• Achromobacter xylosoxidans is an emerging pathogen primarily in the immunocompromised patient. • Achromobacter xylosoxidans can form biofilms on plastics treated with disinfectant solution, including medical products. • Strains of A xylosoxidans have shown multiantibiotic resistance.

In this patient off-label Kybella was effective in improving the contour and removing excess lower abdominal fat after two treatments. While off-label use of Kybella is commonly used every day by physicians across the United States (8, 10), it is not well represented in the literature (9). This case is presented to aid in the discussion of new, safe, noninvasive treatment techniques in which healthcare demand and delivery has outpaced publication and literature support.

Pyogenic granulomas are vascular hyperplasias presenting as red papules, polyps, or nodules on the gingiva, fingers, lips, face and tongue of children and young adults.  Most commonly they are associated with trauma, but systemic retinoids have rarely been implicated as a causative factor in their appearance.  We present a case of spontaneous eruption of multiple pyogenic granulomas of the bilateral periungal fingers in an otherwise healthy adolescent male undergoing isotretinoin therapy for severe nodulocystic acne. These pyogenic granulomas did not resolve spontaneously with discontinuation of isotretinoin, or first line therapeutic modalities. Their resolution did occur with administration of intralesional steroids and ablation with silver nitrate.