Background:Eruptive xanthomas are benign skin lesions caused by localized deposition of lipids in the dermis. The lesions are generally caused by elevated levels of serum triglycerides that leak through the capillaries and are phagocytosed by macrophages in the dermis. Clinical manifestation varies from asymptomatic skin lesions to intense pruritus and tenderness.Methods:We present a case of a middle-aged man admitted with diabetic ketoacidosis secondary to noncompliance with insulin. He was found to have skin lesions as multiple crusted papules on the extremities. Further evaluation revealed elevated serum triglycerides. A diagnosis of eruptive xanthomas was made on skin biopsy, and after starting treatment with lipid lowering agents his cutaneous lesions gradually subsided.Conclusion:Appearance of eruptive xanthomas can signify the onset of serious complications. Prompt recognition of such skin manifestations is warranted to prevent development of fatal medical condition like coronary artery disease and pancreatitis.

Patient: Female, 56Final Diagnosis: Acute fibrinous and organizing pneumoniaSymptoms: Cough • dyspnea • feverMedication: —Clinical Procedure: —Specialty: PulmonologyObjective:Rare diseaseBackground:Acute fibrinous and organizing pneumonia (AFOP) is a newly evolving rare non-infectious lung pathology, characterized by intra-alveolar fibrin balls on histology. It is often difficult to diagnose and is usually mistaken for other lung pathologies. We present an interesting case of AFOP with unusual radiologic findings and disease course.Case Report:A 56-year-old woman presented with a 1-day history of high-grade fever, chills, and profuse sweating. She was febrile to 101.2 degree Fahrenheit on presentation. On physical examination, she had decreased air entry in the left upper lobe of the lung. Laboratory testing showed a white cell count of 27,000 cells per microliter of blood with left shift. A chest radiograph showed a left upper lobe consolidation. Computed tomography (CT) of the chest without intravenous contrast showed advanced centrilobular emphysema and left upper lobe consolidation measuring 6.2×5.9 cm. The patient was started on antibiotics. She clinically improved and was discharged on oral antibiotics. After discharge, a trans-bronchial lung biopsy showed acute inflammatory cell infiltrate with intra-alveolar fibrin balls but no hyaline membrane formation or significant eosinophils. These findings were consistent with acute fibrinous and organizing pneumonia. However, she was subsequently lost to follow-up.Conclusions:Our case adds to the literature a new and unusual finding of upper lobe infiltrates, in contrast to most cases presenting as bilateral lower lobe infiltrates. In our case, symptomatic improvement after antibiotic treatment suggests a possible role of antibiotics in management of this entity.

Cutaneous lesions are a part of common manifestation in multi-systemic sarcoidosis and skin involvement occurs in 20% to 35% of the patients with systemic disease. An exclusive cutaneous involvement is rare and it is reported in about 4%-5% of the patients of sarcoidosis. These lesions have been classified into specific and non-specific, depending on the presence of non-caseating granulomas, on histopathologic studies. In the present study, we are reporting two cases of isolated cutaneous sarcoidosis without systemic manifestations, which is a rare presentation. Sarcoidosis will continue to challenge even the most experienced clinicians with respect to a high degree of suspicion and further investigations for diagnosing and treating this disorder. CASE REPORT ONEA 57-years-old male presented with a raised erythematous lesion which measured 1.5x1.5 cm over the forehead. The lesion started as a papule and gradually progressed to the present size. There was no history of dyspnoea, prolonged fever or other systemic complaints. There was no significant family history which included that of tuberculosis. The haematological and biochemical investigations including angiotensin converting enzyme (ACE) levels, ESR, CRP, ANA and serum calcium showed normal values. The ophthalmological assessment was normal. CASE REPORT TWOA 38 year old male presented with a lesion which measured 2 x 1.5 cm over the elbow region, which was provisionally diagnosed as a neurofibroma. The biopsy showed well formed non caseating granulomas with asterioid bodies and Langhans giant cells and a histopathological diagnosis of sarcoidosis was offered. Further evaluation showed no organ involvement and no hilar lymphadenopathy.The patient showed no ocular involvement on ophthalmological assessment and other investigations were normal, including sputum for AFB culture. ACE levels were on higher side of the normal range.are misdiagnosed. The cutaneous lesions of Sarcoidosis assume a vast array of morphologies [2] and they are therefore considered as great mimickers in the dermatology practice. The specific types of lesions are lupus pernio, small and large nodules, small and large plaques and scar infiltrations. Lupus pernio is the most characteristic among the sarcoid skin lesions and it is seen as a chronic, persistent, bluish, indurated plaque with a predilection for nose and cheek, with nasal, mucosal and septal involvements [3].