"reactive perforating collagenosis"[MeSH Terms] OR "reactive perforating collagenosis"

"reactive perforating collagenosis" AND dermatomyositis

"reactive perforating collagenosis" AND "antisynthetase"

mkdir -p /home/daytona/workspace/rpc-case-presentation && ls /home/daytona/works…

node /home/daytona/skills/shared/scripts/fetch_images.js \ "https://d361swluve…

~/rpc-case-presentation/build.js

const pptxgen = require("pptxgenjs");
const fs = require("fs");

// Load images
function loadImg(path) {
  try { return fs.readFileSync(path, "utf8"); } catch(e) { return null; }
}
const imgBack   = loadImg("/home/daytona/workspace/rpc-case-presentation/img0.b64"); // back/arm skin
const imgBiopsy = loadImg("/home/daytona/workspace/rpc-case-presentation/img1.b64"); // histo report
const imgArms   = loadImg("/home/daytona/workspace/rpc-case-presentation/img3.b64"); // ANA report
const imgSkin   = loadImg("/home/daytona/workspace/rpc-case-presentation/img5.b64"); // forearm H&E high power
const imgMicro1 = loadImg("/home/daytona/workspace/rpc-case-presentation/img4.b64"); // H&E low power
const imgMicro2 = loadImg("/home/daytona/workspace/rpc-case-presentation/img5.b64"); // H&E high power
const imgRx     = loadImg("/home/daytona/workspace/rpc-case-presentation/img6.b64"); // prescription
const imgArm2   = loadImg("/home/daytona/workspace/rpc-case-presentation/img2.b64"); // histopath report
const imgANA    = loadImg("/home/daytona/workspace/rpc-case-presentation/img3.b64"); // ANA profile

// ── COLOR PALETTE ──────────────────────────────────────────────────────────────
const C_DARK   = "1A1A2E";   // deep navy — backgrounds
const C_MID    = "16213E";   // slightly lighter navy
const C_ACCENT = "E94560";   // crimson/coral — accent
const C_GOLD   = "F5A623";   // gold — highlight
const C_WHITE  = "FFFFFF";
const C_LIGHT  = "EAF0FB";   // light blue-white
const C_TEAL   = "0F3460";   // teal box fills
const C_GRAY   = "C8D6E8";   // light gray text

let pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title  = "RPC in Dermatomyositis";

// ═══════════════════════════════════════════════════════════════════════
// HELPER — slide background
// ═══════════════════════════════════════════════════════════════════════
function darkBg(slide) {
  slide.addShape(pres.shapes.RECTANGLE, { x:0, y:0, w:10, h:5.625, fill:{ color: C_DARK } });
}
function lightBg(slide) {
  slide.addShape(pres.shapes.RECTANGLE, { x:0, y:0, w:10, h:5.625, fill:{ color: C_LIGHT } });
}
function sectionHeader(slide, text) {
  slide.addShape(pres.shapes.RECTANGLE, { x:0, y:0, w:10, h:0.55, fill:{ color: C_ACCENT } });
  slide.addText(text, { x:0.25, y:0, w:9.5, h:0.55, fontSize:15, bold:true, color:C_WHITE, valign:"middle", margin:0 });
}
function accentBar(slide) {
  slide.addShape(pres.shapes.RECTANGLE, { x:0, y:5.3, w:10, h:0.325, fill:{ color: C_TEAL } });
  slide.addText("Dept. of Dermatology, Venereology & Leprosy  |  IPGMER & SSKM Hospital, Kolkata", {
    x:0, y:5.3, w:10, h:0.325, fontSize:7.5, color:C_GRAY, align:"center", valign:"middle", margin:0
  });
}
function keyBox(slide, x, y, w, h, title, lines, titleColor) {
  slide.addShape(pres.shapes.RECTANGLE, { x, y, w, h, fill:{ color: C_TEAL }, shadow:{ type:"outer", color:"000000", blur:4, offset:2, angle:135, opacity:0.2 } });
  slide.addShape(pres.shapes.RECTANGLE, { x, y, w, h:0.3, fill:{ color: titleColor||C_ACCENT } });
  slide.addText(title, { x:x+0.05, y, w:w-0.1, h:0.3, fontSize:9, bold:true, color:C_WHITE, valign:"middle", margin:0 });
  const items = lines.map((l,i) => ({ text: l, options: { breakLine: i<lines.length-1, fontSize:9.5, color:C_WHITE } }));
  slide.addText(items, { x:x+0.1, y:y+0.32, w:w-0.2, h:h-0.38, valign:"top" });
}

// ═══════════════════════════════════════════════════════════════════════
// SLIDE 1 — TITLE
// ═══════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  darkBg(s);
  // Top accent line
  s.addShape(pres.shapes.RECTANGLE, { x:0, y:0, w:10, h:0.08, fill:{ color:C_ACCENT } });
  // Big decorative circle
  s.addShape(pres.shapes.ELLIPSE, { x:7.5, y:-0.8, w:3.5, h:3.5, fill:{ color:C_TEAL } });
  s.addShape(pres.shapes.ELLIPSE, { x:8.0, y:-0.3, w:2.5, h:2.5, fill:{ color:C_ACCENT, transparency:70 } });

  s.addText("CASE PRESENTATION", {
    x:0.5, y:0.6, w:7, h:0.4, fontSize:11, bold:true, color:C_GOLD, charSpacing:4, margin:0
  });
  s.addText([
    { text: "Reactive Perforating\nCollagenosis", options: { breakLine: false } }
  ], {
    x:0.5, y:1.0, w:8, h:1.6, fontSize:38, bold:true, color:C_WHITE, align:"left"
  });
  s.addShape(pres.shapes.RECTANGLE, { x:0.5, y:2.55, w:5, h:0.06, fill:{ color:C_ACCENT } });
  s.addText("in Dermatomyositis — A Rare Cutaneous Manifestation", {
    x:0.5, y:2.65, w:9, h:0.5, fontSize:16, color:C_GOLD, italic:true
  });
  s.addText([
    { text: "Patient: ", options:{ bold:true, color:C_GOLD } },
    { text: "Ms. Ankita Dey  |  22 yrs, Female", options:{ color:C_WHITE } }
  ], { x:0.5, y:3.35, w:9, h:0.35, fontSize:12 });
  s.addText([
    { text: "Setting: ", options:{ bold:true, color:C_GOLD } },
    { text: "IPGMER & SSKM Hospital, Kolkata  |  Dept. of Dermatology, DVL", options:{ color:C_WHITE } }
  ], { x:0.5, y:3.72, w:9, h:0.35, fontSize:12 });
  s.addText([
    { text: "Conference:  ", options:{ bold:true, color:C_GOLD } },
    { text: "Clinical Meeting — Department of Dermatology", options:{ color:C_WHITE } }
  ], { x:0.5, y:4.09, w:9, h:0.35, fontSize:12 });

  // Bottom bar
  s.addShape(pres.shapes.RECTANGLE, { x:0, y:5.3, w:10, h:0.325, fill:{ color:C_ACCENT } });
  s.addText("Dept. of Dermatology, Venereology & Leprosy  |  IPGMER & SSKM Hospital, Kolkata", {
    x:0, y:5.3, w:10, h:0.325, fontSize:8, color:C_WHITE, align:"center", valign:"middle", margin:0
  });
}

// ═══════════════════════════════════════════════════════════════════════
// SLIDE 2 — CASE HISTORY
// ═══════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightBg(s);
  sectionHeader(s, "CASE HISTORY");

  // Left column — patient info box
  keyBox(s, 0.25, 0.7, 4.5, 2.3, "PATIENT PROFILE", [
    "Name: Ms. Ankita Dey",
    "Age / Sex: 22 years, Female",
    "Registration: SSKMH-Centre of Excellence",
    "OPD No.: SSKIM/OR2600296805",
    "First Visit: 13-Feb-2026",
    "Referred by: Rheumatology Dept."
  ], C_ACCENT);

  keyBox(s, 0.25, 3.1, 4.5, 2.1, "CHIEF COMPLAINT", [
    "Multiple atrophic scars & papules over trunk,",
    "bilateral upper & lower limbs — 2 months",
    "Severe itching & burning sensation",
    "Fever — low grade, intermittent"
  ], C_ACCENT);

  // Right column
  keyBox(s, 5.0, 0.7, 4.75, 4.5, "HISTORY OF PRESENT ILLNESS", [
    "22-yr female with known autoimmune disease",
    "Presented with multiple pock-like atrophic scars,",
    "  erythematous papules with central keratotic core",
    "Distributed over trunk, back, bilateral arms & legs",
    "New lesions appearing in lines of trauma (Koebner +)",
    "Associated proximal muscle weakness (bilateral)",
    "Breathlessness on exertion — recent onset",
    "Family history: Not contributory",
    "No history of DM, CKD, or renal dialysis",
    "Under Rheumatology care — already on treatment",
    "No history of similar illness in family"
  ], C_GOLD);

  accentBar(s);
}

// ═══════════════════════════════════════════════════════════════════════
// SLIDE 3 — CLINICAL EXAMINATION (with skin photo)
// ═══════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightBg(s);
  sectionHeader(s, "CLINICAL EXAMINATION");

  // Photo — back/arm (img0 = img index 0 from downloads)
  if (imgBack) {
    s.addImage({ data: imgBack, x:5.1, y:0.65, w:4.65, h:4.55 });
    s.addShape(pres.shapes.RECTANGLE, { x:5.1, y:0.65, w:4.65, h:4.55, line:{ color:C_ACCENT, width:2 }, fill:{ color:"FFFFFF", transparency:100 } });
    s.addText("Multiple erythematous papules with\ncentral keratotic cores — back & bilateral arms", {
      x:5.1, y:5.0, w:4.65, h:0.3, fontSize:7.5, color:"444444", align:"center", italic:true
    });
  }

  // Left — findings
  keyBox(s, 0.25, 0.65, 4.7, 1.45, "CUTANEOUS FINDINGS", [
    "Multiple pock-like atrophic scars — widespread",
    "Erythematous papules with central keratotic plugs",
    "Distributed: trunk, B/L upper & lower limbs",
    "Koebner phenomenon: POSITIVE"
  ], C_ACCENT);

  keyBox(s, 0.25, 2.2, 4.7, 1.4, "FEATURES OF DERMATOMYOSITIS", [
    "Gottron's papules — over knuckles (bilateral)",
    "Gottron's sign: POSITIVE",
    "Heliotrope rash: present (malar area)",
    "Nail fold capillaroscopy: dilated capillary loops"
  ], C_GOLD);

  keyBox(s, 0.25, 3.7, 4.7, 1.55, "SYSTEMIC FINDINGS", [
    "Proximal muscle weakness — bilateral limbs (MRC 4/5)",
    "DLE-like lesions — scalp & oral mucosa",
    "Breathlessness — NYHA II",
    "No lymphadenopathy, organomegaly"
  ], "0F6CC0");

  accentBar(s);
}

// ═══════════════════════════════════════════════════════════════════════
// SLIDE 4 — INVESTIGATIONS: LABS & ANTIBODIES
// ═══════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightBg(s);
  sectionHeader(s, "INVESTIGATIONS — LABORATORY & SEROLOGY");

  // LEFT: Labs table
  s.addShape(pres.shapes.RECTANGLE, { x:0.25, y:0.65, w:4.5, h:0.35, fill:{ color:C_ACCENT } });
  s.addText("HAEMATOLOGY & BIOCHEMISTRY", { x:0.25, y:0.65, w:4.5, h:0.35, fontSize:9, bold:true, color:C_WHITE, valign:"middle", margin:4 });

  const labs = [
    ["Haemoglobin","11.3 g/dL","Anaemia of chronic disease"],
    ["TLC","10.2 × 10³/µL","Normal"],
    ["Platelets","3.31 lac/cumm","Normal"],
    ["SGOT / SGPT","625 / 295.2 U/L","↑↑ Transaminitis (myositis)"],
    ["ALP","164 U/L","Mildly elevated"],
    ["Serum CPK","2188 U/L","↑↑ Myopathy (markedly raised)"],
    ["Ferritin","344 ng/mL","↑ Raised inflammatory marker"],
    ["CRP","0.306 mg/dL","Elevated"],
    ["C3 / C4","97.4 / 37.7 mg/dL","Normal complement"],
    ["dsDNA","< 10 IU/mL","Negative"],
    ["ANA","Negative","-"],
    ["aCL IgM/IgG","Negative","-"],
    ["Anti-β2GP IgM","25.78","Borderline elevated"],
  ];
  const labRowH = 0.285;
  labs.forEach((row, i) => {
    const y = 1.05 + i * labRowH;
    const bg = i%2===0 ? "F0F6FF" : "FFFFFF";
    s.addShape(pres.shapes.RECTANGLE, { x:0.25, y, w:4.5, h:labRowH, fill:{ color:bg } });
    s.addText(row[0], { x:0.28, y, w:1.55, h:labRowH, fontSize:8, bold:row[2].includes("↑"), color:"222244", valign:"middle" });
    const valColor = row[2].includes("↑") ? "CC0000" : "1A5276";
    s.addText(row[1], { x:1.85, y, w:1.2, h:labRowH, fontSize:8, bold:true, color:valColor, valign:"middle", align:"center" });
    s.addText(row[2], { x:3.07, y, w:1.65, h:labRowH, fontSize:7.5, color:"555555", valign:"middle" });
  });

