjugate, in patients with HER2‐overexpression and HER2‐low advanced breast cancer: a phase I/Ib study
Authors: Jiayu Wang, Yunjiang Liu, Qingyuan Zhang, Wei Li, Jifeng Feng, Xiaojia Wang, Jianmin Fang, Yiqun Han, Binghe Xu
Journal: Cancer Communications (2024)

Abstract Background Disitamab vedotin (DV; RC48‐ADC) is an antibody‐drug conjugate comprising a human epidermal growth factor receptor 2 (HER2)‐directed antibody, linker and monomethyl auristatin E. Preclinical studies have shown that DV demonstrated potent antitumor activity in preclinical models of breast, gastric, and ovarian cancers with different levels of HER2 expression. In this pooled analysis, we report the safety and efficacy of DV in patients with HER2‐overexpression and HER2‐low advanced breast cancer (ABC). Methods In the phase I dose‐escalation study (C001 CANCER), HER2‐overexpression ABC patients received DV at doses of 0.5‐2.5 mg/kg once every two weeks (Q2W) until unacceptable toxicity or progressive disease. The dose range, safety, and pharmacokinetics (PK) were determined. The phase Ib dose‐range and expansion study (C003 CANCER) enrolled two cohorts: HER2‐overexpression ABC patients receiving DV at doses of 1.5‐2.5 mg/kg Q2W, with the recommended phase 2 dose (RP2D) determined, and HER2‐low ABC patients receiving DV at doses of 2.0 mg/kg Q2W to explore the efficacy and safety of DV in HER2‐low ABC. Results Twenty‐four patients with HER2‐overexpression ABC in C001 CANCER, 46 patients with HER2‐overexpression ABC and 66 patients with HER2‐low ABC in C003 CANCER were enrolled. At 2.0 mg/kg RP2D Q2W, the confirmed objective response rates were 42.9% (9/21; 95% confidence interval [CI]: 21.8%‐66.0%) and 33.3% (22/66; 95% CI: 22.2%‐46.0%), with median progression‐free survival (PFS) of 5.7 months (95% CI: 5.3‐8.4 months) and 5.1 months (95% CI: 4.1‐6.6 months) for HER2‐overexpression and HER2‐low ABC, respectively. Common (≥5%) grade 3 or higher treatment‐emergent adverse events included neutrophil count decreased (17.6%), gamma‐glutamyl transferase increased (13.2%), asthenia (11.0%), white blood cell count decreased (9.6%), peripheral neuropathy such as hypoesthesia (5.9%) and neurotoxicity (0.7%), and pain (5.9%). Conclusion DV demonstrated promising efficacy in HER2‐overexpression and HER2‐low ABC, with a favorable safety profile at 2.0 mg/kg Q2W.
Integrated care pathway for occupational pulmonary diseases
Authors: J. P. M. (Hanna) van der Valk, L. A. A. (Heleen) den Besten, T. H. (Tjerk) Hylkema, J. S. (Jaring) van der Zee, S. F. M. (Suzan) Nijman, L. M. (Leon) Van den Toorn, G. J. (Gert‐Jan) Braunstahl, J. C. C. M. (Johannes) in ’t Veen, P. (Peter) van Balen, J. J. (Jaap) Maas, R. H. A. (Roel) Wennekes, G. J. (Gerda) de Groene, J. H. (Jasper) Kappen
Journal: Allergy (2024)

Data sharing not applicable to this article as no datasets were generated or analysed during the current study.
Waitlist Outcomes for Pediatric Heart Transplantation in the Current Era: An Analysis of the Pediatric Heart Transplant Society Database
Authors: Ryan J. Butts, Leah Toombs, James K. Kirklin, Kurt R. Schumacher, Jennifer Conway, Shawn C. West, Scott Auerbach, Neha Bansal, Hong Zhao, Ryan S. Cantor, Deipanjan Nandi, David M. Peng
Journal: Circulation (2024)

Waitlist mortality (WM) remains elevated in pediatric heart transplantation. Allocation policy is a potential tool to help improve WM. This study aims to identify patients at highest risk for WM to potentially inform future allocation policy changes.
Association of Atrial Fibrillation Burden and Mortality Among Patients With Cardiac Implantable Electronic Devices
Authors: Graham Peigh, Jiani Zhou, Sarah C. Rosemas, Anthony I. Roberts, Colleen Longacre, Katherine Trinh, Tanvi Nayak, Dana Soderlund, Rod S. Passman
Journal: Circulation (2024)

