Publications by authors named "Nooshin Brinster"

64 Publications

A new eruption of bullous pemphigoid within psoriatic plaques following cyclosporine withdrawal.

JAAD Case Rep 2021 Feb 10;8:23-25. Epub 2020 Dec 10.

Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York.

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http://dx.doi.org/10.1016/j.jdcr.2020.12.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7806540PMC
February 2021

Necrolytic acral erythema in a patient with sarcoidosis.

JAAD Case Rep 2020 Nov 6;6(11):1162-1164. Epub 2020 May 6.

The Ronald O. Perelman Department of Dermatology, New York University Langone Health, New York, New York.

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http://dx.doi.org/10.1016/j.jdcr.2020.04.035DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7588658PMC
November 2020

An irregular black patch on the nail plate.

JAAD Case Rep 2020 Oct 31;6(10):1069-1071. Epub 2020 Jul 31.

The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York.

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http://dx.doi.org/10.1016/j.jdcr.2020.07.046DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7509581PMC
October 2020

Polypoid melanoma mistaken for verruca vulgaris.

Cleve Clin J Med 2020 Aug 31;87(9):534-536. Epub 2020 Aug 31.

The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY.

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http://dx.doi.org/10.3949/ccjm.87a.19079DOI Listing
August 2020

A retrospective study on the clinicopathological features of IgG/IgA pemphigus.

J Am Acad Dermatol 2020 Aug 13. Epub 2020 Aug 13.

The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY. Electronic address:

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http://dx.doi.org/10.1016/j.jaad.2020.07.126DOI Listing
August 2020

Scalp nodule in a 59-year-old female.

Int J Dermatol 2020 Jul 8. Epub 2020 Jul 8.

Department of Dermatology, NYU Langone Medical Center, New York, NY, USA.

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http://dx.doi.org/10.1111/ijd.15011DOI Listing
July 2020

Psoriasis With Eczematous Features: A Retrospective Clinicopathologic Study.

Am J Dermatopathol 2021 Feb;43(2):112-118

The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY; and.

Background: Dermatopathologists sometimes encounter patients with features of psoriasis vulgaris and additional changes of eczematous dermatoses. These cases are challenging to diagnose, and the clinical implications are unclear. In the age of targeted therapy, it is important to improve our understanding of these findings so that patients are managed appropriately.

Objective: To characterize the clinical characteristics, histopathological features, diagnostic workup, successful treatment, and outcomes of patients with overlapping histopathologic features of psoriasis vulgaris and eczema.

Methods: We conducted a retrospective chart review of 20 patients who had received the histopathologic diagnosis of psoriasis vulgaris with eczematous changes noted on skin biopsy. A database that included information about clinical characteristics, comorbidities, histopathological features, diagnostic workup, treatment modalities, and outcomes was created and analyzed.

Results: Twenty patients were included in this study, with an average age of 57.3 years. After clinicopathologic correlation, most patients were diagnosed with psoriasis (85%), and the remainder were determined to have an eczematous dermatitis. Thirty-five percent of patients were diagnosed with allergic contact dermatitis, either in combination with psoriasis (6 patients) or alone (1 patient). Topical glucocorticoids were the most common effective therapy used, and systemic therapies were required in nearly half of patients for successful treatment.

Conclusion: This study offers insights into the clinically and histopathologically challenging diagnosis of psoriasis vulgaris with eczematous changes and offers the diagnostic term "eczematized psoriasis" to describe these patients. The presence of allergic contact dermatitis should be considered in these patients.
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http://dx.doi.org/10.1097/DAD.0000000000001711DOI Listing
February 2021

Dermatopathology education during the COVID-19 pandemic: Virtual simulation of the multiheaded microscope.

J Am Acad Dermatol 2020 09 1;83(3):e243-e244. Epub 2020 Jun 1.

The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York.

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http://dx.doi.org/10.1016/j.jaad.2020.05.127DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7262529PMC
September 2020

Telangiectasia macularis eruptiva perstans in the presence of liver cirrhosis.

JAAD Case Rep 2020 May 30;6(5):438-440. Epub 2020 Apr 30.

Department of Dermatology, SUNY Downstate Health Sciences Center, Brooklyn, New York.

