Bullous lung disease caused by tuberculosis is rare, and complications have a poor prognosis with uncertain pathophysiologic mechanisms. We describe a 29-year-old male patient who was admitted to the emergency department due to bilateral tension pneumothorax, which was complicated by bronchopleural fistula. This was managed with the placement of chest tubes, continuity of anti-TB drug treatment, and Heimlich valve placement.

Striae distensae is a common cutaneous phenomenon that begins as reddish linear atrophic plaques (striae rubra) that over time progress to silvery-white coloration (stria alba). Striae distensae in rare occasions becomes edematous, ulcerative, emphysematous, or urticated. Bullous striae distensae is a sequela of conditions causing interstitial edema along with systemic glucocorticoids use. To our knowledge, only eight cases of bullous striae distensae have been reported in the literature. Herein, we report a 17-year-old female, known case of nephrotic syndrome, presented to our clinic with abdominal fluid-fill cutaneous lesions only for 5 days. She had used systemic glucocorticoids for more than a decade before she was labeled as steroid resistant nephrotic syndrome. Cushingoid body habitus were observed during physical examination, in addition to translucent bullae overlying her previously known stretch marks. Punch biopsy of the lesions revealed dermal edema with thinned collagen bundles. Based on these clinicopathological findings, a diagnosis of bullous striae distensae was made. Awareness of this rare complication and unusual clinical presentation is fundamental to avoid unnecessary and excessive interventions whether investigatory or therapeutic in order to provide appropriate management of the underlying condition.

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TNPM is a benign, transient, neonatal pustulosis requiring no active treatment. Diagnosis is clinical, characterized by a vesiculopustular eruption, healing with residual hyperpigmented macules. Before diagnosing TNPM, serious conditions including skin infections should be excluded. This case was unusual in that vesiculobullae predominated, with a notable absence of simple pustules.

Spontaneous pneumomediastinum (SPM), an increasingly documented complication of COVID-19 infection, usually presents with retrosternal chest pain and dyspnea but can present atypically. In this case, an exceptionally rare presentation could have led to inappropriate management and a poor outcome. Here, a previously healthy 41-year-old Afro-Caribbean male non-smoker presents with acute airway compromise due to SPM. Conservative management proved effective, with anxiolysis to mitigate patient self-induced lung injury (PSILI) and oxygen supplementation via a non-rebreather mask to increase the resolution rate till the patient stabilized over the following days. The sequelae of the lung insult were noted in subsequent imaging, showing the formation of many subpleural bullae. Our case demonstrates the need for a high index of suspicion for pneumomediastinum among teams caring for COVID-19 cases. It also highlights the potential need for follow-up for further research on pulmonary sequelae.

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UNASSIGNED: Bullous pemphigoid (BP) is considered the most common bullous autoimmune disorder, characterized by autoantibodies directed against hemidesmosomes in the skin and mucous membranes. It usually affects elderly individuals in the sixth through eighth decades of life, with an average age at onset of 65 years. Only a few cases have been reported in children and teenagers.
UNASSIGNED: Herein, we report a 17-year-old boy who presented with a pruritic vesicular rash on his arms and legs accompanied by erythema. He was treated at the beginning with topical lotion and acyclovir, but the rash kept deteriorating and eventually bullae appeared, involving also his mouth. A dermatologist was consulted and diagnosed him with BP, and he was treated accordingly.
UNASSIGNED: BP is the most prevalent autoimmune bullous illness, caused by autoantibodies against hemidesmosomes in the basement membrane of skin and mucosal surfaces, which in turn attract immune cells, including T-cells and neutrophils, and activate them, which causes damage to and separation of keratinocytes, resulting in the bullous formation. Diagnosis can be accomplished by recognizing clinical symptoms supported by histopathological and immunofluorescence testing. Steroids, whether topical or systemic, are the cornerstone treatment; depending on the extent of the disease, other immunosuppressant drugs can be used as a second line.
UNASSIGNED: BP manifestations are polymorphic; physicians should keep in mind that they may present with non-bullous, pruritic lesions, which may persist for some days to several months before bullae appear. Although this disease is rare in the young population, it should be considered in the differential diagnosis of bullous lesions.

