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Systemic polyarteritis nodosa (PAN) is a vasculitis that affects small to medium-size arteries. Onset in childhood is rare and can cause significant morbidity. Often, cutaneous manifestations can provide early clues toward diagnosis. This article describes a case of childhood systemic PAN that presented with fever, a necrotic skin lesion, and oral ulceration. Intestinal perforation complicated this case. Prompt recognition of childhood PAN is important to prevent serious complications.

This is the first report of transepithelial elimination in a lesion of sarcoidosis localized to the vulvar area, and one of only six reports in the English literature documenting cutaneous sarcoidosis with histopathologic evidence of transepithelial elimination. These reports are reviewed herein. Surprisingly, the results from this case series indicate that transepithelial elimination is more common in cutaneous sarcoidosis than one may surmise from the current literature.

1. Liang CP, Yang CS, Shen JL, Chen YJ. Sorafenib-induced acute localized exanthematous pustulosis in a patient with hepatocellular carcinoma. Br J Dermatol. 2011;165(2):443-445. 2. Bracarda S, Ruggeri EM, Monti M, et al; Sorafenib Working Group. Early detection, prevention and management of cutaneous adverse events due to sorafenib: recommendations from the Sorafenib Working Group. Crit Rev Oncol Hematol. 2012;82(3):378-386. 3. Otsuka T, Eguchi Y, Kawazoe S, et al; Saga Liver Cancer Study Group. Skin toxicities and survival in advanced hepatocellular carcinoma patients treated with sorafenib. Hepatol Res. 2012;42(9):879-886. 4. Schwarz M, Kreuzer KA, Baskaynak G, Dörken B, le Coutre P. Imatinib-induced acute generalized exanthematous pustulosis (AGEP) in two patients with chronic myeloid leukemia. Eur J Haematol. 2002;69(4):254-256.5. Wolkenstein P, Chosidow O, Fléchet ML, et al. Patch testing in severe cutaneous adverse drug reactions, including Stevens-Johnson syndrome and toxic epidermal necrolysis. Contact Dermatitis. 1996;35(4):234-236. 6. Sidoroff A, Halevy S, Bavinck JN, Vaillant L, Roujeau JC. Acute generalized exanthematous pustulosis (AGEP): a clinical reaction pattern.Sarcoidosis is a complex, multisystem disease with an unclear cause. 1 Research suggests that the pathogenetic mechanism of sarcoidosis is dysregulation of the immune system in individuals with a genetic predisposition who are subsequently exposed to inciting environmental agents. 2 Cutaneous sarcoidosis is often one of the earliest clinical signs of the disease and can be divided into 2 subclasses: specific and nonspecific lesions. Specific lesions are characterized by granulomas identified histologically and include macules, papules, plaques, annular lesions, lupus pernio, infiltration of scars, and subcutaneous nodules. 3 Alternatively, nonspecific sarcoid lesions, including erythema nodosum, prurigo, or calcifications, are reactive inflammatory processes. 3Report of a Case | A woman in her 40s presented with erythematous papules with perinasal and periocular distribution involving both the upper and lower eyelids and an atrophic plaque on the dorsal surface of her neck. The patient complained of vaginal changes including itching, burning, tear-ing, pain with intercourse, and a painful lesion in the perianal area. Examination revealed an erythematous scaly plaque on the mons pubis with atrophic, white, discolored patches in the vaginal area without evidence of tearing ( Figure 1).The patient presented with a 5-week history of productive cough with exertional dyspnea, and her chest radiograph revealed upper-lobe calcified granulomas but no bilateral hilar lymphadenopathy. The patient's pulmonary function tests revealed no airflow limitations, normal lung volume, and a mild reduction in the diffusing capacity of the lungs for carbon monoxide. The results of blood tests, including complete blood cell count, comprehensive metabolic panel, angiotensinconverting enzyme level, and erythrocyte sedimentation rate, were within normal limits.Bio...

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