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http://dx.doi.org/10.1016/j.jdcr.2020.02.022DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7200198PMC
May 2020

Blaschkoid lichen planus: Throwing a "curve" in the nomenclature of linear lichen planus.

JAAD Case Rep 2020 Mar 26;6(3):237-239. Epub 2020 Feb 26.

Department of Dermatology, Yale School of Medicine, New Haven, Connecticut.

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http://dx.doi.org/10.1016/j.jdcr.2020.01.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7044646PMC
March 2020

Comparison between organismal staining on histology and tissue culture in the diagnosis of cutaneous infection: A retrospective study.

J Am Acad Dermatol 2020 Jun 28;82(6):1400-1408. Epub 2020 Jan 28.

Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York. Electronic address:

Background: In instances of suspected cutaneous infection, the standard of care includes obtaining skin biopsy specimens for histology and tissue culture. Few studies have compared the clinical utility of each test.

Objective: To assess the concordance of results between tissue culture and histology, as well as the clinicopathologic features that may influence the diagnostic yield of each test.

Methods: A retrospective review of all patients who underwent skin biopsy for histology and tissue culture at New York University from 2013 through 2018.

Results: Of 179 patients, 10% had positive concordance, 21% had positive tissue culture only, and 7% had positive histology only. We calculated a kappa correlation coefficient of 0.25 between histology and tissue culture (reference, 0.21-0.39 indicates minimal agreement). Histology exhibited higher sensitivity in detecting fungi, whereas tissue culture was more sensitive in identifying Gram-negative bacteria. Antimicrobial use before biopsy led to significantly fewer positive cultures (37.5% vs 71%; P = .023) in patients ultimately diagnosed with infection.

Limitations: This study was conducted at a single institution, thereby restricting its broad applicability. The lack of a validated criterion standard to diagnose infection also limits interpretation of the results.

Conclusion: Tissue culture and histopathology often yield discordant results. Dermatologists should recognize specific limitations, yet high clinical utility in special circumstances, of tests when approaching cases of suspected infection.
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http://dx.doi.org/10.1016/j.jaad.2020.01.047DOI Listing
June 2020

Practical Direct Immunofluorescence.

Am J Dermatopathol 2020 Feb;42(2):75-85

Associate Professor, The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY.

Direct immunofluorescence (DIF) remains a valuable tool that may be underused because of perceived challenges in the interpretation, limitations, and processing of DIF specimens. The aim of this review is to provide a practical guide for appropriately incorporating DIF in a variety of clinical diseases, such as autoimmune blistering disorders. In vasculitis, the role of DIF continues to evolve, particularly in the setting of IgA vasculitis. Although typically not indicated for the workup of connective tissue disease, DIF may be helpful in cases with negative serologies, nondiagnostic histologic findings, or scarring alopecia. Practical pearls for biopsy technique, specimen handling, and storage are also discussed.
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http://dx.doi.org/10.1097/DAD.0000000000001516DOI Listing
February 2020

Response of Lichen Planopilaris to Pioglitazone Hydrochloride

J Drugs Dermatol 2019 Dec;18(12):1276-1279

Lichen planopilaris (LPP) is a cicatricial alopecia that often causes permanent hair loss. Pioglitazone, a peroxisome proliferator activated receptor-gamma (PPAR- γ) agonist, has demonstrated immunomodulatory properties that may offer an effective treatment modality. This retrospective analysis describes 23 patients with LPP treated with adjunctive pioglitazone. Most (18/25) demonstrated significant reduction in patient-reported symptoms and clinical signs of inflammation. No adverse effects were reported. J Drugs Dermatol. 2019;18(12):1276-1279.
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December 2019

Ulcerative cutaneous plasmacytosis.

JAAD Case Rep 2019 Jun 10;5(6):540-542. Epub 2019 Jun 10.

Department of Dermatology, SUNY Downstate Medical Center, Brooklyn, New York.

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http://dx.doi.org/10.1016/j.jdcr.2019.04.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6558310PMC
June 2019

Acquired acrodermatitis enteropathica due to zinc-depleted parenteral nutrition.

Pediatr Dermatol 2019 Jul 24;36(4):520-523. Epub 2019 May 24.

The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York.

