DEAR EDITOR, A 40-year-old woman presented with asymptomatic cutaneous lesions on her lower abdomen, which had been present since early childhood (a). Other skin lesions were not noted. Histopathology revealed dermal spindle cells focally entrapped by keloidal collagen and covered by a hyperplastic epidermis (b, c). The spindle cells were negative for S100 and CD34 and focally positive for CD68 (d) and a-smooth muscle actin. Clinicopathological correlation was consistent with congenital multiple clustered dermatofibroma or 'agminated dermatofibroma', a rare entity of unknown aetiology characterized by a defined plaque composed of multiple dermatofibromas representing a segmental cutaneous mosaicism. 1 The only effective therapy is surgery. 2

Patients with cancer frequently receive immune-checkpoint inhibitors (ICIs), which may modulate immune responses to COVID-19 vaccines. Recently, cytokine release syndrome (CRS) was observed in a patient with cancer who received BTN162b2 vaccination under ICI treatment. Here, we analyzed adverse events and serum cytokines in patients with 23 different tumors undergoing (n = 64) or not undergoing (n = 26) COVID-19 vaccination under ICI therapy in a prospectively planned German single-center cohort study (n = 220). We did not observe clinically relevant CRS (≥grade 2) after vaccination (95% CI 0–5.6%; Common Terminology of Adverse Events v.5.0) in this small cohort. Within 4 weeks after vaccination, serious adverse events occurred in eight patients (12.5% 95% CI 5.6–23%), six patients were hospitalized and two patients died. Despite absence of CRS symptoms, a set of pairwise-correlated CRS-associated cytokines, including CXCL8 and interleukin-6 was >1.5-fold upregulated in 40% (95% CI 23.9–57.9%) of patients after vaccination. Hence, elevated cytokine levels are common and not sufficient to establish CRS diagnosis.

is missing (Short communication)

Livedo is a net‐like violaceous skin pattern. It can be classified as physiological or pathological. The physiological livedo reticularis usually appears in cold conditions, whereas the pathological and irregular livedo, which persists in warm temperatures, is often labeled as ‘livedo racemosa’. Some neurological pathologies are associated with livedo, most commonly those with an inflammatory component or those derived from systemic disorders. The present review summarizes the most important central and peripheral neurological diseases in pediatric and adult age groups associated with livedo, providing physicians with an overview of the clinical presentation, etiology, diagnosis and management of these conditions.