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Case Reports

Abstract

Bazex syndrome, otherwise known as acrokeratosis paraneoplastica, is a rare dermatosis that typically presents with psoriasiform scaling to the ears, cheeks, and nose, as well as nail dystrophy. In later stages, involvement spreads to the scalp, trunk, and extremities. Most cases are associated with malignancy, most commonly squamous cell carcinoma of the upper gastrointestinal or respiratory system. We present an unusual case wherein a 51-year-old male presented with left ear pain, muffled hearing, and drainage that progressed over one month to diffuse erythema, edema, scaling, and pruritus of the ears, neck, and face, sparing the lateral cheeks. A shave biopsy of the neck was performed, revealing acanthosis with overlying confluent parakeratosis, focal areas of serum deposition, and scattered apoptotic keratinocytes. The dermis demonstrated marked superficial perivascular and perifollicular mixed inflammation with eosinophils. As these findings are highly suggestive of acrokeratosis paraneoplastica, we recommended screening for malignancy with endoscopy and computed tomography (CT). However, the patient was lost to follow-up. We seek to increase awareness of this entity and recommend considering Bazex syndrome when evaluating nonspecific psoriasiform eruptions, especially in patients without previous history of psoriasis, so that appropriate workup for possible underlying neoplasm can be initiated.