Well-known causes of zinc deficiency, also referred to as acrodermatitis enteropathica (AE), include defects in intestinal zinc transporters and inadequate intake, but a rare cause of acquired zinc deficiency discussed here is an iatrogenic nutritional deficiency caused by parenteral nutrition administered without trace elements. While zinc-depleted parenteral nutrition causing dermatosis of acquired zinc deficiency was first reported in the 1990s, it is now again relevant due to a national vitamin and trace element shortage. A high index of suspicion may be necessary to diagnose zinc deficiency, particularly because early clinical findings are nonspecific. We present this case of acquired zinc deficiency in a patient admitted to a pediatric intensive care unit for respiratory distress and atypical pneumonia, who subsequently developed a severe bullous eruption due to iatrogenic zinc deficiency but was treated effectively with enteral and parenteral zinc supplementation, allowing for rapid re-epithelialization of previously denuded skin.
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http://dx.doi.org/10.1111/pde.13865DOI Listing
July 2019

Vesiculobullous Darier Disease Symptomatically Responsive to Cetirizine

J Drugs Dermatol 2019 Feb;18(2):213-214

Darier disease is an autosomal dominant genodermatosis of abnormal keratinization characterized by hyperkeratotic papules and plaques with a predilection for seborrheic areas. We report a case of a rare vesiculobullous variant of treatment-resistant Darier disease in a 55-year-old woman that failed topical tacrolimus and topical and oral glucocorticoids. Cetirizine was initiated at 10 mg daily and increased to 40 mg daily over four weeks, with resultant marked improvement of the patient’s burning sensation. A punch biopsy revealed a perivascular infiltrate of eosinophils. This patient’s symptomatic improvement with cetirizine, which has antagonizing properties against eosinophils, highlights the potential role of eosinophils in the pathogenesis of vesiculobullous Darier disease. We suggest that major basic protein secreted by eosinophils may propagate blister formation in vesiculobullous Darier disease by disrupting desmosomes. J Drugs Dermatol. 2019;18(2):213-214.
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February 2019

Cutaneous Crohn disease without gastrointestinal involvement in a 9-year-old boy.

Dermatol Online J 2018 Aug 15;24(8). Epub 2018 Aug 15.

The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York.

Cutaneous Crohn disease (CCD) is a rare dermatologic manifestation of Crohn disease and is defined as noncaseating, granulomatous skin lesions noncontiguous with the gastrointestinal tract. It most commonly affects the skin of the legs, although genital CCD is the most common presentation in children. Diagnosis of CCD is made by a combination of clinical and histopathological findings. Therapeutic options include topical, intralesional, and systemic corticosteroids as well as topical and systemic immunosuppressants and immunomodulators. Surgical excision may be considered for refractory cases. We report CCD in a 9-year old boy with penile swelling, granulomatous cheilitis-like lesions, and perianal plaques.
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August 2018

Unusual eruption in association with sorafenib: a case of acquired perforating dermatosis, reactive perforating collagenosis type.

Dermatol Online J 2018 Dec 15;24(12). Epub 2018 Dec 15.

New York University Langone Medical Center, The Ronald O. Perelman Department of Dermatology, New York, New York.

The term, acquired perforating dermatoses (APD), represents a group of skin conditions that develop in adulthood and are characterized by transepidermal elimination of dermal connective tissue. This appears clinically as a papulonodule with a keratotic core. Although APD is typically associated with diabetes mellitus, chronic renal failure, and several other conditions causing generalized pruritus, there have been reports in the literature describing an association of APD with select drugs including sorafenib. We present a case of acquired perforating dermatosis in a patient with HIV and hepatocellular carcinoma undergoing treatment with sorafenib.
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December 2018

Acquired immune deficiency syndrome-related epidemic Kaposi sarcoma.

Dermatol Online J 2018 Dec 15;24(12). Epub 2018 Dec 15.

The Ronald O. Perleman Department of Dermatology, New York University Langone Health, New York, New York.

Kaposi sarcoma (KS) is a vascular neoplasm that is one of the most common human immunodeficiency virus (HIV)-related malignancies. We present the case of a 42-year-old man with a new diagnosis of HIV and acquired immune deficiency syndrome (AIDS)-related epidemic KS.
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December 2018

Frontal fibrosing alopecia: cutaneous associations in women with skin of color.

