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Nahla Shihab, Nahla
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Medicine & Pharmacology

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Journal : Journal of General-Procedural Dermatology

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Segmental zoster paresis Shihab, Nahla; Pusponegoro, Erdina HD; Yanuar, Ahmad
Journal of General - Procedural Dermatology & Venereology Indonesia Vol. 2, No. 1
Publisher : UI Scholars Hub

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Abstract

Herpes zoster is often associated with neurological manifestation but less frequently associated with motoric nerve involvement. The most common motoric involvement is paresis, seen only in 1-5% of all zoster cases. This case report a 39-year-old male, with recurrent abdominal liposarcoma under chemotherapy, presented with symptoms of fever, and painful and weak right leg for 2 weeks. Vesicles eruption was seen on his right leg nine days after these symptoms occurred. Physical examination revealed groups of haemorrhagic vesicles with erythematous base on the right lower leg. Lumbosacral spine x-ray showed spondylosis with radiculopathy. Electromyography (EMG) examination revealed lower motor neuron total denervation corresponding to right L5 radix. The patient was diagnosed as herpes zoster on right L5-S1 segment, herpetic neuralgia, and segmental zoster paresis with recurrent liposarcoma under chemotherapy. He was treated with oral acyclovir 800 mg five times a day and gabapentin 300 mg twice a day. Physical therapy and rehabilitation were started concurrently. Paresis is a rare complication of herpes zoster. Radicular pain and weakness preceded the skin lesion potentially lead to misdiagnoses. The most frequent diagnosis for patient suffering pain and weakness in the extremities is spinal disorder, such as stenosis and disc herniation. EMG can be helpful to recognise motoric involvement of herpes zoster, and preclude other diagnoses.
Eccrine poroma: The prominent mimicker Shihab, Nahla; Kristanti, Inge Ade; Sampurna, Adhimukti T.; Wibawa, Larisa Paramitha
Journal of General - Procedural Dermatology & Venereology Indonesia Vol. 3, No. 1
Publisher : UI Scholars Hub

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Background: Eccrine poroma (EP) is an adnexal benign tumor arising from the eccrine duct epithelium. The appearance of EP can mimic benign and malignant skin tumors, thus often making the diagnosis delayed or inaccurate. Case Illustration: We report two cases of EP, with clinical and dermoscopic features mimicking Bowen’s disease, verruca vulgaris, pyogenic granuloma, skin metastases of breast cancer, and amelanotic melanoma. Both patients were surgically excised and biopsied. Histopathology examination of both cases revealed eccrine poroma. Discussion: Both cases showed similarity with the theories, that EP is most found in middle age population and its predilection on extremities. The dermoscopy appearance of the first patient showed two major components, multiple red dots and lacunae mimicking glomerular vessels, and multiple whitish halos-likekeratosis. Red dots with whitish halos can be seen in dermoscopy of verruca vulgaris, while glomerular vessels and keratosis is usually found in Bowen’s disease. The dermoscopy examination of our second patient only showed some loop hemorrhagic and thrombosed vessels, which are quite inconclusive. Diagnoses were made with histopathology examination which revealed similar pattern of eccrine poroma in both cases. Conclusion: EP is a prominent mimicker, often misdiagnosed because it is uncommon in clinical practice, has variable clinical presentations and dermoscopic appearances. Hence, recognizing and diagnosing this disease becomes a challenge for dermatologist.
Co-Authors Ahmad Yanuar Kristanti, Inge Ade Pusponegoro, Erdina HD Sampurna, Adhimukti T. Wibawa, Larisa Paramitha