Review Article
NERDS: A Syndrome with Two Faces
Issue:
Volume 8, Issue 2, December 2025
Pages:
44-50
Received:
7 July 2025
Accepted:
22 July 2025
Published:
8 August 2025
Abstract: NERDS syndrome (Nodules, Eosinophilia, Rheumatism, Dermatitis, Swelling) is a rare eosinophilic inflammatory disorder, characterized by the presence of periarticular or subcutaneous nodules, persistent peripheral eosinophilia, arthralgias resembling rheumatoid arthritis, chronic dermatitis, and limb swelling. To provide a comprehensive overview of the clinical, laboratory, and histopathological features of NERDS syndrome, and to propose a structured diagnostic approach to differentiate it from other eosinophilic or rheumatologic conditions. We conducted a systematic review of published cases of NERDS syndrome, analyzing clinical manifestations, laboratory findings, histopathological features, and response to treatment. We propose a structured diagnostic approach to differentiate it from other eosinophilic or rheumatologic conditions. NERDS syndrome typically presents with firm nodules near joints, rheumatoid-like joint pain, dermatitis, and localized or generalized swelling. Laboratory tests show marked eosinophilia (>1500/μL), elevated inflammatory markers (CRP, ESR), and eosinophilic infiltration in affected tissues. The main differential diagnoses include DRESS syndrome, eosinophilic granulomatosis with polyangiitis, idiopathic hypereosinophilic syndrome, eosinophilic rheumatoid arthritis, and parasitic infections. NERDS syndrome is a distinct eosinophilic disease requiring careful clinical and laboratory evaluation to ensure accurate diagnosis. Systemic corticosteroids remain the first-line therapy and usually result in rapid improvement. In refractory or relapsing cases, immunosuppressive or biologic agents may be considered. The proposed diagnostic approach may facilitate early recognition and optimal management of this underdiagnosed condition.
Abstract: NERDS syndrome (Nodules, Eosinophilia, Rheumatism, Dermatitis, Swelling) is a rare eosinophilic inflammatory disorder, characterized by the presence of periarticular or subcutaneous nodules, persistent peripheral eosinophilia, arthralgias resembling rheumatoid arthritis, chronic dermatitis, and limb swelling. To provide a comprehensive overview of ...
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Case Report
Wolf’s Isotopic Response in a Post Herpes Zoster Patient Forming Superficial Basal Cell Carcinoma
Sachin Dhawan*,
Komal Sharma
Issue:
Volume 8, Issue 2, December 2025
Pages:
51-56
Received:
21 July 2025
Accepted:
5 August 2025
Published:
26 August 2025
DOI:
10.11648/j.ijcd.20250802.12
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Abstract: Basal cell carcinoma (BCC) is a common cutaneous malignancy in Caucasians but has a low incidence in Indian skin. Most commonly, BCC is found in sun-exposed areas, with intermittent ultraviolet exposure as a major risk factor. Although rarely fatal, BCC can cause tissue damage if left untreated. Varicella zoster virus affects both nerve endings and skin, thereby presenting as a rash that may resolve with persisting pain as a symptom. Wolf’s isotopic response (WIR) phenomenon is the formation of a new unrelated disease in the area of a previously healed disease. A 72-year-old housewife with a clinical history of resolved herpes zoster on the scalp presented with an erythematous, atrophic lesion with crusting and fissuring. The post-herpetic neuralgia gradually resolved, but the lesion was not responding to any form of treatment. The histopathological examination demonstrated a picture consistent with superficial basal cell carcinoma. The neurotransmitters released by the nerve endings during an episode of varicella alter the immune control process. This can be a probable cause of a second, unrelated disease, i.e., viral activation in a specific ganglion may alter local immunity, therefore triggering a neoplastic transformation.
Abstract: Basal cell carcinoma (BCC) is a common cutaneous malignancy in Caucasians but has a low incidence in Indian skin. Most commonly, BCC is found in sun-exposed areas, with intermittent ultraviolet exposure as a major risk factor. Although rarely fatal, BCC can cause tissue damage if left untreated. Varicella zoster virus affects both nerve endings and...
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Review Article
Sister Mary Joseph's Nodule - Clinical Aspests, Pathophysiology and Therapeutic Possibilities
Issue:
Volume 8, Issue 2, December 2025
Pages:
57-62
Received:
14 August 2025
Accepted:
22 August 2025
Published:
11 September 2025
DOI:
10.11648/j.ijcd.20250802.13
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Abstract: Sister Mary Joseph’s nodule (SMJN) is an uncommon but clinically important cutaneous sign of visceral malignancy, presenting as metastatic involvement of the umbilicus. It is reported in approximately 1-3% of patients with intra-abdominal or pelvic neoplasms, most frequently originating from adenocarcinomas of the stomach, ovary, colon, or pancreas. Less common primary sites include the endometrium, gallbladder, lung, and prostate. The metastatic spread to the umbilical region can occur via several mechanisms, including direct peritoneal extension, lymphatic and hematogenous dissemination, or through embryonic remnants such as the urachus, the umbilical vein, and the falciform ligament. Clinically, SMJN manifests as a firm, irregular, and sometimes painful umbilical nodule, which may ulcerate or discharge serous or sanguinous fluid. In many cases, it represents the first visible sign of an otherwise occult malignancy, making its recognition of critical diagnostic value for dermatologists and other clinicians. As a readily accessible cutaneous marker, SMJN provides an opportunity for early suspicion of advanced intra-abdominal cancer, which can lead to timely imaging studies, biopsy, and referral for oncological evaluation. The prognosis associated with SMJN remains poor, with median survival reported between 6 and 12 months, reflecting its association with late-stage disease and widespread metastasis. Treatment is primarily palliative and depends on the type and extent of the underlying malignancy. Therapeutic strategies may include systemic chemotherapy, targeted therapy, or limited surgical excision for symptomatic relief, all within the framework of a multidisciplinary approach involving oncology, surgery, radiology, and dermatology. For dermatologists, awareness of SMJN is essential, as it underscores the role of the skin as a window to systemic disease. Prompt recognition and biopsy of suspicious umbilical lesions may not only establish the diagnosis but also provide critical information guiding further management. Although rare, SMJN remains a valuable clinical indicator that bridges dermatology and oncology, highlighting the importance of cutaneous examination in systemic malignancy.
Abstract: Sister Mary Joseph’s nodule (SMJN) is an uncommon but clinically important cutaneous sign of visceral malignancy, presenting as metastatic involvement of the umbilicus. It is reported in approximately 1-3% of patients with intra-abdominal or pelvic neoplasms, most frequently originating from adenocarcinomas of the stomach, ovary, colon, or pancreas...
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,
Nencho Smilov