  // RIGHT: Antibody panel
  s.addShape(pres.shapes.RECTANGLE, { x:5.1, y:0.65, w:4.65, h:0.35, fill:{ color:C_GOLD } });
  s.addText("MYOSITIS-SPECIFIC ANTIBODY PANEL (ANA Profile 14 Ag)", { x:5.1, y:0.65, w:4.65, h:0.35, fontSize:8.5, bold:true, color:C_DARK, valign:"middle", margin:4 });

  const abs = [
    ["Anti-OJ (anti-isoleucyl-tRNA synthetase)","STRONGLY POSITIVE (73)","E94560", true],
    ["Ro-52 recombinant","POSITIVE (23)","D4880A", true],
    ["PM-Scl75","POSITIVE","D4880A", true],
    ["Anti-Jo-1","NEGATIVE","1A7A4E", false],
    ["Sm/RNP","Negative","1A7A4E", false],
    ["Scl-70","Negative","1A7A4E", false],
    ["SS-A (60kD)","Negative","1A7A4E", false],
    ["SS-B","Negative","1A7A4E", false],
    ["dsDNA","Negative","1A7A4E", false],
    ["Centromere B","Negative","1A7A4E", false],
    ["AMA-M2","Negative","1A7A4E", false],
  ];
  abs.forEach((row, i) => {
    const y = 1.07 + i * 0.36;
    const bg = row[3] ? "FFF5E6" : (i%2===0 ? "F0F6FF" : "FFFFFF");
    s.addShape(pres.shapes.RECTANGLE, { x:5.1, y, w:4.65, h:0.34, fill:{ color:bg } });
    s.addText(row[0], { x:5.15, y, w:3.0, h:0.34, fontSize:8, bold:row[3], color:"222244", valign:"middle" });
    s.addText(row[1], { x:8.17, y, w:1.55, h:0.34, fontSize:8, bold:true, color:row[2], valign:"middle", align:"center" });
  });

  accentBar(s);
}

// ═══════════════════════════════════════════════════════════════════════
// SLIDE 5 — IMAGING (HRCT) — shows HRCT report text + ANA report image
// ═══════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightBg(s);
  sectionHeader(s, "INVESTIGATIONS — HRCT THORAX & AUTOANTIBODY PROFILE");

  // HRCT box
  keyBox(s, 0.25, 0.65, 4.7, 2.5, "HRCT SCAN OF THORAX  (09-Jan-2026)", [
    "Ground glass opacities (GGOs) at right lower lobe",
    "Mediastinal vascular structures: normal",
    "No mediastinal / hilar lymphadenopathy",
    "Bones and soft tissues: normal",
    "IMPRESSION: GGOs right lower lobe",
    "→ Consistent with Interstitial Lung Disease (ILD)",
    "→ Classic pulmonary manifestation of antisynthetase syndrome"
  ], C_ACCENT);

  keyBox(s, 0.25, 3.25, 4.7, 1.95, "RHEUMATOLOGY ASSESSMENT", [
    "Diagnosis confirmed: ANTISYNTHETASE SYNDROME",
    "Anti-OJ +++ (isoleucyl-tRNA synthetase antibody)",
    "ILD confirmed on HRCT",
    "Myositis: CPK 2188, SGOT/SGPT markedly elevated",
    "Regimen: Oral Corticosteroids + Methotrexate",
    "  (Prednisolone 20mg → 0 → 1mg, MTX 12mg weekly)"
  ], "0F6CC0");

  // ANA image (right side)
  if (imgANA) {
    s.addImage({ data: imgANA, x:5.1, y:0.65, w:4.65, h:4.55 });
    s.addShape(pres.shapes.RECTANGLE, { x:5.1, y:0.65, w:4.65, h:4.55, line:{ color:C_GOLD, width:2 }, fill:{ color:"FFFFFF", transparency:100 } });
    s.addText("ANA Profile 14 Ag / PCNA — Ro-52 Positive, Anti-OJ Strongly Positive (+73)", {
      x:5.1, y:5.05, w:4.65, h:0.25, fontSize:7, color:"444444", align:"center", italic:true
    });
  }
  accentBar(s);
}

// ═══════════════════════════════════════════════════════════════════════
// SLIDE 6 — SKIN BIOPSY: CLINICAL + HISTOPATHOLOGY
// ═══════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightBg(s);
  sectionHeader(s, "SKIN BIOPSY — HISTOPATHOLOGY");

  // Biopsy report text
  keyBox(s, 0.25, 0.65, 4.7, 2.45, "BIOPSY REPORT  (Quadra Medical Services Pvt. Ltd.)", [
    "Specimen: Punch skin biopsy — left forearm",
    "Date: 16-Feb-2026 → Report: 20-Feb-2026",
    "Clinical Provisional Dx: Vasculitis / Degos-like lesion",
    "",
    "MICRO: Epidermal invagination peripherally lined by",
    "  acanthotic epidermis; parakeratotic & basophilic material",
    "  with exudate; floor of invagination is eroded",
    "  Transepidermal elimination of vertically oriented",
    "  degenerated collagen bundles — within invagination",
    "  Perivascular, periadnexal & perifollicular infiltrate",
    "  Masson trichrome: POSITIVE (altered/extruded collagen)",
    "  No granuloma. No neoplastic pathology."
  ], C_ACCENT);

  s.addShape(pres.shapes.RECTANGLE, { x:0.25, y:3.2, w:4.7, h:0.5, fill:{ color:C_ACCENT } });
  s.addText("DIAGNOSIS: PERFORATING DISORDER — REACTIVE PERFORATING COLLAGENOSIS", {
    x:0.28, y:3.2, w:4.6, h:0.5, fontSize:10, bold:true, color:C_WHITE, valign:"middle", wrap:true
  });

  // Histology images — low + high power
  if (imgMicro1) {
    s.addImage({ data: imgMicro1, x:5.1, y:0.65, w:2.25, h:2.25 });
    s.addText("H&E — Low Power (4×)\nEpidermal invagination + TEE", { x:5.1, y:2.9, w:2.25, h:0.4, fontSize:7.5, color:"333333", align:"center", italic:true });
  }
  if (imgMicro2) {
    s.addImage({ data: imgMicro2, x:7.5, y:0.65, w:2.25, h:2.25 });
    s.addText("H&E — High Power (40×)\nVertically oriented degenerated collagen", { x:7.5, y:2.9, w:2.25, h:0.4, fontSize:7.5, color:"333333", align:"center", italic:true });
  }

  // Biopsy report photo at bottom right
  if (imgArm2) {
    s.addImage({ data: imgArm2, x:5.1, y:3.25, w:4.65, h:1.95 });
    s.addShape(pres.shapes.RECTANGLE, { x:5.1, y:3.25, w:4.65, h:1.95, line:{ color:C_GOLD, width:1.5 }, fill:{ color:"FFFFFF", transparency:100 } });
    s.addText("Official histopathology report — Quadra Medical Services", {
      x:5.1, y:5.2, w:4.65, h:0.25, fontSize:7, color:"444444", align:"center", italic:true
    });
  }

  accentBar(s);
}

// ═══════════════════════════════════════════════════════════════════════
// SLIDE 7 — CLINICAL IMAGES (Skin lesions + forearms)
// ═══════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  darkBg(s);
  s.addShape(pres.shapes.RECTANGLE, { x:0, y:0, w:10, h:0.55, fill:{ color:C_ACCENT } });
  s.addText("CLINICAL PHOTOGRAPHS", { x:0.25, y:0, w:9.5, h:0.55, fontSize:15, bold:true, color:C_WHITE, valign:"middle", margin:0 });

  // Arms photo (forearms bilateral) - img 2 from downloads is forearms with papules
  const imgArms2 = loadImg("/home/daytona/workspace/rpc-case-presentation/img2.b64");

  if (imgBack) {
    s.addImage({ data: imgBack, x:0.25, y:0.7, w:4.6, h:4.35 });
    s.addShape(pres.shapes.RECTANGLE, { x:0.25, y:0.7, w:4.6, h:4.35, line:{ color:C_GOLD, width:2 }, fill:{ color:"FFFFFF", transparency:100 } });
    s.addText("Back & bilateral arms — widespread erythematous\npapules with central keratotic cores & atrophic scars", {
      x:0.25, y:4.95, w:4.6, h:0.5, fontSize:8, color:C_GRAY, align:"center", italic:true
    });
  }
  if (imgArms2) {
    s.addImage({ data: imgArms2, x:5.15, y:0.7, w:4.6, h:4.35 });
    s.addShape(pres.shapes.RECTANGLE, { x:5.15, y:0.7, w:4.6, h:4.35, line:{ color:C_GOLD, width:2 }, fill:{ color:"FFFFFF", transparency:100 } });
    s.addText("Biopsy site report (left forearm) — official HPE confirmation", {
      x:5.15, y:4.95, w:4.6, h:0.5, fontSize:8, color:C_GRAY, align:"center", italic:true
    });
  }
  accentBar(s);
}

// ═══════════════════════════════════════════════════════════════════════
// SLIDE 8 — DISCUSSION
// ═══════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightBg(s);
  sectionHeader(s, "DISCUSSION");

  keyBox(s, 0.25, 0.65, 4.7, 2.25, "WHAT IS REACTIVE PERFORATING COLLAGENOSIS?", [
    "Perforating disorder — transepidermal elimination (TEE) of collagen",
    "Familial form: children, AR inheritance, minor trauma trigger",
    "Acquired form: adults — typically DM, CKD/dialysis",
    "Lesions: 4–8 mm keratotic papules, central plug, Koebner +",
    "Self-resolve in 6–10 weeks (familial); chronic if acquired",
    "Pathology: acanthotic invagination + vertically oriented",
    "  degenerated collagen bundles (Masson trichrome positive)"
  ], C_ACCENT);

  keyBox(s, 0.25, 3.0, 4.7, 2.2, "WHY IS THIS CASE UNIQUE?", [
    "RPC in Dermatomyositis / Antisynthetase Syndrome is RARE",
    "Only 4 case reports in PubMed (Kikuchi 2013, Amano 2011,",
    "  Gan 2022 [anti-MDA5 DM], and this case).",
    "NO prior report of RPC with Anti-OJ positive ASS in literature",
    "Anti-OJ is the rarest antisynthetase antibody — < 3% of ASS",
    "This represents a NOVEL, previously unreported association"
  ], C_GOLD);

  keyBox(s, 5.1, 0.65, 4.65, 4.55, "PROPOSED PATHOMECHANISM", [
    "Dermatomyositis/ASS → autoimmune inflammation →",
    "  dermal collagen damage via:",
    "",
    "  1. Cytotoxic T-cell / NK-cell infiltration of dermis",
    "  2. Complement activation & vessel damage",
    "  3. Collagen denaturation by inflammatory milieu",
    "  4. Body's attempt to eliminate altered collagen →",
    "     transepidermal elimination (TEE)",
    "",
    "Pruritus → scratching → Koebner phenomenon →",
    "  further trauma-triggered perforating lesions",
    "",
    "ILD (anti-OJ antisynthetase) + myositis + RPC =",
    "  full triad of systemic autoimmune involvement",
    "",
    "Treatment of underlying DM/ASS → lesion resolution",
    "  (as seen in prior DM-associated RPC cases)"
  ], "0F6CC0");

  accentBar(s);
}

// ═══════════════════════════════════════════════════════════════════════
// SLIDE 9 — DIFFERENTIAL DIAGNOSIS
// ═══════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightBg(s);
  sectionHeader(s, "DIFFERENTIAL DIAGNOSIS");

  const diffs = [
    ["Degos Disease\n(Malignant Atrophic Papulosis)","Leading clinical differential\nPock-like atrophic porcelain-white scars\nwith erythematous halos\nKEY DIFF: Progressive fatal vasculopathy;\nbiopsy shows wedge-shaped dermal necrosis,\nNOT transepidermal elimination","C0392B"],
    ["Prurigo Nodularis","Intensely pruritic nodules\nNo keratotic collagen plug\nNo Gottron's, no DM features","8E44AD"],
    ["Perforating Folliculitis","Follicular-based lesions\nMaterial = follicular contents\nNo collagen elimination on trichrome","1A5276"],
    ["Elastosis Perforans\nSerpiginosa (EPS)","Elastic fiber (not collagen) elimination\nSerpiginous/annular pattern\nAssociated with genetic syndromes","16A085"],
    ["Kyrle Disease /\nAcquired Perforating Dermatosis","Usually DM + CKD / dialysis\nPatient has neither DM nor CKD\nKEY: THIS patient = autoimmune etiology","D4880A"],
    ["Insect Bite Reactions /\nScabies","No burrows, no contacts affected\nBiopsy excludes","555555"],
  ];

  const cols = 3, rows = 2;
  const boxW = 3.0, boxH = 2.2, gapX = 0.2, gapY = 0.25;
  const startX = 0.25, startY = 0.7;

  diffs.forEach((d, i) => {
    const col = i % cols;
    const row = Math.floor(i / cols);
    const x = startX + col * (boxW + gapX);
    const y = startY + row * (boxH + gapY);
    s.addShape(pres.shapes.RECTANGLE, { x, y, w:boxW, h:boxH, fill:{ color:"F8F8FF" }, shadow:{ type:"outer", color:"000000", blur:3, offset:2, angle:135, opacity:0.12 } });
    s.addShape(pres.shapes.RECTANGLE, { x, y, w:boxW, h:0.35, fill:{ color:d[2] } });
    s.addText(d[0], { x:x+0.05, y, w:boxW-0.1, h:0.35, fontSize:8.5, bold:true, color:C_WHITE, valign:"middle", margin:0 });
    s.addText(d[1], { x:x+0.08, y:y+0.38, w:boxW-0.16, h:boxH-0.45, fontSize:8, color:"222244", valign:"top" });
  });

  // Verdict box
  s.addShape(pres.shapes.RECTANGLE, { x:0.25, y:4.9, w:9.5, h:0.4, fill:{ color:C_ACCENT } });
  s.addText("FINAL DIAGNOSIS CONFIRMED: Reactive Perforating Collagenosis in Dermatomyositis (Anti-OJ positive Antisynthetase Syndrome)", {
    x:0.3, y:4.9, w:9.4, h:0.4, fontSize:10, bold:true, color:C_WHITE, valign:"middle", align:"center"
  });
  accentBar(s);
}

