Cutaneous Leukemic Infiltration Following Varicella - a Case of Wolf's Isotopic Response

Wolf's isotopic response designates the appearance of two subsequent unrelated dermatoses in the same anatomic location. We report the case of a 51-year-old man with a medical history of chronic lymphocytic leukemia without known extra-hematopoietic involvement. The patient developed a disseminated papulo-vesiculous eruption, diagnosed as varicella. Few days after recovering, an erythematous and violaceous papular dermatosis with histopathological examination compatible with leukemic infiltration appeared on the scars of previous herpetic lesions. Complete remission was obtained under systemic corticotherapy, without cutaneous recurrence or blastic transformation. Wolf's isotopic response is attributed to a localized immunologic imbalance following a certain stimulus. In this patient, herpetic infection acted as a local spur for inaugural cutaneous leukemic infiltration, with no impact on the prognosis for the underlying disease.info:eu-repo/semantics/publishedVersio

G\"odel-type Spacetimes in Induced Matter Gravity Theory

A five-dimensional (5D) generalized G\"odel-type manifolds are examined in the light of the equivalence problem techniques, as formulated by Cartan. The necessary and sufficient conditions for local homogeneity of these 5D manifolds are derived. The local equivalence of these homogeneous Riemannian manifolds is studied. It is found that they are characterized by three essential parameters $k$, $m^2$ and $\omega$: identical triads $(k, m^2, \omega)$ correspond to locally equivalent 5D manifolds. An irreducible set of isometrically nonequivalent 5D locally homogeneous Riemannian generalized G\"odel-type metrics are exhibited. A classification of these manifolds based on the essential parameters is presented, and the Killing vector fields as well as the corresponding Lie algebra of each class are determined. It is shown that the generalized G\"odel-type 5D manifolds admit maximal group of isometry $G_r$ with $r=7$, $r=9$ or $r=15$ depending on the essential parameters $k$, $m^2$ and $\omega$. The breakdown of causality in all these classes of homogeneous G\"odel-type manifolds are also examined. It is found that in three out of the six irreducible classes the causality can be violated. The unique generalized G\"odel-type solution of the induced matter (IM) field equations is found. The question as to whether the induced matter version of general relativity is an effective therapy for these type of causal anomalies of general relativity is also discussed in connection with a recent article by Romero, Tavakol and Zalaletdinov.Comment: 19 pages, Latex, no figures. To Appear in J.Math.Phys.(1999

Telangiectasia Mucosa e Periungual como Indícios de Doença Sistémica

info:eu-repo/semantics/publishedVersio

Patch Tests Under Systemic Immunossupression - An Absolute Contra-Indication?

Introdução: As provas epicutâneas (PE) são o exame complementar de diagnóstico indicado para avaliação de suspeita de dermite de contacto alérgica. Idealmente, devem ser realizadas sem que o doente se encontre sob imunossupressores. Existem contudo situações clínicas em que tal não é possível, não havendo informação disponível acerca de como realizar e valorizar os resultados das PE nestes doentes. O objectivo do presente trabalho é rever a literatura no que concerne à realização de PE sob imunossupressão iatrogénica. Material e Métodos: Revisão da literatura relevante para o tema publicada até Janeiro de 2015 e indexada à Medline. Resultados: De acordo com o reportado na literatura, foram realizadas PE em 77 doentes sob corticóide sistémico, 78 doentes sob ciclosporina (CyA), 6 sob azatioprina, 10 sob metotrexato (MTX), 4 sob micofenolato de mofetil (MMF), 11 sob fármacos anti-factor de necrose tumoral e 7 sob fármaco anti-IL-12/23. Foram ainda descritos 15 casos de realização de PE sob associação de imunossupressores. Verificaram-se reacções positivas em todos os grupos. Conclusão: O tratamento concomitante com imunossupressores não deve ser uma contra-indicação para realização de PE, estando descritas reacções positivas em doentes sob prednisolona, azatioprina, CyA, MTX, MMF, infliximab, etanercept, adalimumab e ustecinumab. Os resultados negativos ou duvidosos devem, contudo, ser interpretados de forma cautelosa

Pustulose Palmoplantar Recalcitrante: Já foi Considerada a Hipótese de Dermite de Contacto Alérgica?

