Espessamento da pele: desafio diagnóstico

A fasciíte eosinofílica é uma doença rara, caracterizada por edema simétrico doloroso com um progressivo espessamento da pele e tecidos moles, eosinofilia periférica, hipergamaglobulinemia policlonal e velocidade de hemossedimentação elevada. O diagnóstico pode ser feito por biópsia da pele até fáscia ou por ressonância nuclear magnética. Esta doença apresenta sintomas clínicos específicos, como o sinal do sulco que facilita o diagnóstico. Relatamos um caso de fasciíte eosinofílica em uma mulher de 48 anos de idade, com o endurecimento e espessamento da pele, que iniciou nas pernas, depois acometeu os braços e os antebraços e que apresentava o "sinal do sulco". A paciente foi tratada com sucesso com corticoterapia sistêmica e metotrexato

LÍQUEN PLANO PILAR – RELATO DE UM CASO ASSOCIADO A DOENÇAS AUTOIMUNES

Due to the development of large areas of permanent alopecia, patients with lichen planopilaris are more likely to evolve with psychosocial disorders and lower quality of life. Lichen planopilaris (LPP) is characterized by an autoimmune response against antigens of the hair follicle. It is known that can coexist with systemic autoimmune diseases, although this relationship is not well understood. Early recognition and prompt therapy are to protect the base of the hair follicle and fibrosis can stop the progression of hair loss. We present a therapy used with excellent results in a case of lichen planus pillar overlap that occurred in dermatomyositis and scleroderma.Devido ao desenvolvimento de grandes áreas permanentes de alopecia, os pacientes com LPP são mais propensos a evoluir com distúrbios psicossociais e menor qualidade de vida. O líquen plano pilar (LPP) é caracterizado por uma resposta autoimune contra antígenos do folículo piloso. Sabe-se que pode coexistir com doenças imunológicas sistêmicas, porém essa relação ainda não é bem compreendida. O reconhecimento precoce e a terapia imediata são a base para proteger o folículo piloso de possível fibrose e deter a progressão da perda capilar. Apresentamos uma terapêutica com excelente resultado utilizada em um caso de líquen plano pilar que ocorreu em overlap a dermatomiosite e esclerodermia

Sífilis Maligna Precoce em Paciente Imunodeprimido

Early malignant syphilis, also called nodule ulcerative syphilis, was first described by Bazin in 1859, related to varying degrees of immunodeficiency, especially human acquired immunodeficiency syndrome (AIDS) caused by human immunodeficiency virus (HIV). It is an aggressive and generalized variant of secondary syphilis with prodromes of fever, headache, myalgia and arthralgia, followed by papulopustular and necrotic eruptions. Because of its rarity and pleomorphic clinical presentation, this condition is underdiagnosed, which can sometimes lead to a fatal outcome. We report a case of malignant syphilis in a 40-year-old male patient with AIDS with exuberant atypical cutaneous manifestation and constitutional symptoms, which has become rare due to antiretroviral therapy.A sífilis maligna precoce, também chamada sífilis nódulo-ulcerativa, foi descrita inicialmente por Bazin em 1859, relacionada a graus variáveis de imunodeficiência, em especial, a síndrome da imunodeficiência adquirida (SIDA) humana causada pelo vírus da imunodeficiência humana (VIH). É uma variante agressiva e generalizada da sífilis secundária com pródromos de febre, cefaleia, mialgia e artralgia, seguida de erupções papulopustulosas e necróticas. Devido à sua raridade e apresentação clínica pleomórfica, esse quadro é geralmente subdiagnosticado, o que pode levar, por vezes, ao desfecho fatal. Relatamos um caso de sífilis maligna em um paciente do sexo masculino, 40 anos, imunodeprimido por infecção pelo VIH, com manifestação cutânea atípica exuberante e sintomas constitucionais, o que se tem tornado raro devido à introdução de terapêutica antirretroviral altamente eficaz

Síndrome de Sweet e Infecção pelo VIH: O que Podemos Interpretar?