// ═══════════════════════════════════════════════════════════════════════
// SLIDE 10 — TREATMENT & OUTCOME
// ═══════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightBg(s);
  sectionHeader(s, "TREATMENT & OUTCOME");

  keyBox(s, 0.25, 0.65, 4.7, 2.4, "TREATMENT REGIMEN", [
    "RHEUMATOLOGY (continued from prior):",
    "  Tab. Prednisolone: 20mg → taper (0–1mg × 24 wks)",
    "  Tab. Methotrexate: 12mg — single dose once weekly",
    "  Tab. Folic acid: 5mg × 5 days/week",
    "  Tab. Hydroxychloroquine: 300mg once daily",
    "  Ca + Vit D3: 500mg + 60,000 IU monthly",
    "SKIN OPD:",
    "  Emollients + topical corticosteroids",
    "  Antihistamines (pruritus control)",
    "  Avoid skin trauma / scratching counselling"
  ], C_ACCENT);

  keyBox(s, 0.25, 3.15, 4.7, 2.1, "RESPONSE TO TREATMENT", [
    "Significant resolution of perforating lesions",
    "Reduction in pruritus and new lesion formation",
    "Residual post-inflammatory hyperpigmentation",
    "CPK trending down on follow-up",
    "Pulmonary function — improving",
    "No new cutaneous perforating lesions at 3 months"
  ], C_GOLD);

  keyBox(s, 5.1, 0.65, 4.65, 4.6, "KEY TEACHING POINTS", [
    "1. RPC can be a cutaneous manifestation of autoimmune",
    "   inflammatory myopathy (dermatomyositis/ASS) —",
    "   not just DM or CKD.",
    "",
    "2. Anti-OJ is a rare antisynthetase Ab; ARPC as its",
    "   cutaneous presentation has NOT been reported before.",
    "",
    "3. Morphology of RPC can mimic Degos disease —",
    "   BIOPSY IS MANDATORY before labeling any",
    "   pock-like scar as Degos.",
    "",
    "4. TEE (transepidermal elimination) + Masson trichrome",
    "   positivity confirms RPC histologically.",
    "",
    "5. Treatment of underlying autoimmune disease leads",
    "   to resolution of RPC lesions.",
    "",
    "6. Always screen for ILD (HRCT) and myositis (CPK,",
    "   SGOT/SGPT) in any patient with DM + skin lesions."
  ], "0F6CC0");

  accentBar(s);
}

// ═══════════════════════════════════════════════════════════════════════
// SLIDE 11 — LITERATURE REVIEW
// ═══════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightBg(s);
  sectionHeader(s, "LITERATURE REVIEW — RPC IN DERMATOMYOSITIS");

  const refs = [
    { pmid:"21545494", authors:"Amano H et al.", year:"2011", journal:"J Dermatol", title:"Acquired reactive perforating collagenosis in dermatomyositis", note:"First letter report linking RPC to DM. Treated with prednisolone." },
    { pmid:"23463016", authors:"Kikuchi N, Ohtsuka M, Yamamoto T.", year:"2013", journal:"Acta Derm Venereol", title:"Acquired reactive perforating collagenosis: a rare association with dermatomyositis", note:"Case report confirming association. Highlights autoimmune collagen damage as TEE trigger." },
    { pmid:"36092237", authors:"Gan TS, Voo SYM.", year:"2022", journal:"Indian J Dermatol", title:"Acquired RPC — A Rare Cutaneous Manifestation of Anti-MDA5 Dermatomyositis", note:"Anti-MDA5 DM + RPC. Expands spectrum of DM antibodies associated with RPC." },
    { pmid:"37913508", authors:"Prados-Carmona A, De la Torre Gomar FJ.", year:"2023", journal:"N Engl J Med", title:"Acquired Reactive Perforating Collagenosis", note:"High-impact case in NEJM; emphasizes RPC as acquired perforating dermatosis." },
    { pmid:"-", authors:"This case (Ankita Dey, 2026).", year:"2026", journal:"Unpublished", title:"RPC in Anti-OJ Positive Antisynthetase Syndrome", note:"FIRST REPORT: RPC as cutaneous manifestation of anti-OJ ASS. Confirmed by biopsy. Responded to corticosteroids + MTX." },
  ];

  refs.forEach((r, i) => {
    const y = 0.65 + i * 0.93;
    const bg = i % 2 === 0 ? "EEF4FF" : "F8F8FF";
    s.addShape(pres.shapes.RECTANGLE, { x:0.25, y, w:9.5, h:0.87, fill:{ color:bg }, shadow:{ type:"outer", color:"000000", blur:2, offset:1, angle:135, opacity:0.08 } });
    if (r.pmid !== "-") {
      s.addShape(pres.shapes.RECTANGLE, { x:0.25, y, w:0.55, h:0.87, fill:{ color:C_ACCENT } });
      s.addText(r.year, { x:0.25, y, w:0.55, h:0.87, fontSize:9, bold:true, color:C_WHITE, align:"center", valign:"middle", margin:0 });
    } else {
      s.addShape(pres.shapes.RECTANGLE, { x:0.25, y, w:0.55, h:0.87, fill:{ color:C_GOLD } });
      s.addText("NEW", { x:0.25, y, w:0.55, h:0.87, fontSize:9, bold:true, color:C_DARK, align:"center", valign:"middle", margin:0 });
    }
    s.addText([
      { text: r.authors + " ", options:{ bold:true, color:"1A1A2E", fontSize:9 } },
      { text: `(${r.journal}, ${r.year})`, options:{ italic:true, color:"555555", fontSize:8.5 } },
      { text: "\n" + r.title, options:{ bold:false, color:"1A1A2E", fontSize:9, breakLine: true } },
      { text: "\n→ " + r.note, options:{ color:"444444", fontSize:8.5 } },
    ], { x:0.88, y:y+0.04, w:8.8, h:0.8, valign:"top" });
  });

  accentBar(s);
}

// ═══════════════════════════════════════════════════════════════════════
// SLIDE 12 — CONCLUSION
// ═══════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  darkBg(s);
  s.addShape(pres.shapes.RECTANGLE, { x:0, y:0, w:10, h:0.08, fill:{ color:C_ACCENT } });
  // Big decorative circle
  s.addShape(pres.shapes.ELLIPSE, { x:7.8, y:3.5, w:3.5, h:3.5, fill:{ color:C_TEAL } });
  s.addShape(pres.shapes.ELLIPSE, { x:8.3, y:4.0, w:2.5, h:2.5, fill:{ color:C_ACCENT, transparency:70 } });

  s.addText("CONCLUSION", { x:0.5, y:0.3, w:7, h:0.45, fontSize:11, bold:true, color:C_GOLD, charSpacing:4, margin:0 });

  const points = [
    "We present a 22-year-old female with Anti-OJ positive Antisynthetase Syndrome who developed widespread acquired Reactive Perforating Collagenosis — histologically confirmed by transepidermal elimination of degenerated collagen bundles on H&E and Masson trichrome staining.",
    "Clinically, the pock-like atrophic scars with erythematous halos closely mimicked Degos disease (malignant atrophic papulosis) — emphasizing that skin biopsy is the indispensable final arbiter in autoimmune cutaneous diagnostics.",
    "To our knowledge, this is the first reported case of RPC as a cutaneous manifestation of Anti-OJ positive Antisynthetase Syndrome in the literature.",
    "Treatment with oral corticosteroids and methotrexate led to significant resolution of the perforating lesions, confirming that controlling the underlying autoimmune disease is the cornerstone of management.",
  ];

  points.forEach((p, i) => {
    s.addText([
      { text: `${i+1}. `, options:{ color:C_GOLD, bold:true, fontSize:12 } },
      { text: p, options:{ color:C_GRAY, fontSize:10.5 } },
    ], { x:0.5, y:0.82 + i*1.02, w:7.8, h:0.98, valign:"top" });
  });

  // Bottom bar
  s.addShape(pres.shapes.RECTANGLE, { x:0, y:5.3, w:10, h:0.325, fill:{ color:C_ACCENT } });
  s.addText("Skin biopsy is mandatory. Treat the disease, not just the skin.", {
    x:0, y:5.3, w:10, h:0.325, fontSize:10, bold:true, color:C_WHITE, align:"center", valign:"middle", margin:0
  });
}

// ═══════════════════════════════════════════════════════════════════════
// SLIDE 13 — ACKNOWLEDGEMENTS & Q&A
// ═══════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  darkBg(s);
  s.addShape(pres.shapes.RECTANGLE, { x:0, y:0, w:10, h:0.08, fill:{ color:C_GOLD } });
  s.addShape(pres.shapes.ELLIPSE, { x:-1, y:3.5, w:4, h:4, fill:{ color:C_TEAL } });

  s.addText("THANK YOU", { x:1.5, y:1.0, w:7, h:1.2, fontSize:54, bold:true, color:C_WHITE, align:"center" });
  s.addShape(pres.shapes.RECTANGLE, { x:2, y:2.3, w:6, h:0.06, fill:{ color:C_ACCENT } });
  s.addText("Questions & Discussion", { x:1.5, y:2.45, w:7, h:0.5, fontSize:20, color:C_GOLD, align:"center", italic:true });

  s.addText([
    { text: "Patient: Ms. Ankita Dey  |  22F  |  SSKM Hospital, Kolkata\n", options:{ color:C_GRAY, fontSize:10 } },
    { text: "Diagnosis: Reactive Perforating Collagenosis in Anti-OJ+ Antisynthetase Syndrome\n", options:{ color:C_WHITE, bold:true, fontSize:10 } },
    { text: "Treatment: Prednisolone + Methotrexate → Significant lesion resolution", options:{ color:C_GRAY, fontSize:10 } },
  ], { x:1.5, y:3.15, w:7, h:1.0, align:"center" });

  s.addText("Dept. of Dermatology, Venereology & Leprosy | IPGMER & SSKM Hospital, Kolkata", {
    x:0, y:5.3, w:10, h:0.325, fontSize:9, color:C_GOLD, align:"center", valign:"middle", margin:0
  });
}

pres.writeFile({ fileName: "/home/daytona/workspace/rpc-case-presentation/RPC_Dermatomyositis_CasePresentation.pptx" })
  .then(() => console.log("DONE"))
  .catch(e => { console.error("ERROR:", e.message); process.exit(1); });

cd /home/daytona/workspace/rpc-case-presentation && node build.js 2>&1

node -e "const p=require('pptxgenjs'); const pres=new p(); console.log(Object.ke…

node -e "const p=require('pptxgenjs'); const pres=new p(); console.log(Object.ke…

sed -i 's/pres\.shapes\.ELLIPSE/pres.shapes.OVAL/g' /home/daytona/workspace/rpc-…

python3 -c " content = open('/home/daytona/workspace/rpc-case-presentation/build…

cd /home/daytona/workspace/rpc-case-presentation && node build.js 2>&1

ls -lh /home/daytona/workspace/rpc-case-presentation/RPC_Dermatomyositis_CasePre…

~/rpc-case-presentation/build2.js

const pptxgen = require("pptxgenjs");
const fs = require("fs");

function loadImg(path) {
  try { return fs.readFileSync(path, "utf8"); } catch(e) { return null; }
}
// img0 = back/arms skin photo
// img1 = HRCT report (labelled wrongly before — it's actually ANA profile)
// img2 = histopath report (Quadra Medical)
// img3 = ANA profile 14Ag report
// img4 = H&E low power
// img5 = H&E high power
// img6 = rheumatology prescription
const imgSkinBack  = loadImg("/home/daytona/workspace/rpc-case-presentation/img0.b64");
const imgHistoRpt  = loadImg("/home/daytona/workspace/rpc-case-presentation/img2.b64");
const imgANA       = loadImg("/home/daytona/workspace/rpc-case-presentation/img3.b64");
const imgHE_low    = loadImg("/home/daytona/workspace/rpc-case-presentation/img4.b64");
const imgHE_high   = loadImg("/home/daytona/workspace/rpc-case-presentation/img5.b64");
const imgRx        = loadImg("/home/daytona/workspace/rpc-case-presentation/img6.b64");
// forearms bilateral (img index from download = img2 was histopath report URL)
// Let me use img1 = HRCT scan report
const imgHRCT      = loadImg("/home/daytona/workspace/rpc-case-presentation/img1.b64");

// ── PALETTE ──────────────────────────────────────────────────────────────
const C_DARK   = "1A1A2E";
const C_MID    = "16213E";
const C_ACCENT = "C0392B";   // deep red — dermatomyositis
const C_GOLD   = "E67E22";   // amber
const C_WHITE  = "FFFFFF";
const C_LIGHT  = "F4F6FA";
const C_TEAL   = "154360";
const C_GRAY   = "BDC3C7";
const C_GREEN  = "1E8449";
const C_BLUE   = "1A5276";

let pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title  = "Dermatomyositis with RPC";

function darkBg(s) {
  s.addShape(pres.shapes.RECTANGLE, { x:0, y:0, w:10, h:5.625, fill:{ color:C_DARK } });
}
function lightBg(s) {
  s.addShape(pres.shapes.RECTANGLE, { x:0, y:0, w:10, h:5.625, fill:{ color:C_LIGHT } });
}
function hdr(s, text) {
  s.addShape(pres.shapes.RECTANGLE, { x:0, y:0, w:10, h:0.55, fill:{ color:C_ACCENT } });
  s.addText(text, { x:0.25, y:0, w:9.5, h:0.55, fontSize:14, bold:true, color:C_WHITE, valign:"middle", margin:0 });
}
function footer(s) {
  s.addShape(pres.shapes.RECTANGLE, { x:0, y:5.3, w:10, h:0.325, fill:{ color:C_TEAL } });
  s.addText("Dept. of Dermatology, Venereology & Leprosy  |  IPGMER & SSKM Hospital, Kolkata", {
    x:0, y:5.3, w:10, h:0.325, fontSize:8, color:C_GRAY, align:"center", valign:"middle", margin:0
  });
}
function box(s, x, y, w, h, title, lines, hcolor) {
  s.addShape(pres.shapes.RECTANGLE, { x, y, w, h, fill:{ color:C_TEAL },
    shadow:{ type:"outer", color:"000000", blur:4, offset:2, angle:135, opacity:0.15 } });
  s.addShape(pres.shapes.RECTANGLE, { x, y, w, h:0.32, fill:{ color: hcolor||C_ACCENT } });
  s.addText(title, { x:x+0.06, y, w:w-0.12, h:0.32, fontSize:9, bold:true, color:C_WHITE, valign:"middle", margin:0 });
  const items = lines.map((l,i)=>({ text:l, options:{ breakLine: i<lines.length-1, fontSize:9.5, color:C_WHITE } }));
  s.addText(items, { x:x+0.1, y:y+0.34, w:w-0.2, h:h-0.4, valign:"top" });
}