Palmoplantar pustulosis (PPP) is a chronic and relapsing disease of the palms and soles, which tends to be difficult to treat. Classically it was described as a subtype of psoriasis. Nowadays it is regarded as a separate entity, although plaque-type psoriasis affects concomitantly many patients with PPP. A link between allergic contact dermatitis (ACD) and PPP has been described, and the former may encompass a potential to perpetuate the latter. Hereby we report two cases of difficult to treat plantar pustulosis. Underneath the dermatosis’s refractive nature was an allergic sensitization to potassium dichromate and cobalt chloride. Leather shoes and leather insoles were commonly worn, and both allergens are employed by the leather industry. Clinical remission was achieved in both cases with allergen eviction. Patch testing must be considered in cases of PPP without response to treatment. If relevant sensitization is found, allergen eviction measures are mandatory.A pustulose palmoplantar (PPP) é uma doença crónica e recorrente das palmas e plantas, que tende a ser díficil de tratar. Classicamente era descrita como um subtipo de psoríase. Actualmente é considerada uma entidade distinta, embora psoríase em placas afecte concomitantemente muitos doentes com PPP. Uma relação entre dermite de contacto alérgica (DCA) e PPP já foi descrita, e a primeira acarreta um potencial de perpeptuar a última. Aqui descrevemos dois casos de pustulose plantar de tratamento díficil. Subjacente à natureza refractária da dermatose, encontrava-se uma sensitização alergénica ao dicromato de potássio e ao cloreto de cobalto. Sapatos e palmilhas de cabedal eram comumente usadas pelas doentes, e ambos os alergénios referidos são utilizados na indústria do cabedal. Remissão clínica foi atingida em ambos os casos com evicção alergénica. O testes epicutâneos devem ser considerados em casos de PPP refractários ao tratamento. Se for demonstrada sensibilização relevante, medidas de evicção alergénica são obrigatórias

Stellate Ulceration in a Nonuremic Patient

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Phototherapy in Childhood: a 17-Year Retrospective Study Regarding Effectiveness and Safety

Introduction: Skin diseases in paediatric age are often distressing conditions with significant impact in children’s psychosocial development. Additionally, systemic therapeutic options are often limited in childhood, due to its potential toxicity in this vulnerable group. Phototherapy is therefore an endorsed option for photo-responsive dermatological conditions. Objective and Methods:This observational retrospective study aims to access efficacy and safety of Phototherapy in our paediatric population. Relevant clinical data from 1996 to present concerning patients aged 18 years or less was collected. Results: 78 patients were included, of which64,1%was female. Mean age was 12,9 years (range 2-18). Distribution according to diagnosis was:47,4%psoriasis, 34,6% alopecia areata, 9,0% vitiligo, 9,0% other diagnosis. Mean number of cycles was 1,5 (range 1-7), with an average of 16,3 treatments per cycle and mean cumulative dose 134 J/cm2. 70,5% was treated with one single cycle. Topic and systemic PUVA were the first choice in 37,2% and 39,7%, respectively, while UVB TL01 and broadband UVB were used in 11,5% each. On the first cycle 67,5% improved, 14,3% showed no sustained clinical response and 19,5% were lost to follow-up. Psoriasis patients had the best response rates (81,8%), followed by alopecia areata (59,3%). Side effects occurred in 21%, being erythema the most common (12%). None led to therapeutic interruption. Discussion: Phototherapy is a safe and effective option in childhood, yet the withdraw rate might be an important limitation

The Tip of the Iceberg: Cutaneous Manifestations of Paediatric Diseases with Neurological Involvement

Introdução: Algumas alterações cutâneas podem ser as primeiras manifestações clínicas de diversas entidades nosológicas com atingimento sistémico. O presente trabalho tem como objectivo rever a semiologia dermatológica relevante no contexto das doenças com envolvimento neurológico na infância. Material e Métodos: Revisão dos artigos indexados à MedLine publicados nos últimos 12 anos e com relevância para o tema. Resultados: Os principais grupos nosológicos relevantes para o tema compreendem as genodermatoses (com destaque para as síndromes neurocutâneas), as alterações da pigmentação, as doenças vasculares, as endócrinas, os défices enzimáticos congénitos e os disrafismos espinhais ocultos. Discussão: O reconhecimento da semiologia cutânea específica é importante pois pode permitir um diagnóstico muito mais precoce