Doctors at the University Hospitals and Medical School of Geneva recently diagnosed a new disease, which they dubbed the “PlayStation palmar hidradenitis” in reference to the popular Sony PlayStation video game console. It was found in an otherwise healthy 12 year-old girl who demonstrated painful lesions along the palms of both hands. They were noted on physical examination to appear red, firm, nodular, and very tender. No other lesions were detected throughout her body.

The examined lesions resemble those in palmoplantar eccrine hidradenitis, a dermatologic disorder often found on the soles of highly-active children. These are presumably caused from intense sweating and pressure to the affected regions. The girl was not particularly active, but her parents remarked that she had been playing “The Sims” on the Sony PlayStation for several hours daily prior to the appearance of the lesions. This phenomenon is reminiscent of “Wiiitis”, an acute tendonitis from excessive repetitive motions while using the Nintendo Wii controller.

Video games have already been associated with a range of health concerns, including addiction, violent behavior, and lack of physical activity. There are even extreme news reports of video game-associated dehydration and death. Now here is more ammunition for critics of the video gaming industry. I personally enjoy video games and would hate to have creativity and development stifled by future fines or regulations. It would be best that parents monitor and set limits to their children’s gaming habits. As for adults, self-control is key. In other words, play with moderation.

• Sources
• Kasraee B, Masouye I, Piguet V. PlayStation plamar hidradenitis. Br J Dermatol 2009 [Epub ahead of print]
• Image: Wikipedia

In today’s issue of the New England Journal of Medicine, there is the case of a 13-year old tuba player who was found to have left facial pain and swelling. Palpation of the parotid gland produced foamy secretions from the duct. There were otherwise no signs of an infection. The only laboratory abnormality was an elevation in the serum amylase level, which could corroborate a parotid gland inflammation or injury. The computed tomography (CT) scan of the head revealed air collections in the parotid gland (image) and the patient was diagnosed with pneumoparotid. According to the article’s authors, “Pneumoparotid can arise in wind-instrument players, glassblowers, and persons in whom air under positive pressure in the oral cavity is forced into the parotid ductal system.” There goes my aspirations in glassblowing.

On a related note, the Journal had published one year ago the case of an abnormal air collection in the head, or pneumocephalus.

• Sources
• Mukundan D, Jenkins O. A tuba player with air in the parotid gland. NEJM 2009;360:710.
• Image Copyright: New England Journal of Medicine

The figurative use of the word “airhead” originated in the late 1970’s and signified a simple-minded or stupid person. But what are the characteristics of the literal “airhead” (or in medical jargon, pneumocephalus)? Does this person also exhibit similar deficits in cognitive function?

The New England Journal of Medicine recently featured the case of an Argentinian patient who spontaneously developed the so-called pneumocephalus. She is a 54 year-old woman who experienced progressive visual, auditory, and speaking abnormalities. A head radiograph demonstrated an air pocket along her left temporal region (enlarged image). A computed tomography (CT) scan revealed similar findings, with the pocket measuring 4 cm x 3 cm x 5 cm. There was no evidence of fracture or trauma.

The cause of the woman’s sensory and speech deficits can be explained by the air compressing against her brain, with indirect compromise of her brainstem. Her symptoms resolved soon after undergoing neurologic surgery to decompress the air and to repair a defect in an adjacent bone (mastoid). No tumor or infection was noted. Although most cases of pneumocephalus occur secondary to head trauma, it is possible the mastoid bone defect discovered during surgery may have been the source for air to enter the skull.

On a lighter note, the next time someone accuses you of being an airhead, you could refute him figuratively and literally with the following response: “I do not manifest the typical characteristics of pneumocephalus”.

• Sources
• Villa RA, Capdevila A. Spontaneous otogenic pneumocephalus. NEJM 2008;358:e13.
• Image Copyright: New England Journal of Medicine

We typically characterize hives as an allergic skin reaction manifested with diffuse swelling, itching, and redness. In an unusual case (with accompanying image) recently reported in the New England Journal of Medicine, a woman developed a reaction of blue hives.

The cause is not as much an enigma as it is atypical. The patient was a 77 year-old woman who underwent surgical resection of a carcinoma of her right breast. In such cases, it is standard procedure to inject a colored dye (in this case, isosulfan blue) into the lymphatic system to delineate its drainage pathway. This allows the surgeon to roughly identify which sentinel lymph nodes to excise and biopsy. The patient, unfortunately, was one of the 1.5% of patients who are allergic to the dye. She subsequently developed hives intraoperatively. Although technically the hives is not blue, the presence of dye created this visual impression.

• Source
• O’Sullivan MJ, Morrow M. Images in clinical medicine. N Engl J Med 2008;358:e6.

The latest issue of The New England Journal of Medicine features an unusual case of trichobezoar (tricho- for “hair”; bezoar for “indigestible mass in stomach or intestine”), otherwise known as a stomach hairball. The patient is an 18 year-old lady who presented to the Rush University Medical Center (Chicago, IL) with a 5-month history of abdominal pain and vomiting with meals. Computed tomography (CT) demonstrates a large mass in the stomach (see Figure A), which likely contributed to the reported symptoms. Esophagogastroduodenoscopy (EGD)–the insertion of a camera via the oral cavity and advanced to the upper segments of the digestive tract–was able to visualize the impressive bezoar (see Figure B), measuring 37.5 x 17.5 x 17.5 cm. It was later discovered the patient had a habit of eating her own hair (trichophagia). The only option for removal was open surgery. The extracted bezoar weighed 4.5 kg and can be seen in Figure C. Not surprisingly, the patient stopped eating her hair, experienced an improvement in symptoms, and eventually regained her weight.

• Source
• Levy RM, Komanduri S. Images in clinical medicine. Trichobezoar. N Engl J Med 2007;357:e23.