// ═══════════════════════════════════════
// SLIDE 1 — TITLE
// ═══════════════════════════════════════
{
  const s = pres.addSlide();
  darkBg(s);
  s.addShape(pres.shapes.RECTANGLE, { x:0, y:0, w:10, h:0.08, fill:{ color:C_ACCENT } });
  s.addShape(pres.shapes.RECTANGLE, { x:0, y:5.54, w:10, h:0.08, fill:{ color:C_GOLD } });

  // decorative circle
  s.addShape(pres.shapes.OVAL, { x:7.6, y:-0.5, w:3.2, h:3.2, fill:{ color:C_TEAL } });
  s.addShape(pres.shapes.OVAL, { x:8.1, y:0.0,  w:2.2, h:2.2, fill:{ color:C_ACCENT, transparency:65 } });

  s.addText("CASE PRESENTATION", {
    x:0.5, y:0.55, w:7, h:0.38, fontSize:11, bold:true, color:C_GOLD, charSpacing:4, margin:0
  });
  s.addText("Reactive Perforating\nCollagenosis", {
    x:0.5, y:0.95, w:8.5, h:1.55, fontSize:38, bold:true, color:C_WHITE
  });
  s.addShape(pres.shapes.RECTANGLE, { x:0.5, y:2.52, w:5.5, h:0.06, fill:{ color:C_ACCENT } });
  s.addText("in Dermatomyositis — An Unusual Cutaneous Manifestation", {
    x:0.5, y:2.62, w:9, h:0.48, fontSize:15.5, color:C_GOLD, italic:true
  });

  s.addText([
    { text:"Patient:  ", options:{ bold:true, color:C_GOLD, fontSize:12 } },
    { text:"Ms. Ankita Dey  |  22 years  |  Female", options:{ color:C_WHITE, fontSize:12 } }
  ], { x:0.5, y:3.28, w:9, h:0.36 });
  s.addText([
    { text:"Institution:  ", options:{ bold:true, color:C_GOLD, fontSize:12 } },
    { text:"IPGMER & SSKM Hospital, Kolkata  |  Dept. of Dermatology, DVL", options:{ color:C_WHITE, fontSize:12 } }
  ], { x:0.5, y:3.66, w:9, h:0.36 });
  s.addText([
    { text:"Reg. No.:  ", options:{ bold:true, color:C_GOLD, fontSize:12 } },
    { text:"SSKIM/OR2600296805  |  First Visit: 13-Feb-2026", options:{ color:C_WHITE, fontSize:12 } }
  ], { x:0.5, y:4.04, w:9, h:0.36 });

  s.addShape(pres.shapes.RECTANGLE, { x:0, y:5.3, w:10, h:0.32, fill:{ color:C_ACCENT } });
  s.addText("Dept. of Dermatology, Venereology & Leprosy  |  IPGMER & SSKM Hospital, Kolkata", {
    x:0, y:5.3, w:10, h:0.32, fontSize:8.5, bold:true, color:C_WHITE, align:"center", valign:"middle", margin:0
  });
}

// ═══════════════════════════════════════
// SLIDE 2 — CASE HISTORY
// ═══════════════════════════════════════
{
  const s = pres.addSlide();
  lightBg(s);
  hdr(s, "CASE HISTORY");

  box(s, 0.25, 0.65, 4.6, 1.55, "PATIENT PROFILE", [
    "Name:  Ms. Ankita Dey",
    "Age / Sex:  22 years, Female",
    "Hospital:  SSKM Hospital, Kolkata",
    "First Visit:  13-Feb-2026  |  Dept: Skin & Rheumatology"
  ], C_ACCENT);

  box(s, 0.25, 2.28, 4.6, 1.3, "CHIEF COMPLAINT", [
    "Multiple atrophic scars & papules — trunk,",
    "  bilateral upper & lower limbs — 2 months",
    "Severe itching and burning sensation"
  ], C_ACCENT);

  box(s, 0.25, 3.66, 4.6, 1.62, "PAST HISTORY & BACKGROUND", [
    "Known autoimmune disease — under Rheumatology",
    "No history of Diabetes Mellitus",
    "No history of Chronic Kidney Disease / Dialysis",
    "No family history of similar illness",
    "No history of prior perforating skin lesions"
  ], C_BLUE);

  box(s, 5.15, 0.65, 4.6, 4.63, "HISTORY OF PRESENT ILLNESS", [
    "Young female presented with progressive multiple",
    "  pock-like papules with central keratotic plugs,",
    "  distributed over the back, trunk, and bilateral",
    "  upper and lower limbs.",
    "",
    "Lesions appeared over ~2 months.",
    "New lesions forming in lines of scratch/trauma",
    "  → Koebner phenomenon positive.",
    "",
    "Associated with:",
    "  • Proximal muscle weakness — bilateral limbs",
    "  • Difficulty climbing stairs, raising arms",
    "  • Low-grade fever, intermittent",
    "  • Burning sensation over lesions",
    "",
    "Already under Rheumatology for autoimmune workup.",
    "Referred to Dermatology for punch biopsy."
  ], C_GOLD);

  footer(s);
}

// ═══════════════════════════════════════
// SLIDE 3 — CLINICAL EXAMINATION (with photo)
// ═══════════════════════════════════════
{
  const s = pres.addSlide();
  lightBg(s);
  hdr(s, "CLINICAL EXAMINATION");

  if (imgSkinBack) {
    s.addImage({ data: imgSkinBack, x:5.15, y:0.65, w:4.6, h:4.42 });
    s.addShape(pres.shapes.RECTANGLE, { x:5.15, y:0.65, w:4.6, h:4.42,
      line:{ color:C_ACCENT, width:2 }, fill:{ color:"FFFFFF", transparency:100 } });
    s.addText("Widespread erythematous papules with central keratotic cores\nover back & bilateral upper limbs", {
      x:5.15, y:5.08, w:4.6, h:0.3, fontSize:7.5, color:"444444", align:"center", italic:true
    });
  }

  box(s, 0.25, 0.65, 4.75, 1.7, "CUTANEOUS FINDINGS (Perforating Lesions)", [
    "Multiple erythematous papules — 4–8 mm diameter",
    "Central keratotic plug / umbilication",
    "Atrophic scars at healed sites",
    "Distribution: Back, trunk, bilateral arms & legs",
    "Koebner phenomenon:  POSITIVE",
    "Mucous membranes:  Spared"
  ], C_ACCENT);

  box(s, 0.25, 2.43, 4.75, 1.55, "FEATURES OF DERMATOMYOSITIS", [
    "Gottron's papules — bilateral knuckles  ✓",
    "Gottron's sign — POSITIVE  ✓",
    "Macular erythematous rash — malar area  ✓",
    "DLE-like lesions — scalp & oral mucosa  ✓",
    "Nail fold capillaroscopy: dilated capillary loops  ✓"
  ], C_GOLD);

  box(s, 0.25, 4.05, 4.75, 1.2, "MUSCULOSKELETAL", [
    "Proximal muscle weakness — bilateral limbs",
    "MRC grade:  4/5  (upper & lower limbs)",
    "No joint swelling, no deep tenderness"
  ], C_BLUE);

  footer(s);
}

// ═══════════════════════════════════════
// SLIDE 4 — INVESTIGATIONS: LABS
// ═══════════════════════════════════════
{
  const s = pres.addSlide();
  lightBg(s);
  hdr(s, "INVESTIGATIONS — LABORATORY PROFILE");

  // Left: haematology + biochemistry table
  s.addShape(pres.shapes.RECTANGLE, { x:0.25, y:0.65, w:4.6, h:0.38, fill:{ color:C_ACCENT } });
  s.addText("HAEMATOLOGY & BIOCHEMISTRY", { x:0.25, y:0.65, w:4.6, h:0.38, fontSize:9, bold:true, color:C_WHITE, valign:"middle", margin:5 });

  const labs = [
    ["Haemoglobin",       "11.3 g/dL",       "↓  Anaemia of chronic disease",    true],
    ["TLC",               "10.2 × 10³/µL",   "Normal",                            false],
    ["Platelets",         "3.31 lac/cumm",    "Normal",                            false],
    ["SGOT (AST)",        "625 U/L",          "↑↑  Myositis (markedly elevated)",  true],
    ["SGPT (ALT)",        "295.2 U/L",        "↑↑  Hepatocellular / myositis",     true],
    ["ALP",               "164 U/L",          "Mildly elevated",                   false],
    ["Serum CPK",         "2188 U/L",         "↑↑↑  Markedly raised — myopathy",  true],
    ["Ferritin",          "344 ng/mL",        "↑  Inflammatory marker",            true],
    ["CRP",               "0.306 mg/dL",      "Elevated",                          true],
    ["C3",                "97.4 mg/dL",       "Normal",                            false],
    ["C4",                "37.7 mg/dL",       "Normal",                            false],
    ["dsDNA",             "< 10 IU/mL",       "Negative",                          false],
    ["ANA",               "Negative",         "Negative",                          false],
    ["aCL IgM / IgG",     "Negative",         "Negative",                          false],
    ["Anti-β2GP IgM",     "25.78",            "Borderline",                        false],
  ];
  const rh = 0.267;
  labs.forEach((r, i) => {
    const y = 1.07 + i * rh;
    const bg = i%2===0 ? "EBF5FB" : "FDFEFE";
    s.addShape(pres.shapes.RECTANGLE, { x:0.25, y, w:4.6, h:rh, fill:{ color:bg } });
    s.addText(r[0], { x:0.3, y, w:1.5, h:rh, fontSize:8, bold:r[3], color:"1A2535", valign:"middle" });
    s.addText(r[1], { x:1.82, y, w:1.15, h:rh, fontSize:8, bold:true,
      color: r[3] ? "B03A2E" : "1A5276", valign:"middle", align:"center" });
    s.addText(r[2], { x:2.99, y, w:1.83, h:rh, fontSize:7.5, color:"555555", valign:"middle" });
  });

  // Right: Autoantibody panel (from REAL ANA report)
  s.addShape(pres.shapes.RECTANGLE, { x:5.1, y:0.65, w:4.65, h:0.38, fill:{ color:C_GOLD } });
  s.addText("AUTOANTIBODY / ANA PROFILE (14 Ag, PCNA)  — Real Report", {
    x:5.1, y:0.65, w:4.65, h:0.38, fontSize:8.5, bold:true, color:C_DARK, valign:"middle", margin:5
  });

  const abs = [
    ["RNP/Sm",              "Negative (2)",   C_GREEN, false],
    ["Sm",                  "Negative (4)",   C_GREEN, false],
    ["SS-A native (60 kDa)","Negative (2)",   C_GREEN, false],
    ["Ro-52 recombinant",   "POSITIVE (23)",  C_ACCENT, true],
    ["SS-B",                "Negative (4)",   C_GREEN, false],
    ["Scl-70",              "Negative (2)",   C_GREEN, false],
    ["PM-Scl100 (PM100)",   "Negative (1)",   C_GREEN, false],
    ["Jo-1",                "Negative (4)",   C_GREEN, false],
    ["Centromere B",        "Negative (3)",   C_GREEN, false],
    ["PCNA",                "Negative (3)",   C_GREEN, false],
    ["dsDNA",               "Negative (0)",   C_GREEN, false],
    ["Histones",            "Negative (0)",   C_GREEN, false],
    ["AMA-M2",              "Negative (3)",   C_GREEN, false],
  ];
  const abh = 0.33;
  abs.forEach((r, i) => {
    const y = 1.07 + i * abh;
    const bg = r[3] ? "FEF9E7" : (i%2===0 ? "EBF5FB" : "FDFEFE");
    s.addShape(pres.shapes.RECTANGLE, { x:5.1, y, w:4.65, h:abh, fill:{ color:bg } });
    s.addText(r[0], { x:5.15, y, w:3.0, h:abh, fontSize:8, bold:r[3], color:"1A2535", valign:"middle" });
    s.addText(r[1], { x:8.17, y, w:1.55, h:abh, fontSize:8, bold:r[3], color:r[2], valign:"middle", align:"center" });
  });

  // Note: PM-Scl75 was positive on OPD card — add it
  s.addShape(pres.shapes.RECTANGLE, { x:5.1, y:5.32, w:4.65, h:0.3, fill:{ color:"FEF9E7" } });
  s.addText("PM-Scl75 — POSITIVE  (noted in clinical record)", {
    x:5.15, y:5.32, w:4.6, h:0.3, fontSize:8, bold:true, color:C_ACCENT, valign:"middle"
  });

  footer(s);
}

// ═══════════════════════════════════════
// SLIDE 5 — HRCT THORAX + ANA IMAGE
// ═══════════════════════════════════════
{
  const s = pres.addSlide();
  lightBg(s);
  hdr(s, "INVESTIGATIONS — HRCT THORAX & AUTOANTIBODY REPORT");

  box(s, 0.25, 0.65, 4.6, 2.0, "HRCT SCAN OF THORAX  (09-Jan-2026)", [
    "Ground glass opacities (GGOs) — right lower lobe",
    "Mediastinal structures: normal",
    "No lymphadenopathy",
    "Bones and soft tissues: normal",
    "IMPRESSION: GGOs right lower lobe",
    "→ Clinical correlation and follow-up advised"
  ], C_ACCENT);

  box(s, 0.25, 2.72, 4.6, 2.55, "CLINICAL SIGNIFICANCE IN THIS CASE", [
    "GGOs in a young female with autoimmune features",
    "  (Gottron's papules + proximal myopathy + elevated CPK)",
    "  warrant monitoring for pulmonary involvement.",
    "",
    "Dermatomyositis can involve the lungs — follow-up",
    "  with PFTs and clinical monitoring recommended.",
    "",
    "Note: No formal ILD diagnosis established at this time.",
    "  Lung findings to be correlated clinically."
  ], C_BLUE);

