Discrete cutaneous lesions in a critically ill patient treated only for AIDS and miliary tuberculosis: a case report of disseminated histoplasmosis

Histoplasmosis is a systemic mycosis caused by the dimorphic fungus Histoplasma capsulatum, with disseminated histoplasmosis (HD) being one of its clinical forms. As a consequence of the HIV-AIDS pandemic, HD has become prevalent not only in regions that are recognized as endemic but also in areas not considered endemic, such as Europe and Asia. Its clinical manifestations are varied and mimic several infectious diseases, mainly tuberculosis. In endemic areas, it is the first manifestation of AIDS in 50 to 70% of patients. The diagnosis of histoplasmosis is difficult and HD can lead to death if not diagnosed early and if proper treatment is not instituted. The present report presents a patient with a recent diagnosis of HIV-AIDS, in treatment for miliary tuberculosis, who was diagnosed with disseminated histoplasmosis because of his dermatological manifestations

Pioderma Gangrenoso Associado a Hemoglobinúria Paroxística Noturna

Pyoderma gangrenosum is a chronic neutrophilic dermatosis with no established etiology. It is often associated with systemic diseases such as inflammatory rheumatic diseases, inflammatory bowel diseases, malignant neoplasms and haematological diseases including nocturnal paroxysmal hemoglobinuria. It presents as ulcerated and painful skin lesions with rapid and progressive evolution, mainly in the lower limbs. Ulcerations may arise spontaneously or induced by trauma (pathergy phenomenon). The period between the onset of the lesions and the diagnosis is usually prolonged. The diagnosis is based on clinical data and confirmed after the exclusion of other causes of cutaneous ulcerations. We report a case of Pyoderma gangrenosum in the left upper limb with onset after a traumatic event in a patient with nocturnal paroxysmal hemoglobinuria.O pioderma gangrenoso é uma dermatose neutrofílica crônica sem etiologia estabelecida. Sabe-se que se associa a doenças sistémicas como doenças reumatológicas, doenças inflamatórias intestinais, neoplasias malignas, doenças hematológicas, dentre elas a hemoglobinúria paroxística noturna. Manifesta-se através de lesões cutâneas ulceradas e dolorosas com evolução rápida e progressiva, sendo mais comum nos membros inferiores. As ulcerações podem surgir espontaneamente ou induzidas por traumas, sendo característico do pioderma gangrenoso o fenômeno de patergia. O período entre o início das lesões e o diagnóstico costuma ser prolongado. O diagnóstico é baseado em evidências clínicas e confirmado com a exclusão das outras etiologias de lesões ulceradas cutâneas. Relatamos um caso de pioderma gangrenoso em membro superior esquerdo com início após evento traumático em paciente com diagnóstico de hemoglobinúria paroxística noturna

Discrete cutaneous lesions in a critically ill patient treated only for AIDS and miliary tuberculosis: a case report of disseminated histoplasmosis

Histoplasmosis is a systemic mycosis caused by the dimorphic fungus Histoplasma capsulatum, with disseminated histoplasmosis (HD) being one of its clinical forms. As a consequence of the HIV-AIDS pandemic, HD has become prevalent not only in regions that are recognized as endemic but also in areas not considered endemic, such as Europe and Asia. Its clinical manifestations are varied and mimic several infectious diseases, mainly tuberculosis. In endemic areas, it is the first manifestation of AIDS in 50 to 70% of patients. The diagnosis of histoplasmosis is difficult and HD can lead to death if not diagnosed early and if proper treatment is not instituted. The present report presents a patient with a recent diagnosis of HIV-AIDS, in treatment for miliary tuberculosis, who was diagnosed with disseminated histoplasmosis because of his dermatological manifestations