Cutis 2018 Nov;102(5):335-338

Department of Dermatology, University of Southern California, Los Angeles, California, USA.

Frontal fibrosing alopecia (FFA) was first described as a progressive recession of the frontal hairline in postmenopausal women. Since its initial description, recognition and understanding of FFA has expanded. The condition is now defined as a patterned, symmetric, frontotemporal scarring alopecia that is considered to be histopathologically indistinguishable from lichen planopilaris. Numerous case reports and series have suggested clinical variants of and associations with FFA. In addition to reviewing the literature on FFA's associations, this article includes a case series of 5 women with skin of color (Hispanic and black) who presented with various cutaneous findings in association with FFA, including lichen planus pigmentosus (LPP), facial papules, and eyebrow loss. Recognition of the conditions that can occur in association with FFA in individuals with skin of color is important in further expanding our knowledge and understanding of FFA as a disease entity.
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November 2018

Eosinophils Among the Histological Features of Psoriasis.

Am J Dermatopathol 2019 May;41(5):347-349

Ronald O. Perelman Department of Dermatology, New York University Langone Health, New York, NY.

"Eosinophils are absent in psoriasis" has been dogma for generations; yet, there is little published to support this statement. Two recent studies examining the presence of eosinophils in psoriasis came to contrasting conclusions. We reviewed skin biopsies from 50 patients with clinically confirmed cases of psoriasis vulgaris to characterize the histologic features, with a focus on the number of eosinophils in the dermis. We noted the presence of eosinophils in nearly half of our study population (n = 23, 46.0%). There was no significant association between the presence of eosinophils and degree of spongiosis (P = 0.405). Eosinophil density ranged from 0 to 8 per tissue section. The mean average eosinophil density was 1.04 (range: 0-8) per tissue section. Among cases with eosinophils, there were 73.9% (n = 17/23) of cases with 1-2 eosinophils, and 26.1% (n = 6) with 3-8 eosinophils. Mild to moderate spongiosis was noted in the majority of cases (n = 48; 96.0%). Eosinophils were only present in psoriasis cases with evidence of spongiosis (n = 23; 47.9%). We conclude that eosinophils are not an uncommon finding in the dermis of psoriasis vulgaris, although the number is often few. The presence of eosinophils should not preclude a diagnosis of psoriasis, particularly if other histologic features are supportive.
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http://dx.doi.org/10.1097/DAD.0000000000001303DOI Listing
May 2019

What's New in Dermatopathology: Inflammatory Dermatoses.

Adv Anat Pathol 2019 Jan;26(1):40-55

Departments of Dermatology.

Inflammatory skin diseases encompass a vast array of conditions. The field continues to expand and evolve with resurgence of conditions, through newly recognized medication adverse effects, and via more detailed descriptions of known dermatoses. The importance of clinicopathologic correlation and an up to date knowledge of dermatologic conditions cannot be overstated. This review focuses on an array of recent important developments in the histologic diagnosis of inflammatory conditions that affect the skin.
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http://dx.doi.org/10.1097/PAP.0000000000000210DOI Listing
January 2019

Systemic lupus erythematosus and antineutrophilic cytoplasmic antibody-associated vasculitis overlap syndrome complicated by subarachnoid hemorrhage: case-based review.

Rheumatol Int 2018 12 16;38(12):2329-2335. Epub 2018 Oct 16.

Department of Rheumatology, NYU Langone Health, 550 First Avenue, New York, NY, 10016, USA.

Systemic lupus erythematosus (SLE) and antineutrophil cytoplasmic antibody-associated vasculitis (AAV) overlap syndrome is an inflammatory disorder with a mixed presentation that is characterized by clinical features of both SLE and AAV. Although renal disease predominates, any organ system in the body may be affected. Neurologic manifestation in patients with SLE-AAV overlap syndrome is rare and has only been previously documented as cerebral ischemia. We report a patient with SLE-AAV overlap syndrome diagnosed based on clinical, serologic and biopsy-proven histologic findings who presented with subarachnoid hemorrhage (SAH) secondary to ruptured right anterior cerebral artery aneurysm. To the authors' knowledge, this is the first reported case of SLE-AAV overlap syndrome diagnosed in a patient with a SAH due to an intracranial aneurysm. Neurologic involvement in patients with SLE-AAV overlap syndrome is uncommon and has not been well-studied. Clinicians who encounter patients with neurologic signs that present with symptoms and a serologic profile that correspond to both SLE and AAV criteria, should consider the association between SLE-AAV overlap syndrome and a hemorrhagic stroke, specifically SAH.
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http://dx.doi.org/10.1007/s00296-018-4169-zDOI Listing
December 2018

Superficial granulomatous pyoderma of the leg improved after conservative management with Unna boot and intralesional steroid injections.

