Septicaemic erysipeloid caused by Erysipelothrix rhusiopathiae is a rare zoonosis with high mortality. Hepatic injury as a complication has never been documented, and quantitative monitoring of pathogen clearance dynamics remains unexplored. To investigate the clinical characteristics of liver function damage caused by septicaemic erysipeloid, and explore reasonable diagnosis and treatment strategies. The clinical data of a 46-year-old male patient with liver function damage caused by septicaemic erysipeloid are summarized. Blood agar plate culture, drug sensitivity test, and a PCR method were used to detect the presence of Erysipelothrix rhusiopathiae in the blood and to dynamically monitor the results of drug treatment. Erysipelothrix rhusiopathiae was detected in blood cultures and confirmed by PCR. Longitudinal molecular monitoring revealed a progressive decline in bacterial load during treatment (day 0 to day 10), demonstrating significant antibiotic efficacy (p<0.01). By day 10, bacterial levels showed no significant difference compared to the negative control group (p>0.05). This study is the first to delineate the pathogen clearance kinetics of septicaemic erysipeloid through longitudinal molecular monitoring, providing a quantitative basis for therapeutic efficacy evaluation.

BackgroundLocal spread linked to breast carcinoma demonstrates a diverse spectrum of clinical presentations, including zosteriform, telangiectatic, and erysipeloid lesions. Pigmented epidermotropic infiltration resulting from breast carcinoma is seldom observed, occasionally posing diagnostic challenges owing to its resemblance to various other pigmentary disorders, such as malignant melanoma and other melanocytic lesions.Patient PresentationA 47-year-old woman presented with complaints of a hyperpigmented, crusted lesion involving the nipple-areolar region of the left breast, which on histopathology revealed an invasive tumor involving the dermis, composed of discohesive cells arranged in single files and linear cords, extending directly into the overlying epidermis in a pagetoid pattern with extensive pigment incontinence. On employing a comprehensive panel of special stains and immunohistochemical markers, the presence of classic Paget cells was ruled out, and a final diagnosis of direct epidermotropic infiltration by underlying invasive lobular carcinoma (ILC) of the breast was found.ConclusionEpidermotropic spread of ILC with associated pigment incontinence is a rare histopathological pattern that can closely mimic both pigmented mammary Paget disease and melanocytic disorders. The distinction is critical, as these entities differ significantly in their pathogenesis, prognosis, and management.

Erysipelothrix rhusiopathiae is a pathogenic bacterium infecting both humans and animals and causing erysipeloid, a disease that can leads to osteoarticular conditions, abscesses, and septic arthritis. Here, we report the sequenced ancient genome of E. rhusiopathiae obtained from teeth of an Alan child who lived in the North Caucasus in 6th-7th centuries AD. Differential diagnosis using paleopathological methods suggested that the child suffered from tuberculosis. However, analysis of tooth pulp revealed no signs of M. tuberculosis but a massive presence of ancient E. rhusiopathiae DNA. A complete high-quality ancient E. rhusiopathiae genome was assembled and found to belong to clade II of the extant E. rhusiopathiae phylogeny tree, nested in a subclade of closely related modern isolates infecting wild boars and domestic pigs. The ancient genome belongs to serotype 5 and encodes the key E. rhusiopathiae virulence factor SpaA group 1 along with vancomycin resistance genes. We propose that infection with E. rhusiopathiae, alone or together with other pathogens, is the likely cause of skeletal pathologies observed.

Cutaneous metastases are rare manifestations of malignancies. We report a case of a 50-year-old man with an atypical presentation of erysipelas-like skin lesions, later found to be cutaneous metastases from an unknown primary. 18 F-FDG PET/CT revealed visceral metastases; however, it failed to demonstrate uptake in the skin lesion, while 68 Ga-FAPI PET/CT additionally showed intense uptake in the skin, including the right parotid gland, which is likely the primary site. IHC findings confirmed a primary salivary duct adenocarcinoma. This case underscores FAPI PET/CT's utility in detecting FDG-negative lesions and identifying occult primaries in atypical presentations, also reflecting the intratumoral heterogeneity of salivary duct carcinomas.

