We report an atypical presentation of a current disease to highlight the importance of making a correct diagnosis of scabies surrepticius in front of any itchy dermatosis especially in elderly patients. The misdiagnosis of this disease results in extensive infestation, especially with the use of corticosteroids.
A verrucuous tumor of the legA 56-year-old woman, with no medical history, presented with a chronic nodular lesion of the left leg, of two year’s duration. There were no associated systemic symptoms. Physical examination revealed a warty mass with a keratotic surface of measured 2 cm. (Figure 1)A surgical excision was performed. Histological examination showed hyperkeratosis, parakeratosis, papillomatosis and cystic invaginations extending downwards from the epidermis. Two different epithelial cell layers consisting of outer small cuboidal cells and inner columnar cells were present. The papillary projections and dermis had also dense infiltration of plasma cells. (Figure 2) Based on these findings, a diagnosis of Syringocystadenoma Papilliferum (SCAP) of the leg was established.SCAP is a benign adnexal tumor. Most of the cases present with solitary lesion in the head and neck region at birth or in early childhood.1 In fact, only two cases of SCAP on lower leg have been reported in literature.1,2 It is mainly, associated with oragnoid nevus. Histogenesis of this tumor remains controversial.2 Histopathologically, there is no difference between SCAP on different locations.1Despite its rarity, we must consider it in the differential diagnosis of any longstanding nodular lesion with crusted surface. Surgical excision is curative.
Fat necrosis (FN) is an uncommon etiology of panniculitis. It is mainly caused by trauma and may be associated to other conditions such as pancreatic disease. We report an interesting case of subcutaneous FN caused by intramuscular injections of cefazolin and meglumine antimoniate in a 38-year-old female patient.