JAAD Case Rep 2018 Sep 14;4(8):797-799. Epub 2018 Sep 14.

The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York.

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http://dx.doi.org/10.1016/j.jdcr.2018.03.020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6141699PMC
September 2018

Genital ulcers in an immunocompromised man.

JAAD Case Rep 2018 Aug 14;4(7):619-621. Epub 2018 Jul 14.

The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York.

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http://dx.doi.org/10.1016/j.jdcr.2017.10.024DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6070680PMC
August 2018

Severe Oral Mucositis: A Rare Adverse Event of Pembrolizumab.

J Drugs Dermatol 2018 Jul;17(7):807-809

Treatment of malignancy with anti-programmed cell death 1 (PD-1) immune checkpoint inhibitors can cause mucocutaneous side effects resulting from T cell activation. Due to their recent development, the full side effect profile remains to be fully elucidated, however dermatologic adverse events are most common. The main oral toxicities of these immune checkpoint inhibitors include: xerostomia, dysgeusia, and lichenoid reactions. Oral mucositis occurs more rarely in the setting of PD-1 inhibition, and few other reports of a Grade 3 or higher, severe, stomatitis have been reported in the literature. We present a case of a 78-year-old woman with Grade 3 ulcerative oral mucositis that occurred 13 months after initiation of PD-1 inhibitor, pembrolizumab, for the treatment for lung adenocarcinoma. She was successfully treated with prednisone, and pembrolizumab was temporarily held by her oncologist. Physicians should be aware of the possibility of severe mucositis in the setting of PD-1 inhibitors, as well as the management. J Drugs Dermatol. 2018;17(7):807-809.
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July 2018

Cold panniculitis: Adverse cutaneous effect of whole-body cryotherapy.

JAAD Case Rep 2018 May 1;4(4):344-345. Epub 2018 Apr 1.

Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York.

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http://dx.doi.org/10.1016/j.jdcr.2018.02.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5911975PMC
May 2018

Paraneoplastic Pemphigus in a 34-year-old.

Dermatol Online J 2017 Dec 15;23(12). Epub 2017 Dec 15.

New York University Health, New York.

Paraneoplastic Pemphigus (PNP) is a rare and often fatal autoimmune mucocutaneous blistering disease associated with an underlying malignancy. It is thought to be caused by antibodies to tumor antigenscross-reacting with epithelial antigens, specifically desmosomal and hemidesmosomal antigens. There are at least five clinical morphologic variants of PNP, with the earliest and most consistent finding beingsevere stomatitis. Diagnosis of PNP requires direct immunofluorescence of perilesional skin and indirect immunofluorescence. Treatment of PNP is difficult and largely limited to glucocorticoids, steroid-sparing immunomodulators, rituximab and intravenous immunoglobulin (IVIG). Despite therapies, prognosis is poor. We report a case of paraneoplastic pemphigus in a 34-year old male with severe stomatitis and lichenplanus-like cutaneous lesions.
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December 2017

Epidermolysis bullosa acquisita.

Dermatol Online J 2017 Dec 15;23(12). Epub 2017 Dec 15.

New York University, New York.

Epidermolysis bullosa acquisita (EBA) is a rare, acquired subepidermal blistering disease. EBA is characterized by autoantibodies to collagen VII,which serves to link the epidermis to the dermis. The two most common presentations of EBA are classical noninflammatory EBA and bullous pemphigoid-like EBA. Diagnosis of EBA can be challenging as it sharesclinical and histopathologic features with other blistering diseases. Treatment is often recalcitrant and will often necessitate multiple therapies. We presenta case of a thirty-six-year-old Chinese man with EBA and review the literature.
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December 2017