case_images: PMC8942188_01
case_images: Skin findings. Left: View of skin findings from the back. Right: View from the right side. (a) Pre-operative presentation of rash. (b) Resolution of rash two 2 weeks after operation. (c) Persisting resolution of rash six 6 weeks after operation.
case_images: SNI-12-635-g001.jpg
case_images: PMC8942188_01_SNI-12-635-g001.jpg
case_images: F1
case_images: Two years later, he presented with multiple oval patches measuring 6 x 6 cm-8 x 8 cm on his posterior trunk/ thoracic area extending into his right axilla [Figure 1a]. The patient demonstrated full resolution of the rash within 6 weeks after surgery [Figure 1b and Figure 1c].
case_images: Intraoperative imaging. Previous hardware with metal allergens that were removed and replaced.
case_images: SNI-12-635-g002.jpg
case_images: PMC8942188_01_SNI-12-635-g002.jpg
case_images: F2
case_images: As the patient had not formed a complete arthrodesis at T5-T6 and had the presence of metal allergies, he had the prior instrumentation removed and replaced with commercially pure titanium [Figure 2].
case_images: Histopathological examination. (a) Hematoxylin and eosin-stained sections from skin plaques demonstrated spongiotic dermatitis with multifocal parakeratosis scale crust and superficial to mid-dermal perivascular lymphocytic infiltrate with occasional eosinophils (arrow). These findings are compatible with an allergic eczematous dermatitis. Left: x20, right: x40. (b) Muscle sections demonstrated chronic inflammation, occasional eosinophils (arrow), basophilic fibers, atrophy, nuclear clumping, and increased internal nuclei. Hematoxylin and eosin stain at x40.
case_images: SNI-12-635-g003.jpg
case_images: PMC8942188_01_SNI-12-635-g003.jpg
case_images: F3
case_images: Pathological findings compatible with an allergic eczematous dermatitis on hematoxylin and eosin staining of skin plaques demonstrated spongiotic dermatitis with multifocal parakeratosis scale crust and superficial to middermal perivascular lymphocytic infiltrate with occasional eosinophils [Figure 3a]. In addition, muscle sections demonstrated chronic inflammation, occasional eosinophils, basophilic fibers, atrophy, nuclear clumping, and increased internal nuclei [Figure 3b].