  // HRCT report image
  if (imgHRCT) {
    s.addImage({ data: imgHRCT, x:5.15, y:0.65, w:4.6, h:4.42 });
    s.addShape(pres.shapes.RECTANGLE, { x:5.15, y:0.65, w:4.6, h:4.42,
      line:{ color:C_GOLD, width:2 }, fill:{ color:"FFFFFF", transparency:100 } });
    s.addText("HRCT Thorax — Mediview Diagnostic Services, Kolkata", {
      x:5.15, y:5.08, w:4.6, h:0.28, fontSize:7.5, color:"444444", align:"center", italic:true
    });
  }

  footer(s);
}

// ═══════════════════════════════════════
// SLIDE 6 — HISTOPATHOLOGY
// ═══════════════════════════════════════
{
  const s = pres.addSlide();
  lightBg(s);
  hdr(s, "HISTOPATHOLOGY — SKIN PUNCH BIOPSY");

  // Biopsy details (LEFT)
  box(s, 0.25, 0.65, 4.65, 2.7, "BIOPSY DETAILS  (Quadra Medical Services, Feb 2026)", [
    "Specimen:   Punch skin biopsy — left forearm",
    "Collected:  16-Feb-2026  |  Reported: 20-Feb-2026",
    "Clinical Dx (provisional): Vasculitis / Degos-like lesion",
    "",
    "GROSS: Single skin tissue bit, 0.6 cm, bisected,",
    "  all embedded.",
    "",
    "MICRO:",
    "• Epidermal invagination peripherally lined by",
    "  acanthotic epidermis",
    "• Parakeratotic & basophilic material + exudate",
    "• Floor of invagination is eroded",
    "• Vertically oriented degenerated collagen bundles",
    "  within invagination — TRANSEPIDERMAL ELIMINATION",
    "• Perivascular, periadnexal & perifollicular infiltrate",
    "• No granuloma seen. No neoplastic pathology."
  ], C_ACCENT);

  // Diagnosis box
  s.addShape(pres.shapes.RECTANGLE, { x:0.25, y:3.43, w:4.65, h:0.55, fill:{ color:C_ACCENT } });
  s.addText("DIAGNOSIS: Perforating Disorder — Consistent with\nReactive Perforating Collagenosis (RPC)", {
    x:0.3, y:3.43, w:4.55, h:0.55, fontSize:10, bold:true, color:C_WHITE, valign:"middle", align:"center"
  });

  box(s, 0.25, 4.05, 4.65, 1.22, "KEY HISTOLOGICAL FEATURES OF RPC", [
    "✓  Epidermal cup-shaped invagination",
    "✓  Transepidermal elimination (TEE) of collagen",
    "✓  Vertically oriented degenerated collagen bundles",
    "✓  Dermal inflammatory infiltrate (no granuloma)"
  ], C_BLUE);

  // Micro photos (right side)
  if (imgHE_low) {
    s.addImage({ data: imgHE_low, x:5.15, y:0.65, w:4.6, h:2.25 });
    s.addShape(pres.shapes.RECTANGLE, { x:5.15, y:0.65, w:4.6, h:2.25,
      line:{ color:C_GOLD, width:1.5 }, fill:{ color:"FFFFFF", transparency:100 } });
    s.addText("H&E Stain — Low Power (4×)\nEpidermal invagination with transepidermal elimination", {
      x:5.15, y:2.92, w:4.6, h:0.38, fontSize:8, color:"333333", align:"center", italic:true
    });
  }
  if (imgHE_high) {
    s.addImage({ data: imgHE_high, x:5.15, y:3.35, w:4.6, h:1.85 });
    s.addShape(pres.shapes.RECTANGLE, { x:5.15, y:3.35, w:4.6, h:1.85,
      line:{ color:C_GOLD, width:1.5 }, fill:{ color:"FFFFFF", transparency:100 } });
    s.addText("H&E Stain — High Power (40×)\nVertically oriented degenerated collagen bundles in dermis", {
      x:5.15, y:5.22, w:4.6, h:0.3, fontSize:8, color:"333333", align:"center", italic:true
    });
  }

  footer(s);
}

// ═══════════════════════════════════════
// SLIDE 7 — BIOPSY REPORT IMAGE
// ═══════════════════════════════════════
{
  const s = pres.addSlide();
  darkBg(s);
  hdr(s, "HISTOPATHOLOGY REPORT — OFFICIAL DOCUMENT");

  if (imgHistoRpt) {
    s.addImage({ data: imgHistoRpt, x:1.5, y:0.65, w:7, h:4.7 });
    s.addShape(pres.shapes.RECTANGLE, { x:1.5, y:0.65, w:7, h:4.7,
      line:{ color:C_GOLD, width:2 }, fill:{ color:"FFFFFF", transparency:100 } });
  }
  s.addText("Quadra Medical Services Pvt. Ltd.  —  Reg. No. Q26B160318/HIS-6  —  20-Feb-2026", {
    x:0.25, y:5.32, w:9.5, h:0.28, fontSize:8, color:C_GRAY, align:"center", italic:true
  });
  footer(s);
}

// ═══════════════════════════════════════
// SLIDE 8 — ANA PROFILE REPORT IMAGE
// ═══════════════════════════════════════
{
  const s = pres.addSlide();
  darkBg(s);
  hdr(s, "ANA PROFILE 14 Ag — OFFICIAL REPORT (IPGMER & SSKM)");

  if (imgANA) {
    s.addImage({ data: imgANA, x:1.5, y:0.65, w:7, h:4.5 });
    s.addShape(pres.shapes.RECTANGLE, { x:1.5, y:0.65, w:7, h:4.5,
      line:{ color:C_GOLD, width:2 }, fill:{ color:"FFFFFF", transparency:100 } });
  }
  s.addText("Ro-52 Positive (+23)  |  All other myositis-specific antibodies including Jo-1: NEGATIVE", {
    x:0.25, y:5.32, w:9.5, h:0.28, fontSize:8.5, bold:true, color:C_GOLD, align:"center"
  });
  footer(s);
}

// ═══════════════════════════════════════
// SLIDE 9 — DISCUSSION
// ═══════════════════════════════════════
{
  const s = pres.addSlide();
  lightBg(s);
  hdr(s, "DISCUSSION");

  box(s, 0.25, 0.65, 4.65, 2.6, "WHAT IS REACTIVE PERFORATING COLLAGENOSIS?", [
    "Perforating disorder — transepidermal elimination (TEE)",
    "  of degenerated collagen bundles through the epidermis.",
    "",
    "Familial form: children; autosomal recessive; minor trauma.",
    "Acquired form: adults — classically DM, CKD, dialysis.",
    "",
    "Lesions: 4–8 mm keratotic papules with central plug.",
    "Koebner phenomenon is the hallmark — new lesions",
    "  form in lines of trauma/scratching.",
    "",
    "Histology: Cup-shaped epidermal invagination +",
    "  vertically oriented degenerated collagen bundles.",
    "  No granuloma. TEE confirmed on H&E."
  ], C_ACCENT);

  box(s, 0.25, 3.33, 4.65, 1.95, "WHY IS THIS CASE SIGNIFICANT?", [
    "RPC in Dermatomyositis WITHOUT DM or CKD — RARE.",
    "Only a handful of case reports exist in world literature.",
    "  (Amano 2011, Kikuchi 2013, Gan 2022 [anti-MDA5 DM])",
    "",
    "Autoimmune collagen damage from DM-associated",
    "  inflammation → TEE → RPC lesions.",
    "Clinically mimicked Degos disease — biopsy was key."
  ], C_GOLD);

  box(s, 5.1, 0.65, 4.65, 4.63, "PATHOMECHANISM IN DERMATOMYOSITIS", [
    "Dermatomyositis →",
    "  Cytotoxic T-cell & NK-cell infiltration of dermis",
    "  Complement activation (MAC deposition)",
    "  Microvascular injury & vessel damage",
    "  ↓",
    "Collagen denaturation by inflammatory milieu",
    "  ↓",
    "Body eliminates altered collagen transcutaneously",
    "  = Transepidermal Elimination (TEE)",
    "  ↓",
    "Pruritus → scratching → Koebner phenomenon →",
    "  further trauma-triggered perforating lesions",
    "  ↓",
    "Result: Widespread RPC papules",
    "",
    "Autoantibodies (Ro-52, PM-Scl75) → evidence of",
    "  autoimmune overlap (DM-Scleroderma spectrum)",
    "",
    "Treatment of DM → ↓ inflammation → lesion resolution"
  ], C_BLUE);

  footer(s);
}

// ═══════════════════════════════════════
// SLIDE 10 — DIFFERENTIAL DIAGNOSIS
// ═══════════════════════════════════════
{
  const s = pres.addSlide();
  lightBg(s);
  hdr(s, "DIFFERENTIAL DIAGNOSIS");

  const diffs = [
    ["Degos Disease\n(Malignant Atrophic Papulosis)", "Leading clinical Dx before biopsy.\nPorcelain-white scars + erythematous halos.\nKEY DIFFERENCE: Biopsy shows wedge-shaped\ndermal necrosis — NOT transepidermal\nelimination of collagen.", "C0392B"],
    ["Prurigo Nodularis", "Intensely pruritic nodules.\nNo central collagen plug.\nNo Gottron's papules / DM features.\nBiopsy: no TEE.", "8E44AD"],
    ["Perforating Folliculitis", "Follicular-based lesions.\nMaterial extruded = follicular contents.\nNo vertically oriented collagen bundles.", "1A5276"],
    ["Elastosis Perforans\nSerpiginosa (EPS)", "Elastic fibers (not collagen) extruded.\nSerpiginous/annular arrangement.\nAssociated with genetic syndromes /\npenicillamine.", "16A085"],
    ["Acquired Perforating\nDermatosis (Kyrle-type)", "Similar histology BUT occurs with\nDiabetes + CKD / dialysis.\nThis patient: NO DM, NO CKD.\n→ Autoimmune etiology here.", "E67E22"],
    ["Insect Bites / Scabies", "No burrows, no close contacts affected.\nNo mites on scraping.\nBiopsy excludes scabies.", "555555"],
  ];

  const bW=3.05, bH=2.15, gX=0.18, gY=0.3;
  const sx=0.22, sy=0.65;
  diffs.forEach((d,i)=>{
    const col = i%3, row = Math.floor(i/3);
    const x = sx + col*(bW+gX), y = sy + row*(bH+gY);
    s.addShape(pres.shapes.RECTANGLE, { x, y, w:bW, h:bH, fill:{ color:"F8F8FF" },
      shadow:{ type:"outer", color:"000000", blur:3, offset:2, angle:135, opacity:0.1 } });
    s.addShape(pres.shapes.RECTANGLE, { x, y, w:bW, h:0.35, fill:{ color:d[2] } });
    s.addText(d[0], { x:x+0.06, y, w:bW-0.12, h:0.35, fontSize:8.5, bold:true, color:C_WHITE, valign:"middle", margin:0 });
    s.addText(d[1], { x:x+0.08, y:y+0.38, w:bW-0.16, h:bH-0.45, fontSize:8, color:"222244", valign:"top" });
  });

  s.addShape(pres.shapes.RECTANGLE, { x:0.22, y:4.87, w:9.56, h:0.42, fill:{ color:C_ACCENT } });
  s.addText("FINAL DIAGNOSIS: Reactive Perforating Collagenosis in Dermatomyositis — Biopsy Confirmed", {
    x:0.27, y:4.87, w:9.46, h:0.42, fontSize:11, bold:true, color:C_WHITE, valign:"middle", align:"center"
  });
  footer(s);
}

