Toxic epidermal necrolysis (TEN) is a rare but potentially life-threatening dermatological condition. It is characterised by diffuse exfoliation of >30% of the skin and mucous membranes due to immune-mediated destruction of the epidermis. It is thought to be due to a hypersensitivity reaction to a variety of medications. The mainstay of treatment involves withdrawal of the potential offending agent, supportive care and use of non-adherent dressings. Pre-packaged dressings are expensive or not readily available in our locality; hence, the need for improvisation, to manage the condition and improve outcomes. We report a case of TEN in a 2-year old female who presented with a 6-day history of fever and a rash on the trunk, for which mother applied topical calamine lotion, gave an oral herbal concoction for 3 days, with no improvement, after which she commenced amoxicillin + clavulanic acid. Twenty-four hours later, the rash progressed to involve the whole body. On presentation, she had extensive exfoliation of >70% of the body surface area, with multiple bullae, intraoral ulcers and excoriation of the eyelids and genitals. She was admitted into the Paediatric Intensive Care Unit, where she received intravenous hydration and antibiotics, micronutrients, nasogastric feeds and eye care. The skin was cleaned daily with 0.9% saline and dressed with petroleum jelly-impregnated gauze prepared at the Central Sterilising Services Department of the hospital. Skin ulcers resolved, and she was discharged after 6 weeks. In resource-poor settings such as ours, cheaper, sterile locally available materials could be used for dressing to improve outcomes.

Histoplasmosis is an endemic mycosis in certain regions of Brazil and represents a rare opportunistic infection in solid organ transplant recipients. This report describes the case of a 68-year-old female liver transplant recipient (due to Caroli disease) who presented with abdominal pain, nausea, vomiting, and a distended, tender abdomen. Abdominal computed tomography revealed parietal thickening of the bowel wall, and colonoscopy identified polymorphic ulcers and ileocecal stenosis. Given the suspicion of tuberculosis, chest computed tomography was performed, which demonstrated pulmonary opacities. Although testing for acid-fast bacilli was negative, fungal staining was positive for Histoplasma capsulatum. Antifungal therapy with amphotericin B was initiated; however, due to clinical refractoriness, surgical intervention was required, including ileocecal resection with ileo-ascending anastomosis. A reoperation was performed due to postoperative complications, resulting in the creation of a terminal ileostomy. Following this intervention, the patient showed clinical improvement and tolerated an oral diet. This case highlights an atypical presentation of disseminated histoplasmosis with pulmonary and intestinal involvement, culminating in intestinal subocclusion in a late-stage liver transplant recipient. It underscores the importance of considering histoplasmosis in the differential diagnosis of immunosuppressed patients and the need for early investigation and treatment.

Oral cancer is one of the most common health hazards encountered among the South Asian population. Oral cancer ranks sixth among other cancers worldwide. The risk factors for oral cancer are usually multifactorial, and the distribution of oral cancer varies according to ethnic origin. Risk factors for oral cancer include tobacco use (smoking and chewing), excessive alcohol consumption, betel nut chewing, human papillomavirus (HPV) infection, and a diet low in fruits and vegetables. Oral cancer significantly impacts both the quality of life and the survival of affected individuals. Oral cancer refers to cancers that develop in the tissues of the mouth or throat, including the lips, tongue, gums, floor of the mouth, and roof of the mouth. It can manifest as a sore, lump, or ulcer in the mouth that does not heal, difficulty or pain with swallowing, persistent mouth pain, or changes in voice. Early detection and treatment of oral cancers are crucial for improving outcomes in oral cancer patients. Unfortunately, many cases are diagnosed at advanced stages, which reduces the chances of successful treatment and increases morbidity and mortality rates. Dentists and healthcare providers play a critical role in the early detection of oral cancer through regular screenings, especially in high-risk individuals. Early detected stage I cancer has a better prognosis than newly diagnosed stage III or stage IV cancer, which usually affects quality of life, resulting in poor survival and mortality. This article provides a comprehensive overview of the clinical features of oral cancer in different regions of the oral cavity and the importance of early diagnosis of this neglected entity.

Behcet's disease (BD) is a chronic, multisystem autoimmune vasculitis that can cause severe genital ulcers. Giant vulvar ulcers (diameter ≥4 cm) secondary to BD pose significant therapeutic challenges due to their refractory nature, risk of functional impairment, and impact on fertility and aesthetic outcomes.

Horse flies are common dipteran insects that can be found in most parts of the world. They feed on the blood of their hosts, including humans. Female horse flies pierce the skin of the host, inject anticoagulant saliva, and suck the blood, which can result in minor cutaneous reactions (eg, urticaria, papules localized to the bite site). In severe cases, bites also can result in anaphylaxis. Horse flies can transmit tularemia, which typically manifests as cutaneous ulcers and lymphadenopathy but also can result in severe systemic reactions such as septic shock. Minor cutaneous reactions can be treated with symptomatic management and oral antihistamines, while anaphylaxis and tularemia require systemic therapy with intramuscular epinephrine and intravenous gentamicin, respectively. Exposure to horse flies can be minimized via use of protective clothing, topical repellants, and traps.

Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis that may occur after surgery and mimic wound infection. We report the case of a 30-year-old woman who developed painful progressive ulceration 7 days after caesarean section. Initial treatment with broad-spectrum antibiotics for presumed surgical site infection was ineffective. Clinical examination showed a large hypogastric ulcer with an erythematous base and undermined inflammatory borders. Histopathological examination of a biopsy taken from the ulcer edge demonstrated a dense dermal neutrophilic infiltrate, supporting the diagnosis of PG. Oral prednisolone at 1 mg/kg/day was started, with progressive improvement and complete re-epithelialization after 4 months. This case highlights the importance of considering PG in postoperative wounds that worsen despite adequate antimicrobial treatment, in order to avoid unnecessary surgical procedures and initiate timely immunosuppressive therapy.