Multiple eruptive dermatofibromas in an HIV-positive man

Multiple dermatofibromas, associated clinical and histological characteristics: A systematic review

Multiple dermatofibromas (DFs) are rare benign fibrohistiocytic lesions characterized by asymptomatic hyperpigmented nodules. Several diseases, like systemic lupus erythematosus (SLE) and human immunodeficiency virus (HIV) infection, are found to be associated with multiple DFs. Here, we designed a systematic review by an electronic search of PubMed and Embase databases to select case reports of multiple DFs (29 May 2021). From 2,145 initially found articles, 96 studies (106 cases) were included. We classified multiple DFs (>1 DF lesion) into four subtypes and separately investigated clinical characteristics of each one: multiple eruptive DFs (MEDFs) (n = 45), multiple (n = 41), multiple clustered DFs (MCDFs) (n = 18), and giant combined (n = 2). The patients' mean age was 38.3 ± 14.7 years. The majority were female (61.3 %). The lesions were commonly on the trunk and extremities (36.8 %). MEDFs (n = 36) had the most rapid disease onset (2.0 ± 6.6 years). Immunosuppression induced by either HIV (10.3 %) and hematologic malignancy (9.4 %) or immunosuppressive drugs (23.4 %) along with SLE (19.8 %) were the most observed associations. However, 66.7 % of the MCDF patients were otherwise healthy individuals. As for disease management, surgery and follow-up were the preferred options. Most of the cases showed neither resolution nor development of new lesions in follow-up.

Multiple eruptive dermatofibromas in a patient with dermatomyositis taking prednisolone and methotrexate

Dermatofibroma (DF) is a common, benign, dermal tumor, often occurring as a single lesion. Multiple eruptive DFs are rare and usually associated with autoimmune diseases, immunosuppressant therapy, or both. We present the case of a 28-year-old woman with dermatomyositis who developed multiple eruptive DFs after undergoing methotrexate and corticosteroid treatment. Immunosuppressants such as methotrexate and corticosteroids might cause multiple eruptive DFs.

Multiple eruptive myxoid dermatofibromas: report of first case and review of literature

Multiple eruptive dermatofibromas are a rare presentation of dermatofibroma which are frequently associated with underlying diseases such as human immunodeficiency virus infection or lupus erythematosus. Eruptive dermatofibromas generally present a characteristic histology with a poorly circumscribed lesion showing hyperplasia of the epidermis, prominent bundles of collagen and a diffuse proliferation of fibrocytes. We report an unusual case of multiple eruptive dermatofibromas showing massive depositions of mucin within the dermis. A 20-year-old woman presented with nearly 100 red to yellowish papules and nodules distributed symmetrically all over the integument which developed over a period of 9 years. Comprehensive clinical and laboratory diagnostics showed no signs indicating any underlying disease. To our knowledge this is the first report of multiple eruptive myxoid dermatofibromas. We consider this case to be a unique presentation of multiple eruptive dermatofibroma showing massive deposition of mucin.

Multiple eruptive dermatofibromas in patients with systemic lupus erythematosus treated with prednisone

Solitary dermatofibromas are a common occurrence, especially on the lower limbs of young women, while multiple dermatofibromas (MDF) are rare, accounting for less than 0.3% of all dermatofibromas and may suddenly develop in immunosuppressed patients. We report a patient with systemic lupus erythematosus (SLE) who developed MDF while she was taking oral prednisone. A 46-year-old woman presented in 1989 complaining of photosensitivity, arthralgias, fatigue, malaise and dyspepsia. The patient denied fever, Raynaud's phenomenon, oral ulcer and hair loss. On examination she presented a typical SLE malar rash. Erythrocyte sedimentation rate (ESR) was elevated (54 mm/h). Speckle patterned IgG/IgM antinuclear antibodies were present at 1/1280 titer. Antibodies anti Ro/SSA were detected by counterimmunelectrophoresis up to 1/8 titer. Other laboratory findings were negative or within normal limits. Systemic lupus erythematosus was diagnosed and the patient given 50 mg/day prednisone. After a few months, both clinical symptoms and immunologic parameters improved. Eighteen months later, prednisone was replaced by 500 mg/day hydroxychloroquine. In 1994, she presented again with malar rash, arthralgias and facial hyperpigmentation. Prednisone 15 mg/day was reintroduced and hydroxychloroquine stopped being a possible cause of the facial hyperpigmented macules. In 1996, while she was taking 5 mg/day prednisone, several nodules developed on her limbs within a few months. On examination we observed 16 firm, slightly elevated 3-15-mm wide brown nodules on her arms, legs and trunk. A biopsy specimen of a lesion of the trunk revealed an epidermal seborrheic-keratosis-like hyperplasia with dermal fibrosis and fibroblastic proliferation (Fig. 1). Dermatofibroma was diagnosed.

Utility of HHV8 RNA detection for differentiating Kaposi's sarcoma from its mimics

BACKGROUND

The diagnostic distinction of atypical vascular lesion or angiomatoid/hemosiderotic dermatofibroma and Kaposi's sarcoma can be difficult, especially in AIDS patients. Given the strong association between human herpes virus 8 (HHV8) and Kaposi's sarcoma, this study attempts to determine if HHV8 RNA detection by reverse transcription (RT) in situ polymerase chain reaction (PCR) could help in differentiating these entities.

METHODS

Twenty-three Kaposi's sarcoma cases, 13 dermatofibromas, including 7 angiomatoid or hemosiderotic variants and eight atypical vascular lesions were tested for HHV8 by RT in situ PCR; five of the patients in the latter two groups were known to have AIDS.

RESULTS

HHV8 RNA was detected in each of the 23 cases considered on histologic grounds to represent Kaposi's sarcoma; viral RNA and DNA localized to the majority of the endothelial and stromal spindle cells. None of the cases of dermatofibroma were HHV8 positive, whereas two of the atypical vascular lesions were viral positive, leading to a final diagnosis of Kaposi's sarcoma.

CONCLUSIONS

RT in situ PCR for HHV8 RNA is a useful tool in the differential diagnosis between Kaposi's sarcoma and its mimics.

Multiple maxillary and mandibular exostoses associated with multiple dermatofibromas: a case report

Exostoses of the maxilla and mandible are nodular protuberances of mature bone that need to be accurately distinguished from other more diagnostically significant lesions, notably exosteal osteomas. Multiple dermatofibromas are rare and may be associated with altered immune function. We report the case of an otherwise healthy 47-year-old woman who was first seen with multiple maxillary and mandibular exostoses associated with multiple dermatofibromas. This association has not been previously reported.