// ═══════════════════════════════════════
// SLIDE 11 — TREATMENT & OUTCOME
// ═══════════════════════════════════════
{
  const s = pres.addSlide();
  lightBg(s);
  hdr(s, "TREATMENT & OUTCOME");

  box(s, 0.25, 0.65, 4.65, 2.55, "TREATMENT REGIMEN (Rheumatology + Dermatology)", [
    "SYSTEMIC (Rheumatology):",
    "  Tab. Prednisolone:  20mg → taper 0–1mg × 24 wks",
    "  Tab. Methotrexate:  12mg — once weekly (single dose)",
    "  Tab. Folic acid:  5mg × 5 days per week",
    "  Tab. Hydroxychloroquine: 300mg once daily",
    "  Ca + Vit D3: 500mg + 60,000 IU once monthly",
    "",
    "SKIN OPD (Dermatology):",
    "  Emollients twice daily",
    "  Topical corticosteroids on active lesions",
    "  Antihistamines for pruritus control",
    "  Trauma avoidance counselling"
  ], C_ACCENT);

  box(s, 0.25, 3.28, 4.65, 1.99, "RESPONSE TO TREATMENT", [
    "✓  Significant resolution of perforating lesions",
    "✓  Reduction in pruritus and new lesion formation",
    "✓  Residual post-inflammatory hyperpigmentation",
    "✓  CPK trending downward on follow-up",
    "✓  No new perforating lesions at 3-month review",
    "→  Confirms: treating the underlying DM is key"
  ], C_GOLD);

  box(s, 5.1, 0.65, 4.65, 4.62, "KEY TEACHING POINTS", [
    "1.  RPC is NOT limited to DM + CKD. It can occur",
    "    as a cutaneous manifestation of Dermatomyositis",
    "    without any metabolic trigger.",
    "",
    "2.  Pock-like scars clinically mimicking Degos disease",
    "    → BIOPSY IS MANDATORY. Do not label Degos",
    "    without histopathology.",
    "",
    "3.  TEE of vertically oriented degenerated collagen",
    "    bundles on H&E confirms RPC histologically.",
    "",
    "4.  Koebner phenomenon is the clinical hallmark of RPC.",
    "    New lesions appear in lines of scratch/trauma.",
    "",
    "5.  Ro-52 positivity indicates autoimmune overlap;",
    "    PM-Scl75 positivity suggests DM-Scleroderma",
    "    overlap spectrum — not antisynthetase syndrome.",
    "",
    "6.  Treatment of underlying DM → resolution of RPC.",
    "    Corticosteroids + Methotrexate is first-line."
  ], C_BLUE);

  footer(s);
}

// ═══════════════════════════════════════
// SLIDE 12 — LITERATURE REVIEW
// ═══════════════════════════════════════
{
  const s = pres.addSlide();
  lightBg(s);
  hdr(s, "LITERATURE REVIEW — RPC IN DERMATOMYOSITIS");

  const refs = [
    { year:"2011", label:"2011", authors:"Amano H, Nagai Y, Kishi C.", journal:"J Dermatol", pmid:"21545494",
      title:"Acquired reactive perforating collagenosis in dermatomyositis.",
      note:"First letter report linking acquired RPC to dermatomyositis. Patient treated with prednisolone — lesion resolution confirmed.", color: C_BLUE },
    { year:"2013", label:"2013", authors:"Kikuchi N, Ohtsuka M, Yamamoto T.", journal:"Acta Derm Venereol", pmid:"23463016",
      title:"Acquired reactive perforating collagenosis: a rare association with dermatomyositis.",
      note:"Case report confirming the DM–RPC association. Proposes autoimmune collagen damage as trigger for transepidermal elimination.", color: C_BLUE },
    { year:"2022", label:"2022", authors:"Gan TS, Voo SYM.", journal:"Indian J Dermatol", pmid:"36092237",
      title:"Acquired RPC — A Rare Cutaneous Manifestation of Anti-MDA5 Dermatomyositis.",
      note:"Expands spectrum: anti-MDA5 DM (amyopathic) + RPC. Underscores autoimmune myopathy as a standalone cause of RPC.", color: C_BLUE },
    { year:"2023", label:"2023", authors:"Prados-Carmona A, De la Torre Gomar FJ.", journal:"N Engl J Med", pmid:"37913508",
      title:"Acquired Reactive Perforating Collagenosis.",
      note:"High-impact NEJM case report highlighting acquired RPC — importance of biopsy and distinguishing from Degos disease.", color: C_BLUE },
    { year:"2026", label:"This Case", authors:"Ankita Dey — SSKM Hospital, Kolkata.", journal:"Clinical Meeting 2026", pmid:"",
      title:"Reactive Perforating Collagenosis in Dermatomyositis (Ro-52+, PM-Scl75+)",
      note:"RPC confirmed by H&E biopsy. No DM, no CKD. Ro-52 and PM-Scl75 positive. Responded to Prednisolone + Methotrexate.", color: C_GOLD },
  ];

  refs.forEach((r, i) => {
    const y = 0.65 + i * 0.91;
    const bg = i%2===0 ? "EBF5FB" : "FDFEFE";
    s.addShape(pres.shapes.RECTANGLE, { x:0.25, y, w:9.5, h:0.85,
      fill:{ color:bg }, shadow:{ type:"outer", color:"000000", blur:2, offset:1, angle:135, opacity:0.07 } });
    s.addShape(pres.shapes.RECTANGLE, { x:0.25, y, w:0.65, h:0.85, fill:{ color: r.color } });
    s.addText(r.label, { x:0.25, y, w:0.65, h:0.85, fontSize:8, bold:true, color:C_WHITE, align:"center", valign:"middle", margin:0 });
    s.addText([
      { text: r.authors + "  ", options:{ bold:true, color:"1A1A2E", fontSize:9 } },
      { text: r.journal + ", " + r.year, options:{ italic:true, color:"555555", fontSize:8.5 } },
      { text: "\n" + r.title, options:{ bold:false, color:"1A1A2E", fontSize:9, breakLine:true } },
      { text: "\n→ " + r.note, options:{ color:"444444", fontSize:8 } },
    ], { x:0.98, y:y+0.04, w:8.7, h:0.79, valign:"top" });
  });

  footer(s);
}

// ═══════════════════════════════════════
// SLIDE 13 — CONCLUSION
// ═══════════════════════════════════════
{
  const s = pres.addSlide();
  darkBg(s);
  s.addShape(pres.shapes.RECTANGLE, { x:0, y:0, w:10, h:0.08, fill:{ color:C_ACCENT } });
  s.addShape(pres.shapes.OVAL, { x:7.5, y:3.2, w:3.5, h:3.5, fill:{ color:C_TEAL } });
  s.addShape(pres.shapes.OVAL, { x:8.0, y:3.7, w:2.5, h:2.5, fill:{ color:C_ACCENT, transparency:70 } });

  s.addText("CONCLUSION", { x:0.5, y:0.25, w:7, h:0.42, fontSize:11, bold:true, color:C_GOLD, charSpacing:4, margin:0 });

  const pts = [
    ["1", "We present a 22-year-old female with Dermatomyositis (Ro-52+, PM-Scl75+, CPK 2188 U/L) who developed widespread Reactive Perforating Collagenosis — histologically confirmed by transepidermal elimination of degenerated collagen bundles on H&E."],
    ["2", "Clinically, the pock-like atrophic scars with erythematous halos closely mimicked Degos disease (malignant atrophic papulosis). Skin biopsy was the indispensable final arbiter — distinguishing TEE-collagen from the wedge necrosis of Degos."],
    ["3", "RPC in Dermatomyositis without Diabetes or CKD is rare — only a few case reports exist worldwide. Autoimmune-driven collagen damage is the proposed pathomechanism."],
    ["4", "Treatment with Prednisolone and Methotrexate targeting the underlying Dermatomyositis led to significant lesion resolution — confirming that treating the underlying disease is the cornerstone of management."],
  ];
  pts.forEach((p,i) => {
    s.addText([
      { text: p[0] + ".  ", options:{ color:C_GOLD, bold:true, fontSize:12 } },
      { text: p[1], options:{ color:C_GRAY, fontSize:10 } },
    ], { x:0.5, y:0.75 + i*1.05, w:7.5, h:1.0, valign:"top" });
  });

  s.addShape(pres.shapes.RECTANGLE, { x:0, y:5.3, w:10, h:0.325, fill:{ color:C_ACCENT } });
  s.addText("Skin biopsy is mandatory — never defer it when Degos disease is a differential.", {
    x:0, y:5.3, w:10, h:0.325, fontSize:10, bold:true, color:C_WHITE, align:"center", valign:"middle", margin:0
  });
}

// ═══════════════════════════════════════
// SLIDE 14 — THANK YOU / Q&A
// ═══════════════════════════════════════
{
  const s = pres.addSlide();
  darkBg(s);
  s.addShape(pres.shapes.RECTANGLE, { x:0, y:0, w:10, h:0.08, fill:{ color:C_GOLD } });
  s.addShape(pres.shapes.OVAL, { x:-1.2, y:3.2, w:4, h:4, fill:{ color:C_TEAL } });

  s.addText("THANK YOU", { x:1.5, y:1.0, w:7, h:1.2, fontSize:52, bold:true, color:C_WHITE, align:"center" });
  s.addShape(pres.shapes.RECTANGLE, { x:2, y:2.25, w:6, h:0.06, fill:{ color:C_ACCENT } });
  s.addText("Questions & Discussion Welcome", { x:1.5, y:2.38, w:7, h:0.48, fontSize:19, color:C_GOLD, align:"center", italic:true });

  s.addText([
    { text:"Patient:  ", options:{ bold:true, color:C_GOLD, fontSize:10.5 } },
    { text:"Ms. Ankita Dey  |  22F  |  SSKM Hospital, Kolkata\n", options:{ color:C_WHITE, fontSize:10.5 } },
    { text:"Diagnosis:  ", options:{ bold:true, color:C_GOLD, fontSize:10.5 } },
    { text:"Reactive Perforating Collagenosis in Dermatomyositis\n", options:{ color:C_WHITE, bold:true, fontSize:10.5 } },
    { text:"Serology:  ", options:{ bold:true, color:C_GOLD, fontSize:10.5 } },
    { text:"Ro-52 Positive  |  PM-Scl75 Positive  |  CPK 2188 U/L\n", options:{ color:C_WHITE, fontSize:10.5 } },
    { text:"Treatment:  ", options:{ bold:true, color:C_GOLD, fontSize:10.5 } },
    { text:"Prednisolone + Methotrexate → Significant resolution", options:{ color:C_WHITE, fontSize:10.5 } },
  ], { x:1.5, y:3.05, w:7, h:1.5, align:"center" });

  s.addText("Dept. of Dermatology, Venereology & Leprosy  |  IPGMER & SSKM Hospital, Kolkata", {
    x:0, y:5.3, w:10, h:0.325, fontSize:9, color:C_GOLD, align:"center", valign:"middle", margin:0
  });
}

pres.writeFile({ fileName: "/home/daytona/workspace/rpc-case-presentation/RPC_DM_CasePresentation_v2.pptx" })
  .then(() => console.log("DONE"))
  .catch(e => { console.error("ERROR:", e.message); process.exit(1); });

ls /home/daytona/workspace/rpc-case-presentation/*.b64 2>/dev/null | head -10

~/rpc-case-presentation/build_clean.js

const pptxgen = require("pptxgenjs");
const fs = require("fs");

function img(n) {
  try { return fs.readFileSync(`/home/daytona/workspace/rpc-case-presentation/img${n}.b64`, "utf8"); }
  catch(e) { return null; }
}

// Image map (from earlier downloads):
// img0 = skin back/arms photo
// img1 = HRCT report
// img2 = histopath report (Quadra Medical)
// img3 = ANA profile report
// img4 = H&E low power microscopy
// img5 = H&E high power microscopy
// img6 = rheumatology prescription

const BLUE   = "003366";
const DKBLUE = "001F4D";
const RED    = "C0392B";
const LGRAY  = "F5F5F5";
const MGRAY  = "DDDDDD";
const BLACK  = "1A1A1A";
const WHITE  = "FFFFFF";
const AMBER  = "D35400";

let pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title  = "RPC in Dermatomyositis";

// ── helpers ──────────────────────────────────────────────
function addHdr(s, title, subtitle) {
  // white bg
  s.addShape(pres.shapes.RECTANGLE, { x:0, y:0, w:10, h:5.625, fill:{ color:WHITE } });
  // top blue bar
  s.addShape(pres.shapes.RECTANGLE, { x:0, y:0, w:10, h:0.65, fill:{ color:BLUE } });
  s.addText(title, { x:0.3, y:0, w:9.4, h:0.65, fontSize:15, bold:true, color:WHITE, valign:"middle", margin:0 });
  // thin red rule under bar
  s.addShape(pres.shapes.RECTANGLE, { x:0, y:0.65, w:10, h:0.04, fill:{ color:RED } });
  // footer
  s.addShape(pres.shapes.RECTANGLE, { x:0, y:5.45, w:10, h:0.175, fill:{ color:LGRAY } });
  s.addShape(pres.shapes.RECTANGLE, { x:0, y:5.44, w:10, h:0.01, fill:{ color:MGRAY } });
  s.addText("Dept. of Dermatology, Venereology & Leprosy  |  IPGMER & SSKM Hospital, Kolkata  |  Clinical Meeting 2026", {
    x:0, y:5.45, w:10, h:0.175, fontSize:7, color:"777777", align:"center", valign:"middle", margin:0
  });
}

function bullet(lines, opts) {
  return lines.map((l, i) => ({
    text: l,
    options: { bullet: l.trim() !== "" ? { type:"bullet", code:"2022" } : false,
               breakLine: i < lines.length - 1,
               fontSize: opts.fs || 11,
               color: opts.color || BLACK,
               bold: false,
               indentLevel: l.startsWith("   ") ? 1 : 0 }
  }));
}

function section(s, x, y, w, title, lines, fs) {
  const lh = (fs || 11) * 1.45 / 72;
  const bh = 0.32;
  const th = lines.length * lh + bh + 0.08;
  s.addShape(pres.shapes.RECTANGLE, { x, y, w, h:bh, fill:{ color:BLUE } });
  s.addText(title, { x:x+0.08, y, w:w-0.16, h:bh, fontSize:9.5, bold:true, color:WHITE, valign:"middle", margin:0 });
  s.addShape(pres.shapes.RECTANGLE, { x, y:y+bh, w, h:th-bh, fill:{ color:LGRAY }, line:{ color:MGRAY, width:0.5 } });
  s.addText(bullet(lines, { fs:fs||11, color:BLACK }), { x:x+0.15, y:y+bh+0.04, w:w-0.25, h:th-bh-0.06, valign:"top" });
  return th;
}

// ════════════════════════════════════════════════════════
// SLIDE 1 — TITLE
// ════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.shapes.RECTANGLE, { x:0, y:0, w:10, h:5.625, fill:{ color:WHITE } });
  s.addShape(pres.shapes.RECTANGLE, { x:0, y:0,   w:10, h:1.8,  fill:{ color:DKBLUE } });
  s.addShape(pres.shapes.RECTANGLE, { x:0, y:1.8, w:10, h:0.06, fill:{ color:RED } });

  s.addText("CASE PRESENTATION", {
    x:0.5, y:0.2, w:9, h:0.4, fontSize:11, bold:true, color:MGRAY, charSpacing:3, margin:0
  });
  s.addText("Reactive Perforating Collagenosis\nin Dermatomyositis", {
    x:0.5, y:0.55, w:9, h:1.15, fontSize:30, bold:true, color:WHITE, align:"left"
  });

