2006 Abstracts - American Contact Dermatitis Society

TRANSITIONAL CELL CARCINOMA PRESENTING AS CONTACTDERMATITISLael Desmond, M. D., University of South Florida, Tampa, FL, Debra Fett, M. D.,NOVA Southeastern University, Largo, FLWe present a 61-year-old woman with referral diagnoses of dermatitis anddelusions of parasitosis. She reported a 2 year history of pruritic patches on skin,the passage of long worms in her urine and the sensation that these were crawlingunder her skin. She had been seen by multiple specialists without definitivediagnosis and was refractory to treatment. She was using a topical medicationcontaining grapefruit extract. Her exam revealed impetiginized plaques.Laboratories were normal except for mild eosinophilia and elevated alkalinephosphatase. Skin biopsy was notable for epidermal necrosis with superficialdermal edema and eosinophilia. A “worm” specimen she collected from her urinewas negative for parasites and was subsequently sent for histopathology, yieldingthe diagnosis of red cell cast. Abdominal and pelvic CT scan revealed anobstructing mass at the right renal pelvis, ultimately leading to the diagnosis oftransitional cell carcinoma. Following right nephrectomy, her symptoms improvedsignificantly.We present this case for interest and for discussion of unusual outcomewith the diagnosis of contact dermatitis.14