Facial Vegetating Lesions in a Patient With Kidney Failure

Acute iododerma presenting as cryptococcoid neutrophilic dermatosis: A clinicopathological pitfall and interesting findings gleaned from a review of the literature

“…Circumventing this pitfall is paramount in avoiding delay in diagnosis, quickly instituting of corticosteroid therapy and avoiding unnecessary investigations and use of antimicrobials. Since the characterization of CND in 2012, it is only in the past 2 years that four cases of iododerma presenting as such have surfaced, identical to that of our patient 5,8 . To the best of our knowledge, all previous cases of iododerma with histopathological evaluation in the literature exhibited dense dermal neutrophilia with variable amounts of epidermal hyperplasia, hemorrhage, LCV, and granulomatous dermal inflammation without resemblance to cryptococcosis.…”

“…Up to now, 19 cases of CND have been reported and are summarized in Table 1. Various etiologies aside from iododerma, ranging from drug‐induced/idiopathic/leukemia‐related SS, levamisole‐induced ANCA vasculitis, and drug‐induced lupus erythematosus have been implicated 7–14 . Interestingly, at least 8 of 15 of the non‐iododerma cases had significant kidney impairment (National Kidney Foundation Kidney Disease Outcomes Quality Initiative Stage 3 and beyond), an important predisposing comorbidity for iododerma.…”

“…were detected in the acellular cryptococcoid bodies in nine cases. 5,[8][9][10][11][12] Although this may raise the suspicion that these vacuolated structures are ballooned histiocytes, it should be re-emphasized that they are indeed the result of neutrophil-driven cellular autolysis, as confirmed on electron microscopy. 7 Histiocytoid SS, a variant of SS strongly associated with myelogenous leukemia, is characterized by a dense dermal mononuclear cellular infiltrate of immature neutrophils, bearing cresentic nuclei, and an immunophenotype consistent with both neutrophil and monocyte/histiocyte origin.…”

“…Various etiologies aside from iododerma, ranging from drug-induced/idiopathic/leukemia-related SS, levamisoleinduced ANCA vasculitis, and drug-induced lupus erythematosus have been implicated. [7][8][9][10][11][12][13][14] Interestingly, at least 8 of 15 of the noniododerma cases had significant kidney impairment (National Kidney Foundation Kidney Disease Outcomes Quality Initiative Stage 3 and beyond), an important predisposing comorbidity for iododerma. Specific data on the renal function at time of cutaneous eruption in the other seven cases were not furnished.…”

Iododerma after Lugol use for pre-operative preparation of thyroidectomy

“…Systemic exposure can occur when potassium iodine is used for the treatment of some diseases such as asthma, hyperthyroidism, chronic bronchitis and sporotrichosis, or when iodinated radiocontrast media is used 1,2 . This disease mainly affects patients with kidney disease, due to the difficulty in excreting iodine and, consequently, accumulation in the bloodstream 3,4 .…”