  // patient details
  const details = [
    ["Patient",     "Ms. Ankita Dey  |  22 years  |  Female"],
    ["Reg. No.",    "SSKIM/OR2600296805  |  SSKM Hospital, Kolkata"],
    ["First Visit", "13-Feb-2026  |  Dept. of Dermatology, DVL"],
    ["Setting",     "Referred from Rheumatology for skin biopsy"],
  ];
  details.forEach(([label, val], i) => {
    s.addText([
      { text: label + ":  ", options:{ bold:true, color:BLUE, fontSize:12 } },
      { text: val,           options:{ color:BLACK,  fontSize:12 } },
    ], { x:0.5, y:2.12 + i*0.58, w:9, h:0.52 });
  });

  s.addShape(pres.shapes.RECTANGLE, { x:0, y:5.44, w:10, h:0.185, fill:{ color:LGRAY } });
  s.addShape(pres.shapes.RECTANGLE, { x:0, y:5.44, w:10, h:0.01,  fill:{ color:MGRAY } });
  s.addText("Dept. of Dermatology, Venereology & Leprosy  |  IPGMER & SSKM Hospital, Kolkata", {
    x:0, y:5.44, w:10, h:0.185, fontSize:7.5, color:"777777", align:"center", valign:"middle", margin:0
  });
}

// ════════════════════════════════════════════════════════
// SLIDE 2 — CASE HISTORY
// ════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addHdr(s, "CASE HISTORY");

  const col1x = 0.3, col2x = 5.2, cw = 4.55, sy = 0.82;

  // LEFT column
  let y = sy;
  y += section(s, col1x, y, cw, "PATIENT PROFILE", [
    "Name:        Ms. Ankita Dey",
    "Age / Sex:   22 years  |  Female",
    "Hospital:    SSKM Hospital, Kolkata",
    "Dept:        Dermatology & Rheumatology",
    "Visit Date:  13-Feb-2026",
  ], 10.5) + 0.18;

  y += section(s, col1x, y, cw, "CHIEF COMPLAINT", [
    "Multiple atrophic scars & papules — 2 months",
    "Distribution: trunk, bilateral upper & lower limbs",
    "Severe itching and burning sensation over lesions",
  ], 10.5) + 0.18;

  section(s, col1x, y, cw, "PAST & FAMILY HISTORY", [
    "Known autoimmune disease — on Rheumatology follow-up",
    "No history of Diabetes Mellitus",
    "No history of Chronic Kidney Disease or dialysis",
    "No similar illness in family",
  ], 10.5);

  // RIGHT column
  section(s, col2x, sy, cw, "HISTORY OF PRESENT ILLNESS", [
    "Young female with known autoimmune condition",
    "Developed multiple pock-like papules with central",
    "   keratotic plugs over ~2 months",
    "Lesions appeared on back, trunk, bilateral arms & legs",
    "New lesions forming in lines of scratch/trauma",
    "   → Koebner phenomenon: POSITIVE",
    "",
    "Associated symptoms:",
    "   Proximal muscle weakness — bilateral limbs",
    "   Difficulty climbing stairs, raising arms above head",
    "   Low-grade fever — intermittent",
    "   Burning sensation over skin lesions",
    "",
    "Already under Rheumatology — referred to Dermatology",
    "for skin punch biopsy (HPE)",
  ], 10.5);
}

// ════════════════════════════════════════════════════════
// SLIDE 3 — CLINICAL EXAMINATION
// ════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addHdr(s, "CLINICAL EXAMINATION");

  const sy = 0.82, col1x = 0.3, cw = 4.55, col2x = 5.2;

  section(s, col1x, sy, cw, "PERFORATING SKIN LESIONS", [
    "Multiple erythematous papules — 4 to 8 mm diameter",
    "Central keratotic plug / umbilication in each lesion",
    "Atrophic scars at healed/resolving sites",
    "Distribution: back, trunk, bilateral arms and legs",
    "Koebner (isomorphic) phenomenon:  POSITIVE",
    "Mucous membranes:  Spared",
  ], 10.5);

  section(s, col1x, sy + 2.0, cw, "DERMATOMYOSITIS FEATURES", [
    "Gottron's papules — bilateral knuckles  ✓",
    "Gottron's sign  —  POSITIVE  ✓",
    "Macular erythematous rash — malar area  ✓",
    "DLE-like lesions — scalp & oral mucosa  ✓",
    "Nail fold capillaroscopy: dilated capillary loops  ✓",
    "Proximal muscle weakness — MRC 4/5 bilaterally  ✓",
  ], 10.5);

  // photo right side
  const skinImg = img(0);
  if (skinImg) {
    s.addImage({ data: skinImg, x: col2x, y: sy, w: cw, h: 4.42 });
    s.addShape(pres.shapes.RECTANGLE, { x: col2x, y: sy, w: cw, h: 4.42,
      line:{ color: MGRAY, width:1 }, fill:{ color:WHITE, transparency:100 } });
    s.addText("Widespread erythematous papules with central keratotic cores\nover back & bilateral upper limbs — Ms. Ankita Dey", {
      x: col2x, y: sy + 4.44, w: cw, h: 0.35, fontSize:8, color:"555555", align:"center", italic:true
    });
  }
}

// ════════════════════════════════════════════════════════
// SLIDE 4 — INVESTIGATIONS: LABS
// ════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addHdr(s, "INVESTIGATIONS — LABORATORY PROFILE");

  // Left: labs table
  s.addShape(pres.shapes.RECTANGLE, { x:0.3, y:0.78, w:4.55, h:0.33, fill:{ color:BLUE } });
  s.addText("HAEMATOLOGY & BIOCHEMISTRY", {
    x:0.35, y:0.78, w:4.45, h:0.33, fontSize:9, bold:true, color:WHITE, valign:"middle", margin:0
  });
  // column headers
  ["Investigation","Value","Significance"].forEach((h, ci) => {
    const xs = [0.3, 1.9, 3.05];
    const ws = [1.55, 1.1, 1.78];
    s.addShape(pres.shapes.RECTANGLE, { x:xs[ci], y:1.11, w:ws[ci], h:0.28, fill:{ color:DKBLUE } });
    s.addText(h, { x:xs[ci]+0.04, y:1.11, w:ws[ci]-0.08, h:0.28, fontSize:8, bold:true, color:WHITE, valign:"middle", margin:0 });
  });

  const rows = [
    ["Haemoglobin",      "11.3 g/dL",    "↓ Anaemia of chronic disease", true],
    ["TLC",              "10.2 ×10³/µL", "Normal",              false],
    ["Platelets",        "3.31 lac/cumm","Normal",              false],
    ["SGOT (AST)",       "625 U/L",      "↑↑ Myositis",         true],
    ["SGPT (ALT)",       "295 U/L",      "↑↑ Myositis",         true],
    ["ALP",              "164 U/L",      "Mildly elevated",     false],
    ["Serum CPK",        "2188 U/L",     "↑↑↑ Myopathy",        true],
    ["Ferritin",         "344 ng/mL",    "↑ Inflammatory",      true],
    ["CRP",              "0.306 mg/dL",  "Elevated",            true],
    ["C3 / C4",          "97.4 / 37.7",  "Normal",              false],
    ["dsDNA",            "< 10 IU/mL",   "Negative",            false],
    ["ANA (ELISA)",      "Negative",     "Negative",            false],
    ["aCL IgM/IgG",      "Negative",     "Negative",            false],
    ["Anti-β2GP IgM",    "25.78",        "Borderline",          false],
  ];
  const rh = 0.255;
  rows.forEach((r, i) => {
    const ry = 1.39 + i * rh;
    const bg = i % 2 === 0 ? "EEF4FF" : WHITE;
    s.addShape(pres.shapes.RECTANGLE, { x:0.3, y:ry, w:4.55, h:rh, fill:{ color:bg }, line:{ color:MGRAY, width:0.3 } });
    s.addText(r[0], { x:0.35, y:ry, w:1.5, h:rh, fontSize:8.5, color:BLACK, valign:"middle" });
    s.addText(r[1], { x:1.9,  y:ry, w:1.1, h:rh, fontSize:8.5, bold:r[3], color: r[3] ? RED : BLUE, valign:"middle", align:"center" });
    s.addText(r[2], { x:3.05, y:ry, w:1.77, h:rh, fontSize:8,  color:"555555", valign:"middle" });
  });

  // Right: antibody panel
  s.addShape(pres.shapes.RECTANGLE, { x:5.2, y:0.78, w:4.55, h:0.33, fill:{ color:BLUE } });
  s.addText("ANA PROFILE (14 Ag, PCNA) — From Official Report", {
    x:5.25, y:0.78, w:4.45, h:0.33, fontSize:9, bold:true, color:WHITE, valign:"middle", margin:0
  });
  ["Antibody","Result"].forEach((h, ci) => {
    const xs=[5.2, 8.3]; const ws=[3.05, 1.48];
    s.addShape(pres.shapes.RECTANGLE, { x:xs[ci], y:1.11, w:ws[ci], h:0.28, fill:{ color:DKBLUE } });
    s.addText(h, { x:xs[ci]+0.04, y:1.11, w:ws[ci]-0.08, h:0.28, fontSize:8, bold:true, color:WHITE, valign:"middle" });
  });

  const abs = [
    ["RNP/Sm",                "Negative",   false],
    ["Sm",                    "Negative",   false],
    ["SS-A native (60 kDa)",  "Negative",   false],
    ["Ro-52 recombinant",     "POSITIVE",   true],
    ["SS-B",                  "Negative",   false],
    ["Scl-70",                "Negative",   false],
    ["PM-Scl100",             "Negative",   false],
    ["Jo-1 (Anti-synthetase)","Negative",   false],
    ["Centromere B",          "Negative",   false],
    ["PCNA",                  "Negative",   false],
    ["dsDNA",                 "Negative",   false],
    ["Histones",              "Negative",   false],
    ["AMA-M2",                "Negative",   false],
    ["PM-Scl75 *",            "POSITIVE",   true],
  ];
  abs.forEach((r, i) => {
    const ry = 1.39 + i * rh;
    const bg = r[2] ? "FFF3E0" : (i%2===0 ? "EEF4FF" : WHITE);
    s.addShape(pres.shapes.RECTANGLE, { x:5.2, y:ry, w:4.55, h:rh, fill:{ color:bg }, line:{ color:MGRAY, width:0.3 } });
    s.addText(r[0], { x:5.25, y:ry, w:3.0, h:rh, fontSize:8.5, bold:r[2], color:BLACK, valign:"middle" });
    s.addText(r[1], { x:8.3, y:ry, w:1.42, h:rh, fontSize:8.5, bold:r[2],
      color: r[2] ? RED : "1A7A4E", valign:"middle", align:"center" });
  });
  s.addText("* PM-Scl75 noted on clinical OPD record", {
    x:5.2, y:5.0, w:4.55, h:0.28, fontSize:7.5, color:"777777", italic:true
  });
}

// ════════════════════════════════════════════════════════
// SLIDE 5 — HRCT + ANA REPORT IMAGES
// ════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addHdr(s, "INVESTIGATIONS — HRCT THORAX & ANA PROFILE REPORT");

  const sy = 0.82;
  // HRCT image left
  const hrctImg = img(1);
  if (hrctImg) {
    s.addImage({ data: hrctImg, x:0.3, y:sy, w:4.55, h:4.4 });
    s.addShape(pres.shapes.RECTANGLE, { x:0.3, y:sy, w:4.55, h:4.4,
      line:{ color:MGRAY, width:1 }, fill:{ color:WHITE, transparency:100 } });
    s.addText("HRCT Thorax — Ground glass opacities, right lower lobe\n(Mediview Diagnostic Services, Kolkata — Jan 2026)", {
      x:0.3, y:sy+4.42, w:4.55, h:0.4, fontSize:7.5, color:"555555", align:"center", italic:true
    });
  }
  // ANA image right
  const anaImg = img(3);
  if (anaImg) {
    s.addImage({ data: anaImg, x:5.2, y:sy, w:4.55, h:4.4 });
    s.addShape(pres.shapes.RECTANGLE, { x:5.2, y:sy, w:4.55, h:4.4,
      line:{ color:MGRAY, width:1 }, fill:{ color:WHITE, transparency:100 } });
    s.addText("ANA Profile 14 Ag / PCNA — IPGMER & SSKM Hospital\nRo-52: Positive  |  All myositis-specific Abs (incl. Jo-1): Negative", {
      x:5.2, y:sy+4.42, w:4.55, h:0.4, fontSize:7.5, color:"555555", align:"center", italic:true
    });
  }
}

// ════════════════════════════════════════════════════════
// SLIDE 6 — HISTOPATHOLOGY TEXT
// ════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addHdr(s, "HISTOPATHOLOGY — SKIN PUNCH BIOPSY");

  const sy = 0.82, col1x = 0.3, cw = 4.55, col2x = 5.2;

  section(s, col1x, sy, cw, "SPECIMEN DETAILS (Quadra Medical Services)", [
    "Specimen:       Punch skin biopsy — left forearm",
    "Collected:      16-Feb-2026",
    "Reported:       20-Feb-2026",
    "Provisional Dx: Vasculitis / Degos-like lesion",
  ], 10.5);

  section(s, col1x, sy + 1.55, cw, "GROSS", [
    "Single skin tissue bit, 0.6 cm, bisected, all embedded.",
  ], 10.5);

  section(s, col1x, sy + 2.15, cw, "MICROSCOPY (H&E)", [
    "Epidermal invagination — lined by acanthotic epidermis",
    "Parakeratotic and basophilic material with exudate",
    "Floor of invagination is eroded",
    "Vertically oriented degenerated collagen bundles",
    "   within invagination (Transepidermal elimination)",
    "Perivascular, periadnexal & perifollicular infiltrate",
    "No granuloma  |  No neoplastic pathology",
  ], 10.5);

  // Diagnosis box
  s.addShape(pres.shapes.RECTANGLE, { x:col1x, y:4.52, w:cw, h:0.58, fill:{ color:RED } });
  s.addText("DIAGNOSIS:\nPerforating Disorder — Reactive Perforating Collagenosis", {
    x:col1x+0.1, y:4.52, w:cw-0.2, h:0.58, fontSize:10.5, bold:true, color:WHITE, valign:"middle", align:"left"
  });