Ribociclib, a cyclin-dependent kinase 4/6 inhibitor, is a novel targeted therapy for advanced-stage breast cancer. Although ribociclib-induced cutaneous side effects have been previously noted, they have not been well documented. Herein, we present a case of ribociclib-induced phototoxicity, which manifested as dyschromia over sun-exposed forearms and neck initially and as bullae formation subsequently. A 71-year-old woman with metastatic breast cancer developed dyschromia after daily treatment with ribociclib (600 mg) for 7 months. Skin biopsy of the pigmented lesion revealed interface dermatitis with melanin incontinence and dyskeratotic cells and ballooning keratinocytes with loss of melanocytes in the basal layer. Further, clefting at the basal layer of epidermis was noted in a more hyperpigmented field. Fontana-Masson staining revealed melanophages in the dermis. Human Melanoma Black-45 staining revealed decreased melanocyte numbers in the epidermis above the cleft. Immunohistochemical analyses revealed activated CD1a+ epidermal Langerhans cells and infiltrating CD4+ and CD8+ T cells in the epidermis and dermis, thereby indicating type IV hypersensitivity that was associated with damage to keratinocytes and melanocytes. To prevent progression of bullous dermatitis, we advised the patient to discontinue ribociclib and prescribed oral and topical prednisolone. Due to the risk of phototoxicity, we educated the patient on sun-protection strategies. The patient\'s skin lesions subsided during the 2 months of treatment. Phototoxicity with dyschromia is a rare but significant ribociclib-induced cutaneous side effect. Early diagnosis, rapid ribociclib withdrawal, protection from sunlight, and prompt treatment are critical for preventing subsequent severe bullous dermatosis.

Introduction: Epidermolysis bullosa (EB) is a genetically inherited disease characterized by recurrent bullae and erosions on the skin with numerous signs of dental caries and poor oral hygiene. The aim of this study was to investigate the general clinical and oral findings of patients with EB. Materials and Methods: In this prospective study, the clinical and oral findings and family history of 26 cases with EB were evaluated. The type of EB, gender, age, parental consanguinity, dental caries, oral findings, distribution of lesions and presence of associated anomalies, clinical and oral findings correlated with gender were recorded. Results: All 26 patients with EB had a history of consanguinity and siblings with EB to varying degrees. In our study, malnutrition, anemia and growth retardation, gastrointestinal system complications, hair thinning, hand and nail deformity, ocular problems and renal disease (in one case) were observed with variable frequencies. When the intraoral findings of the patients were investigated, extensive dental caries in all EB types, enamel hypoplasia in junctional EB (JEB) and the presence of tooth-root to be extracted in dystrophic EB (DEB), intraoral bullae and lesions, ankyloglossia, vestibular sulcus insufficiency, microstomia and maxillary atrophy were observed. Three cases had restorative treatment and one case had prosthetic rehabilitation. Conclusions: Oral involvement can be seen with varying frequencies depending on the type of EB and the severity of the disease. It may result from delayed oral and dental rehabilitation due to physical disabilities, limitations and more pressing medical problems. Microstomy, pain from mucosal lesions, and restricted access to the mouth can be caused by poor oral hygiene. Oral complications and caloric needs of individuals with EB should be determined, and individual prophylaxis should be applied to prevent caries formation and protect teeth.

Giant bullous emphysema, also known as \"vanishing lung syndrome\", is a rare manifestation of chronic obstructive pulmonary disease (COPD) that is associated with high mortality. Cigarette smoking and alpha-1 antitrypsin deficiency (A1AD) are two main causes that result in permanent enlargement of airspaces, inefficient gas exchange, fibrosis of the airways, and collapse of the alveoli. A typical presentation can be found in a long-term smoker with dyspnea on exertion and progressive shortness of breath that may be associated with a productive cough. One of the clinical difficulties in diagnosing giant bullous emphysema is separating it from other etiologies like pneumothorax. It is paramount to differentiate giant bullous emphysema from pneumothorax as the management is completely different; both can, however, have similar clinical presentations and radiographic manifestations on initial assessment. In this report, we present the case of a 39-year-old African American male who presented with worsening shortness of breath and productive cough and was found to have bullous emphysema but was misdiagnosed and treated for pneumothorax in the initial encounter. The purpose of this case report is to raise awareness of this condition in the medical literature and discuss the similarity of bullous emphysema and pneumothorax in clinical presentation and radiographic findings, as well as the differences in treatment options.