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Angiolymphoid hyperplasia with eosinophilia (ALHE) is a rare entity that usually occurs as 0.5-3 cm pink to brown nodules in the skin surface and subcutaneous tissues of the head & neck. Here we report an unusual occurrence in size and appearance of ALHE in the tissues of the cheek of an adult Asian male.

No abstract

There is marked underdiagnosis and undertreatment of cardiac risk in RA. Several major barriers exist, including lack of time. Most rheumatologists feel that this aspect of care is the responsibility of primary care physicians.

. Calcium, vitamin D, parathyroid hormone, urate, creatinine, and inflammatory markers were normal. Serum voriconazole and beta-crosslinks (a marker of bone resorption) were normal. Given the elevated ALP, periostitis, osteophytic reactions and lack of clubbing, he was diagnosed with voriconazole-induced periostitis deformans (VIPD). Voriconazole was discontinued and symptoms and ALP improved within 3 months. DiscussionVoriconazole is a triazole antifungal used to treat invasive fungal infections which are commonly encountered in immunocompromised hosts. Fluoride is a major component of this antifungal, and is central in the pathophysiology of VIPD through stimulation of osteoblasts.1 Classically VIPD presents with diffuse bony pain and swelling, elevated serum ALP and fluoride levels, dense periosteal reaction on radiographs, as well as multiple areas of uptake on bone scintigraphy.2,3 Despite the aforementioned abnormalities, voriconazole troughs are often within normal limits. 4 It differs from hypertrophic pulmonary osteoarthropathy in its predilection for distinct areas such as the ribs, irregular and dense periosteal reactions, and lack of clubbing and joint effusions. 2,3Symptoms typically resolve soon after discontinuing voriconazole. 2,5Figure 1. Hand radiographs are notable for multifocal periosteal reaction involving the metacarpals, and proximal and middle phalanges in an asymmetrical manner. The patient is skeletally immature. Anatomic alignment and joint spaces are preserved.