Current estimates of atrial fibrillation (AF)-associated mortality rely on claims- or clinical-derived diagnoses of AF, limit AF to a binary entity, or are confounded by comorbidities. The objective of the present study is to assess the association between device-recognized AF and mortality among patients with cardiac implantable electronic devices capable of sensitive and continuous atrial arrhythmia detection. Secondary outcomes include relative mortality among cohorts with no AF, paroxysmal AF, persistent AF, and permanent AF. Using the deidentified Optum Clinformatics US claims database (2015 to 2020) linked to the Medtronic CareLink database, we identified individuals with a cardiac implantable electronic device who transmitted data ≥6 months after implantation. AF burden was assessed during the first 6 months after implantation (baseline period). Subsequent mortality, assessed from claims data, was compared between patients with and without AF, with adjustment for age, geographic region, insurance type, Charlson Comorbidity Index, and implantation year. Of 21 391 patients (age, 72.9±10.9 years; 56.3% male) analyzed, 7798 (36.5%) had device-recognized AF. During a mean of 22.4±12.9 months (median, 20.1 [12.8-29.7] months) of follow-up, the overall incidence of mortality was 13.5%. Patients with AF had higher adjusted all-cause mortality than patients without AF (hazard ratio, 1.29 [95% CI, 1.20-1.39]; P<0.001). Among those with AF, patients with nonparoxysmal AF had the greatest risk of mortality (persistent AF versus paroxysmal AF: hazard ratio, 1.36 [95% CI, 1.18-1.58]; P<.001; permanent AF versus paroxysmal AF: hazard ratio, 1.23 [95% CI, 1.14-1.34]; P<.001). After adjustment for potential confounding factors, the presence of AF was associated with higher mortality in our cohort of patients with cardiac implantable electronic devices. Among those with AF, nonparoxysmal AF was associated with the greatest risk of mortality.
Anti-Arrhythmic Mechanisms of Epidural Blockade After Myocardial Infarction
Authors: Jonathan D. Hoang, Valerie Y.H. van Weperen, Ki-Woon Kang, Neil R. Jani, Mohammed A. Swid, Christopher A. Chan, Zulfiqar Ali Lokhandwala, Robert L. Lux, Marmar Vaseghi
Journal: Circulation Research (2024)

BACKGROUND: Thoracic epidural anesthesia (TEA) has been shown to reduce the burden of ventricular tachycardia in small case series of patients with refractory ventricular tachyarrhythmias and cardiomyopathy. However, its electrophysiological and autonomic effects in diseased hearts remain unclear, and its use after myocardial infarction is limited by concerns for potential right ventricular dysfunction. METHODS: Myocardial infarction was created in Yorkshire pigs (N=22) by left anterior descending coronary artery occlusion. Approximately, six weeks after myocardial infarction, an epidural catheter was placed at the C7-T1 vertebral level for injection of 2% lidocaine. Right and left ventricular hemodynamics were recorded using Millar pressure–conductance catheters, and ventricular activation recovery intervals (ARIs), a surrogate of action potential durations, by a 56-electrode sock and 64-electrode basket catheter. Hemodynamics and ARIs, baroreflex sensitivity and intrinsic cardiac neural activity, and ventricular effective refractory periods and slope of restitution (S max ) were assessed before and after TEA. Ventricular tachyarrhythmia inducibility was assessed by programmed electrical stimulation. RESULTS: TEA reduced inducibility of ventricular tachyarrhythmias by 70%. TEA did not affect right ventricular–systolic pressure or contractility, although left ventricular–systolic pressure and contractility decreased modestly. Global and regional ventricular ARIs increased, including in scar and border zone regions post-TEA. TEA reduced ARI dispersion specifically in border zone regions. Ventricular effective refractory periods prolonged significantly at critical sites of arrhythmogenesis, and S max was reduced. Interestingly, TEA significantly improved cardiac vagal function, as measured by both baroreflex sensitivity and intrinsic cardiac neural activity. CONCLUSIONS: TEA does not compromise right ventricular function in infarcted hearts. Its antiarrhythmic mechanisms are mediated by increases in ventricular effective refractory period and ARIs, decreases in S max , and reductions in border zone electrophysiological heterogeneities. TEA improves parasympathetic function, which may independently underlie some of its observed antiarrhythmic mechanisms. This study provides novel insights into the antiarrhythmic mechanisms of TEA while highlighting its applicability to the clinical setting.
Therapeutic Efficacy of Mexiletine for Long QT Syndrome Type 2: Evidence From Human Induced Pluripotent Stem Cell–Derived Cardiomyocytes, Transgenic Rabbits, and Patients
Authors: Lia Crotti, Raquel Neves, Federica Dagradi, Giulia Musu, Federica Giannetti, J. Martijn Bos, Miriam Barbieri, Paolo Cerea, Fulvio L.F. Giovenzana, Margherita Torchio, Manuela Mura, Massimiliano Gnecchi, Giulio Conte, Angelo Auricchio, Luca Sala, Katja E. Odening, Michael J. Ackerman, Peter J. Schwartz
Journal: Circulation (2024)

Despite major advances in the clinical management of long QT syndrome, some patients are not fully protected by beta-blocker therapy. Mexiletine is a well-known sodium channel blocker, with proven efficacy in patients with sodium channel-mediated long QT syndrome type 3. Our aim was to evaluate the efficacy of mexiletine in long QT syndrome type 2 (LQT2) using cardiomyocytes derived from patient-specific human induced pluripotent stem cells, a transgenic LQT2 rabbit model, and patients with LQT2.