The mucocutaneous manifestations of Corona Virus Disease 2019 (COVID‐19) logically may reflect systemic visceral involvements. These findings are visible and easy to approach like biopsies for exact histopathologic evaluations. This systematic review was conducted to collect the mucocutaneous histopathologic data of COVID‐19 patients for future investigations and interpretations. The COVID‐19 dermatology resource of the Centre of Evidence‐Based Dermatology (CEBD) at the University of Nottingham, PubMed, Scopus, Google Scholar and Medscape was searched for relevant English articles published by June 3, 2020. This review included 31 articles, involving 459 patients. The common primary virus‐related mucocutaneous manifestations are easy to approach in the course of COVID‐19. The authors of this study supposed dermatopathological findings as the predictors of the nature of potential systemic involvements and outcomes of COVID‐19. Scrutinizing these findings can help with adopting more effective therapeutic and management strategies; nevertheless, this review found the severity and time of onset of symptoms not to be associated with the laboratory and histopathological findings. Deterioration of clinical conditions and laboratory tests was also not related to the histopathological findings. It is recommended that meta‐analyses be conducted in the future to detail on these data for having more comprehensive and better conclusion.

Rituximab is a FDA-approved monoclonal antibody for adults with moderate to severe potentially life-threatening pemphigus vulgaris. Recent studies have focused on assessments of efficacy and safety of low-dose rituximab (<2 gram in each cycle). Databases were searched from 2010 to 2020 (last update: 1 June 2020). Nine studies were entered; including180 cases (92: women, 88: men, age range: 9-83 years). The dosages of each Rituximab cycle varied between ultra-low-dose (≤500 mg for a cycle, either multiple infusions or a single infusion), low-dose (2 × 375 mg/m2 or 2 × 500 mg) and modified-dose (3 × 375 mg/m2 or 3 × 500 mg). The efficacy and safety of Rituximab in the studies are known by the recovery time, relapse time, and side events. According to the studies, 2 × 500 can lead to complete remission in a broad range, from 35 to 82%. These differences might be explained by different end-points and variable cumulative corticosteroid dosage after RTX administration. Although the studies showed that low dose RTX is efficient, there are some controversies regarding the choosing low-dose for severe patients. Considering the effectiveness of low-dose, intermediate dose, and ultra-low-dose protocols of Rituximab in inducing remission in pemphigus disease and considering factors such as cost of therapy, and the need to induce a minimum of immunosuppression for a minimum duration in the COVID-19 pandemic, suggested to use low-dose Rituximab protocol (2 infusions of 500 mg Rituximab: interval of 2 weeks) to induce the remission in mild-to-moderate pemphigus patients.

Amyand’s hernia, defined as the presence of the vermiform appendix within an inguinal hernia sac, is a rare clinical entity that is often diagnosed intraoperatively. We report the case of a 55-year-old man with a recurrent right inguinal hernia who presented with acute groin pain, nausea, vomiting, and signs of bowel obstruction. Preoperative imaging suggested an incarcerated inguinal hernia. Emergency surgical exploration revealed an inflamed appendix and cecal component within the hernia sac, confirming the diagnosis of Amyand's hernia. Appendectomy and modified Bassini repair were performed. Histopathological examination demonstrated acute appendicitis associated with a sessile serrated lesion and retention cyst without evidence of dysplasia or malignancy. Follow-up colonoscopy performed three months later showed no synchronous colorectal neoplasia. This case highlights the diagnostic challenges of Amyand's hernia and emphasizes the importance of routine histopathological examination and appropriate postoperative colorectal evaluation when unexpected appendiceal lesions are identified.

Introduction: Idiopathic sclerosing encapsulating peritonitis (SEP), or abdominal cocoon syndrome, is a rare cause of chronic small bowel obstruction characterized by encasement of the small intestine within a fibrocollagenous membrane. Its nonspecific presentation and variable imaging findings frequently make preoperative diagnosis difficult. Case presentation: A 39-year-old man presented with several months of progressive intolerance to solid food, recurrent vomiting, abdominal pain, constipation, and weight loss. He had no history of abdominal surgery, tuberculosis, inflammatory bowel disease, peritoneal dialysis, or recurrent peritonitis. Laboratory evaluation showed mild normocytic anemia and hypokalemia. Upper gastrointestinal endoscopy demonstrated mild chronic Helicobacter pylori gastritis without mechanical obstruction. A repeat contrast-enhanced computed tomography scan showed diffuse gastric and small bowel dilatation with delayed transit but no definite transition point or visible encapsulating membrane. Because symptoms persisted despite conservative management, diagnostic laparoscopy was performed and was converted to laparotomy because of extensive adhesions. The entire small intestine was enclosed within a dense fibrocollagenous membrane. Complete membrane excision and adhesiolysis were performed without bowel resection. Histopathology confirmed SEP and showed no evidence of tuberculosis or malignancy. Chronic opium use may have contributed to gastrointestinal dysmotility but could not explain the structural encapsulation. The patient remained symptom-free for 6 months of follow-up. Conclusion: Idiopathic SEP should be considered in patients with chronic or recurrent obstructive symptoms despite nondiagnostic imaging. Definitive diagnosis may require operative exploration and histopathological examination.