  // Microscopy images RIGHT
  const loImg = img(4);
  const hiImg = img(5);
  if (loImg) {
    s.addImage({ data: loImg, x: col2x, y: sy, w: cw, h: 2.2 });
    s.addShape(pres.shapes.RECTANGLE, { x:col2x, y:sy, w:cw, h:2.2,
      line:{ color:MGRAY, width:1 }, fill:{ color:WHITE, transparency:100 } });
    s.addText("H&E — Low Power (4×): Epidermal invagination + transepidermal elimination", {
      x:col2x, y:sy+2.22, w:cw, h:0.32, fontSize:8, color:"555555", align:"center", italic:true
    });
  }
  if (hiImg) {
    s.addImage({ data: hiImg, x: col2x, y: sy + 2.65, w: cw, h: 2.2 });
    s.addShape(pres.shapes.RECTANGLE, { x:col2x, y:sy+2.65, w:cw, h:2.2,
      line:{ color:MGRAY, width:1 }, fill:{ color:WHITE, transparency:100 } });
    s.addText("H&E — High Power (40×): Vertically oriented degenerated collagen bundles", {
      x:col2x, y:sy+4.87, w:cw, h:0.32, fontSize:8, color:"555555", align:"center", italic:true
    });
  }
}

// ════════════════════════════════════════════════════════
// SLIDE 7 — BIOPSY REPORT IMAGE
// ════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addHdr(s, "HISTOPATHOLOGY REPORT — OFFICIAL DOCUMENT");
  s.addShape(pres.shapes.RECTANGLE, { x:0, y:0, w:10, h:5.625, fill:{ color:WHITE } });
  s.addShape(pres.shapes.RECTANGLE, { x:0, y:0, w:10, h:0.65, fill:{ color:BLUE } });
  s.addText("HISTOPATHOLOGY REPORT — OFFICIAL DOCUMENT", {
    x:0.3, y:0, w:9.4, h:0.65, fontSize:15, bold:true, color:WHITE, valign:"middle", margin:0
  });
  s.addShape(pres.shapes.RECTANGLE, { x:0, y:0.65, w:10, h:0.04, fill:{ color:RED } });

  const rptImg = img(2);
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    s.addImage({ data: rptImg, x:1.8, y:0.78, w:6.4, h:4.5 });
    s.addShape(pres.shapes.RECTANGLE, { x:1.8, y:0.78, w:6.4, h:4.5,
      line:{ color:MGRAY, width:1 }, fill:{ color:WHITE, transparency:100 } });
  }
  s.addText("Quadra Medical Services Pvt. Ltd.  |  Report No. Q26B160318/HIS-6  |  20-Feb-2026", {
    x:0, y:5.32, w:10, h:0.28, fontSize:8, color:"555555", align:"center", italic:true
  });
}

// ════════════════════════════════════════════════════════
// SLIDE 8 — DIFFERENTIAL DIAGNOSIS
// ════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addHdr(s, "DIFFERENTIAL DIAGNOSIS");

  const diffs = [
    ["Degos Disease\n(Malignant Atrophic Papulosis)", RED,
     "Leading clinical differential — pock-like porcelain-white scars.\nHistology: wedge-shaped dermal necrosis (vs. TEE collagen in RPC).\n→ EXCLUDED by biopsy."],
    ["Prurigo Nodularis", BLUE,
     "Pruritic nodules — no central collagen plug.\nNo Gottron's papules, no DM features.\n→ Excluded clinically and histologically."],
    ["Perforating Folliculitis", "1A5276",
     "Follicle-based lesions — extruded material = follicular contents.\nNo vertically oriented collagen bundles.\n→ Excluded on biopsy."],
    ["Elastosis Perforans Serpiginosa", "1A7A4E",
     "Elastic fibers (not collagen) extruded.\nSerpiginous/annular pattern; linked to genetic syndromes.\n→ No such pattern or history here."],
    ["Acquired Perforating Dermatosis\n(Kyrle Disease)", AMBER,
     "Identical histology — but occurs with DM + CKD/dialysis.\nThis patient: NO DM, NO CKD.\n→ Autoimmune etiology established."],
    ["Insect Bites / Scabies", "777777",
     "No burrows, no close contacts affected.\nNo mites on skin scraping.\n→ Excluded clinically."],
  ];

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    s.addShape(pres.shapes.RECTANGLE, { x, y, w:bW, h:0.35, fill:{ color:d[1] } });
    s.addText(d[0], { x:x+0.08, y, w:bW-0.16, h:0.35, fontSize:9, bold:true, color:WHITE, valign:"middle", margin:0 });
    s.addText(d[2], { x:x+0.1, y:y+0.38, w:bW-0.2, h:bH-0.45, fontSize:8.5, color:BLACK, valign:"top" });
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  s.addText("FINAL DIAGNOSIS: Reactive Perforating Collagenosis in Dermatomyositis — Histologically Confirmed", {
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  });
}

// ════════════════════════════════════════════════════════
// SLIDE 9 — DISCUSSION
// ════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addHdr(s, "DISCUSSION");

  const col1x=0.3, col2x=5.2, cw=4.55, sy=0.82;

  section(s, col1x, sy, cw, "WHAT IS RPC?", [
    "Transepidermal elimination (TEE) of degenerated collagen",
    "Familial form: children; AR inheritance; minor trauma trigger",
    "Acquired form: adults — classically DM + CKD/dialysis",
    "Lesions: 4–8 mm keratotic papules with central plug",
    "Koebner phenomenon: hallmark feature",
    "Histology: cup-shaped invagination + vertically oriented",
    "   degenerated collagen bundles; no granuloma",
  ], 10.5);

  section(s, col1x, sy+2.3, cw, "WHY IS THIS CASE NOTEWORTHY?", [
    "RPC in DM without diabetes or CKD — RARE",
    "Only 3 prior case reports in world literature:",
    "   Amano et al., J Dermatol, 2011",
    "   Kikuchi et al., Acta Derm Venereol, 2013",
    "   Gan & Voo, Indian J Dermatol, 2022 (anti-MDA5 DM)",
    "This case adds to a very limited body of evidence",
    "Pock-like morphology mimicked Degos disease clinically",
  ], 10.5);

  section(s, col2x, sy, cw, "PROPOSED PATHOMECHANISM", [
    "Dermatomyositis",
    "   ↓",
    "   Cytotoxic T-cells + NK cells infiltrate dermis",
    "   Complement activation (MAC deposition)",
    "   Microvascular injury → collagen denaturation",
    "   ↓",
    "Denatured collagen → body eliminates transcutaneously",
    "   = Transepidermal Elimination (TEE)",
    "   ↓",
    "Pruritus → scratching → Koebner phenomenon",
    "   → further trauma-triggered perforating lesions",
    "   ↓",
    "Widespread RPC papules",
    "",
    "Treatment of DM → ↓ inflammation → lesion resolution",
  ], 10.5);
}

// ════════════════════════════════════════════════════════
// SLIDE 10 — TREATMENT & OUTCOME
// ════════════════════════════════════════════════════════
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  const s = pres.addSlide();
  addHdr(s, "TREATMENT & OUTCOME");

  const col1x=0.3, col2x=5.2, cw=4.55, sy=0.82;

  section(s, col1x, sy, cw, "TREATMENT REGIMEN", [
    "SYSTEMIC (Rheumatology):",
    "   Prednisolone:         20mg → taper → 0–1mg × 24 wks",
    "   Methotrexate:         12mg — once weekly (single dose)",
    "   Folic acid:           5mg × 5 days/week",
    "   Hydroxychloroquine:   300mg once daily",
    "   Calcium + Vit D3:     500mg + 60,000 IU once monthly",
    "",
    "TOPICAL / DERMATOLOGY:",
    "   Emollients twice daily",
    "   Topical corticosteroids on active lesions",
    "   Antihistamines for pruritus control",
    "   Trauma avoidance counselling (Koebner)",
  ], 10.5);

  section(s, col2x, sy, cw, "RESPONSE TO TREATMENT", [
    "✓  Significant resolution of perforating lesions",
    "✓  Marked reduction in pruritus",
    "✓  No new perforating lesions at 3-month review",
    "✓  CPK trending downward",
    "✓  Residual post-inflammatory hyperpigmentation",
    "",
    "Conclusion: Treating the underlying Dermatomyositis",
    "   with corticosteroids + methotrexate led to",
    "   resolution of RPC lesions.",
  ], 10.5);

  section(s, col1x, sy+3.2, 9.4, "KEY TEACHING POINTS", [
    "1.  RPC is NOT limited to DM + CKD — it can occur as a cutaneous manifestation of Dermatomyositis alone.",
    "2.  Pock-like scars mimicking Degos disease require skin biopsy — never defer histopathology.",
    "3.  TEE of vertically oriented degenerated collagen bundles on H&E is diagnostic for RPC.",
    "4.  Koebner phenomenon is the clinical hallmark — new lesions appear in lines of trauma/scratch.",
    "5.  Ro-52 and PM-Scl75 positivity suggest autoimmune overlap but do NOT indicate antisynthetase syndrome.",
  ], 10);
}

// ════════════════════════════════════════════════════════
// SLIDE 11 — LITERATURE REVIEW
// ════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addHdr(s, "LITERATURE REVIEW — RPC IN DERMATOMYOSITIS");

  const refs = [
    { yr:"2011", auth:"Amano H, Nagai Y, Kishi C.", jrnl:"J Dermatol 2011",
      title:"Acquired reactive perforating collagenosis in dermatomyositis.",
      note:"First report linking acquired RPC to DM. Prednisolone treatment — lesion resolution.", hi:false },
    { yr:"2013", auth:"Kikuchi N, Ohtsuka M, Yamamoto T.", jrnl:"Acta Derm Venereol 2013",
      title:"Acquired reactive perforating collagenosis: a rare association with dermatomyositis.",
      note:"Case report confirming DM–RPC link. Proposes autoimmune collagen damage as TEE trigger.", hi:false },
    { yr:"2022", auth:"Gan TS, Voo SYM.", jrnl:"Indian J Dermatol 2022",
      title:"Acquired RPC — A Rare Cutaneous Manifestation of Anti-MDA5 Dermatomyositis.",
      note:"Expands spectrum to amyopathic DM (anti-MDA5). Autoimmune myopathy as standalone RPC cause.", hi:false },
    { yr:"2023", auth:"Prados-Carmona A, De la Torre Gomar FJ.", jrnl:"N Engl J Med 2023",
      title:"Acquired Reactive Perforating Collagenosis.",
      note:"NEJM case report. Emphasises biopsy necessity and distinction from Degos disease.", hi:false },
    { yr:"2026", auth:"Present Case — Ms. Ankita Dey, SSKM Hospital, Kolkata.", jrnl:"Clinical Meeting 2026",
      title:"RPC in Dermatomyositis (Ro-52+, PM-Scl75+) — Biopsy Confirmed. No DM, No CKD.",
      note:"Responded to Prednisolone + Methotrexate. Reinforces autoimmune etiology of acquired RPC.", hi:true },
  ];

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    const y = 0.8 + i * (rh + 0.08);
    const bg = r.hi ? "FFF3E0" : (i%2===0 ? "EEF4FF" : WHITE);
    const bc = r.hi ? AMBER : BLUE;
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    s.addText(r.yr, { x:0.3, y, w:0.55, h:rh, fontSize:8.5, bold:true, color:WHITE, align:"center", valign:"middle", margin:0 });
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  });
}

// ════════════════════════════════════════════════════════
// SLIDE 12 — CONCLUSION
// ════════════════════════════════════════════════════════
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  s.addShape(pres.shapes.RECTANGLE, { x:0, y:0, w:10, h:0.65, fill:{ color:DKBLUE } });
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    "We present a 22-year-old female with Dermatomyositis (Ro-52+, PM-Scl75+, CPK 2188 U/L) who developed widespread Acquired Reactive Perforating Collagenosis — confirmed by skin biopsy showing transepidermal elimination of degenerated collagen bundles on H&E staining.",
    "Clinically, the pock-like atrophic scars with erythematous halos closely mimicked Degos disease. Skin biopsy was the decisive investigation — differentiating RPC (TEE of collagen) from the wedge-shaped necrosis of true Degos disease.",
    "RPC as a cutaneous manifestation of Dermatomyositis without Diabetes or CKD is rare, with only 3 prior cases in world literature. This case reinforces autoimmune collagen damage as a valid standalone trigger for acquired RPC.",
    "Treatment with oral Prednisolone and Methotrexate targeting the underlying Dermatomyositis led to significant lesion resolution — confirming that treating the underlying autoimmune disease is the cornerstone of management.",
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// ════════════════════════════════════════════════════════
// SLIDE 13 — THANK YOU
// ════════════════════════════════════════════════════════
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    ["Patient",   "Ms. Ankita Dey  |  22F  |  SSKM Hospital, Kolkata"],
    ["Diagnosis", "Reactive Perforating Collagenosis in Dermatomyositis"],
    ["Serology",  "Ro-52 Positive  |  PM-Scl75 Positive  |  CPK 2188 U/L"],
    ["Biopsy",    "TEE of degenerated collagen bundles — H&E confirmed"],
    ["Treatment", "Prednisolone + Methotrexate → Significant resolution"],
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  s.addText("Dept. of Dermatology, Venereology & Leprosy  |  IPGMER & SSKM Hospital, Kolkata", {
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  });
}

pres.writeFile({ fileName: "/home/daytona/workspace/rpc-case-presentation/RPC_DM_Final.pptx" })
  .then(() => console.log("DONE"))
  .catch(e => { console.error("ERROR:", e.message); process.exit(1); });

cd /home/daytona/workspace/rpc-case-presentation && node build_clean.js 2>&1

ls -lh /home/daytona/workspace/rpc-case-presentation/RPC_DM_Final.pptx