We presented a middle-aged woman with nonspecific signs and symptoms, including dyspnea, lower limb edema, and elevated jugular venous pressure. Among these, the skin changes including nail changes, macroglossia and periorbital RASH were the most important clues to suspect primary amyloidosis. Paraclinical studies were anemia, proteinuria and restricted cardiomyopathy. Abdominal fat pad biopsy is usually the first step to confirm the amyloidosis. However, despite the negative histologic result of fat-pad biopsy, we performed duodenal biopsy that confirmed amyloidosis. This case report demonstrates the important value of duodenal tissue in order to conform the diagnosis of amyloidosis.

Human brucellosis is common in developing countries and is a multi-system disease with a broad spectrum of clinical manifestations. Cutaneous lesions associated with brucellosis have been rarely reported in the literature. Here we present a case of a 32-year-old man with history of consumption of cheese made from raw milk seen with occurrence of pancytopenia and diffuse maculopapular RASH during the course of Brucella infection. Physical examination showed fever, splenomegaly, mild hepatomegaly and pruritic maculopapular exanthema over the trunk, arms and legs. Laboratory tests revealed pancytopenia. Parasitic examinations and serologic tests for syphilis, salmonellosis, rickettsiasis, toxoplasmosis, Epstein-Barr virus, human immunodeficiency virus, and hepatitis B and C viruses were negative. There was no history of drug consumption.The Brucella agglutination test titer was 1/1280 and histological examination of skin biopsy showed lymphohistiocytic perivascular infiltrates in the upper dermis.Lesions were interpreted as Brucellar dermatitis, The patient was subsequently treated with oral doxycycline and rifampin and was discharged in good health. If there is suspicion of exposure to infected food products, brucellosis should be included in the differential diagnosis of pancytopenia in Brucella-endemic areas; there may be skin lesions other than purpura that can accompany thrombocytopenia.

Background: Inflammation caused by diapers is one of the most common skin diseases in infants and children all over the world. Among the current therapies, modern chemical medicines are the most common ways of therapy despite their potential risks. In the present study, a variety of available chemical and complementary therapies are presented to facilitate the selection or further research on the range of available treatments with no or fewer side effects.Methods: Published articles on diaper dermatitis were searched in databases and search engines, including Magiran, Irandoc, SID, Ovid, PubMed, Google Scholar, Science Direct, and IranMedex from 2010 to 2018. Finally, a total of 80 articles out of the 138 related articles were reviewed.Results: The treatments were divided into two general categories of topical and systemic treatments. Topical treatments included chemical and herbal subcategories. Corticosteroids, antibacterial agents, antifungals, and other medications composed chemical treatments. According to the information obtained from each category, corticosteroids are the most risky and herbal medicine the safest medication. However, herbal and traditional medicines were the most widely-used treatments for diaper dermatitis.Conclusion: According to the findings, the choice of appropriate prescription and safe treatment for medical personnel and parents of children is limited. Further studies are recommended on traditional medicines that little information is available about them.

Background: Fever of Unknown Origin (FUO) is defined as temperatures of >38/3°c and duration of fever of > 3 weeks with failure to reach a diagnosis despite 1 week of inpatient investigation. Case report: A 20 year-old man presented with FUO and skin RASH from 3 weeks ago. Physical examination revealed cervical adenopathy, decreased sound of heart, splenomegaly with generalized maculopapular RASH. Echocardiography study revealed pericarditis. In abdominal sonography, splenomegaly and in laboratory test leukocytosis with CRP3+, increased liver function test, increased ferritin and other serologic study was normal. In this case with above findings, Adult onset still disease was diagnosed.Conclusion: Although rare, Adult onset still disease can manifest as Fever of unknown origin and if diagnosed rapidly, it would be possible to prevent joint deformity.

Background: Methotrexate is an anti-metabolite drug and one of the folic acid analog that it can play an important and functional role in the treatment of many malignancies and inflammatory diseases. However, the development of petechiae (maculopapular RASH) is a very rare complication. Case Presentation: The patient was a 77 years old woman, Aryan race, who was known a case of severe and progressive rheumatoid arthritis. She previously was treated by multiple drugs such as salicylates, gold, corticosteroids, because of unresponsiveness to these drugs, physician prescribed methotrexate once a day, but patient misunderstands and use three times per day for days. Patient with this history referred to a poisoning emergency. In a physical exam, she had oral and throat erythema and swelling of mucosa. In the funduscopy of eyes, bottom of the eyes was normal and conjunctival eyes were prurient she had multiple petechiae at the upper part of chest and base of neck and shoulders and arms with no swelling around petechiae. The lesion had no itching. She had no other sign besides laboratory analysis showed a high level of creatinine, leukopenia, decreased the level of platelets, patient with high suspicious of methotrexate poisoning underwent to granulocyte-macrophage colony-stimulating factor (GM-CSF) and folic acid treatment. After treatment all of her signs recovered and laboratory tests became normal. Conclusion: At the time of taking methotrexate by the patient, even with appointment of a specialist physician, with any skin signs such as maculopapular RASH without itching, we should consider poisoning with methotrexate, and think appropriately about it. This suggests that methotrexate can cause side effects even at low doses.

The drought myth has been reflected in various forms in Iranian religious and literary works. "Sheikh Mand and Sheikh RASH" is one of the Kurdish folk poems, named "Beyt". This text shows the struggle between good and evil; this study claims that this beyt has a ritualistic and mythical content, and it is an illustration of drought myth. Therefore, after presenting the Persian translation of this Kurdish beyt, the reasons of its being mythical and its relation with drought myth are explained. Later, its elements and characters are compared with one of the important drought myths in Iran (Tiryasht in Avesta). This study shows that there are more than twenty cases of similitudes in form and content between "Sheikh Mand and Sheikh RASH" and "Tiryasht". Also, it was realized that ancient myth patterns have been effective in the formation of "Sheikh Mand and Sheikh RASH".

Dear Editor, The novel H7N9 influenza infection is still the big problem in China and it is under focus for the worldwide epidemic. As an outbreak of new emerging disease, the clinical presentation of the novel H7N9 influenza is very interesting. In most cases, the patients present with acute respiratory tract signs and symptoms, according to the nature of influenza virus infection. In some cases, additional non-respiratory signs and symptoms can be observed.

A 38 year old Iranian man presented with fever and nonproductive cough for 1 month. Patient developed non-pruritic RASHes on hands, forearms (figure 1) and anterior aspect of legs a few days after his fever commencement. He didn’t have any history of allergy, previous lung disease, addiction, travel history or animal contact but had history of unpasteurized milk ingestion. The patient had received amoxicillin for 10 days without improvement before referring to the hospital.