Erysipeloid cutaneous leishmaniasis (ECL) is a rare presentation of cutaneous leishmaniasis that classically presents as erythematous, infiltrated lesions on the centrofacial region. We conducted a systematic review on the demographic characteristics, clinical presentations, laboratory findings, and treatment of ECL in the Old World. A systematic literature search was performed using the terms ("erysipeloid" OR "erysipelas") AND "leishmaniasis" across Web of Science, PubMed, Scopus, Embase, and Google Scholar. Only studies reporting cases from the Old World were included. Based on the anatomic location of lesions, we defined three clinical distributions of ECL: (1) centrofacial involvement, (2) non-centrofacial lesions involving the face and/or scalp, and (3) lesions on the neck, trunk, and extremities. Our search yielded 3290 publications, of which 24 met the inclusion criteria. In total, 103 patients with ECL, including 73 females (70.9%) and 30 males (29.1%) with a mean age ± standard deviation of 52.1 ± 12.3 years, were included. Seventy-two patients (57 females, 15 males) had centrofacial lesions. Females comprised 83.8% of this subgroup, a difference that was statistically significant (p < 0.005). ECL was more common in postmenopausal females. ECL lesions on the trunk and extremities were reported in five patients. Sixty-five patients (63.1%) were treated with pentavalent antimonials alone or in combination with other drugs. In conclusion, ECL is a rare presentation of cutaneous leishmaniasis, most often affecting elderly women and primarily localizing to the mid-face. Old age and menopause might predispose to ECL development. Clinical suspicion is necessary for the diagnosis of lesions suggestive of ECL in endemic regions.

Skin is an outer reflection of our overall health. Cutaneous metastases occur due to the persistence or recurrence of primary solid tumors. It occurs in 0.7 to 10.4% of all patients diagnosed with cancer, although they represent only 2% of all skin tumors. Cutaneous metastasis from breast carcinoma has varied presentations with different morphologies and appearances. It presents as red, firm papules, nodules, or plaques with either smooth, crusted, or ulcerated surfaces over ipsilateral chest wall. However, it can occur at some unusual sites like the scalp, eyelids, inframammary area, arms, umbilicus, nails, and mastectomy scar. Skin lesions of breast cancer metastases can be confused with some benign cutaneous lesions (cysts, dermatofibroma), skin malignancies (melanoma and non-melanoma skin cancers), infections (folliculitis, pyoderma, erysipelas, herpes zoster), dermatological conditions (dermatitis, hidradenitis suppurativa), reactive erythemas (urticaria, insect bite hypersensitivity), and vascular conditions (petechiae, purpura, pyogenic granuloma, angiosarcoma). Carcinoma en cuirasse, carcinoma erysipeloides, carcinoma telangiectoides, and carcinoma hemorrhagiectoides are various patterns of skin metastases. Concerning morphology and appearance, a dermatologist should have adequate knowledge to recognize and evaluate such patients, with or without a history of breast cancer, for early detection of metastasis and further treatment. Here, we report a case series of 10 patients with diverse appearances of metastatic breast cancer that could mimic other dermatological conditions.

We report a rare case of carcinoma erysipeloides (CE) in a man in his 80s. The patient exhibited a 15 year history of progressive nodularity over the right areola, accompanied by violaceous erythema extending from the right chest to both the right and left abdomen. The diagnostic workup confirmed invasive ductal carcinoma beneath the areola, intralymphatic carcinoma consistent with CE involving the regional skin and metastatic involvement of a single lymph node. The tumour tested positive for oestrogen and progesterone receptors but negative for HER2; genetic testing revealed the patient harboured germline mutations for BRCA1 and BRCA2. Oncology initiated anastrozole and palbociclib treatment, resulting in objective improvement in his breast cancer and his CE. This case highlights a unique presentation of male breast cancer with CE in the context of BRCA mutations and underscores the importance of genetic evaluation and tailored treatment in men with familial breast cancer syndromes.

Leishmaniasis is caused by an intracellular parasite transmitted to humans by the bite of a sandfly: Phlebotomus. The disease can present in three ways: visceral, cutaneous, or mucocutaneous forms. Unusual clinical presentations of cutaneous leishmaniasis have been reported: psoriasiform, eczematiform, erysipeloid, and sporotrichoid, depending on host immune status and Leishmania subspecies. We report a case of an unusual presentation of erysipeloid cutaneous leishmaniasis treated with the combination of Metronidazole and Clarithromycin. A 67-year-old woman presented with a 2-month history of swelling of the centrofacial region, with an erythematous and edematous plaque; the episode was treated as facial erysipelas with antibiotics. In the absence of improvement, the diagnosis of cutaneous leishmaniasis in its erysipeloid form was suspected and then confirmed by a skin smear showing the presence of leishmania amastigotes. The patient was treated with metronidazole and clarithromycin for 30 days, with good progression.