Sweet's syndrome is a neutrophilic dermatosis whose etiopathogenesis is not yet fully known. Histopathology of cutaneous lesions shows an infiltrate with mature neutrophils diffusely distributed in the papillary dermis. The diagnosis is made through clinical, laboratory and histopathological criteria. Association of Sweet syndrome and HIV infection is scarcely related in the literature, having been reported with the use of abacavir, opportunistic infections and vaccination. The explicit evidence for the association is considering Sweet's syndrome as a manifestation of immune reconstitution syndrome, which occurs in 10% to 45% of HIV-infected individuals at the start of antiretroviral therapy. The present report describes the case of a patient HIV-positive for 4 years, who maintained antiretroviral therapy irregularity and, after regularizing the use of antiretrovirals, developed Sweet syndrome.A síndrome de Sweet é uma dermatose neutrofílica cuja etiopatogenia ainda não é totalmente conhecida. A análise histopatológica das lesões cutâneas evidencia infiltrado com predominância de neutrófilos maduros que são distribuídos de forma difusa na derme papilar. O diagnóstico é realizado através de critérios clínicos, laboratoriais e histopatológicos. A relação entre síndrome de Sweet e infecção VIH está escassamente relatada na literatura, sendo geralmente relacionada ao uso de abacavir, infecções oportunistas e vacinação. Uma das possíveis explicações descritas para a associação entre o VIH e a síndrome de Sweet consiste na síndrome de Sweet como manifestação clínica da síndrome da reconstituição imune , a qual afeta 10% a 45% de indivíduos infectados pelo VIH após o início da terapêutica anti-retroviral. O presente relato descreve o caso de uma paciente, VIH positivo há 4 anos, que manteve terapêutica anti-retroviral irregular e após regularizar o uso dos antirretrovirais, evoluiu com síndrome de Sweet

Delayed healthcare and secondary infections following freshwater stingray injuries: Risk factors for a poorly understood health issue in the Amazon

Introduction: This study aimed to describe the profile of freshwater stingray injuries in the State of Amazonas, Brazilian Amazon, and to identify the associated risk factors for secondary infections. Methods: This cross-sectional study used surveillance data from 2007 to 2014 to identify factors associated with secondary infections from stingray injuries. Results: A total of 476 freshwater stingray injuries were recorded, with an incidence rate of 1.7 cases/100,000 person/year. The majority of injuries were reported from rural areas (73.8%) and 26.1% were related to work activities. A total of 74.5% of patients received medical assistance within the first 3 hours of injury. Secondary infections and necrosis were observed in 8.9% and 3.8%, respectively. Work-related injuries [odds ratio (OR) 4.1, confidence interval (CI); 1.87-9.13] and >24 hours from a sting until receiving medical care (OR; 15.5, CI; 6.77-35.40) were independently associated with the risk of secondary bacterial infection. Conclusions: In this study, work-related injuries and >24 hours from being stung until receiving medical care were independently and significantly associated with the risk of secondary infection. The frequency of infection following sting injuries was 9%. The major factor associated with the risk of secondary bacterial infection was a time period of >24 hours from being stung until receiving medical care. © 2018, Sociedade Brasileira de Medicina Tropical. All rights reserved

Aplicação da dermatoscopia no auxílio diagnóstico da ocronose exógena Use of dermoscopy for diagnosis of exogenous ochronosis

A ocronose exógena consiste em hiperpigmentação crônica de áreas previamente tratadas com agentes tópicos como: a hidroquinona, a resorcina, os antimaláricos e o fenol. O diagnóstico precoce permite suspender prontamente o agente causador, uma vez que as opções terapêuticas disponíveis são escassas e com resultados insatisfatórios. Reportam-se três casos de ocronose exógena na face, diagnosticados pela dermatoscopia. O estudo dermatoscópico evidenciou estruturas amorfas de coloração cinza-enegrecido, algumas obliterando as aberturas foliculares. O exame histopatológico corroborou o diagnóstico<br>Exogenous ochronosis consists of chronic hyperpigmentation of areas previously treated with topical agents such as hydroquinone, resorcinol, antimalarials and phenol. Early diagnosis allows to promptly suspend the causative agent and it is imperative since the available therapeutic options are scarce and have presented so far unsatisfactory results. Three cases of exogenous ochronosis on the face which were diagnosed with the use of dermoscopy are presented. Dermatoscopy showed blackish-gray amorphous structures, some obliterating the follicular openings. Histopathological examination confirmed the diagnosi

Delayed healthcare and secondary infections following freshwater stingray injuries: risk factors for a poorly understood health issue in the Amazon

Abstract INTRODUCTION This study aimed to describe the profile of freshwater stingray injuries in the State of Amazonas, Brazilian Amazon, and to identify the associated risk factors for secondary infections. METHODS This cross-sectional study used surveillance data from 2007 to 2014 to identify factors associated with secondary infections from stingray injuries. RESULTS A total of 476 freshwater stingray injuries were recorded, with an incidence rate of 1.7 cases/100,000 person/year. The majority of injuries were reported from rural areas (73.8%) and 26.1% were related to work activities. A total of 74.5% of patients received medical assistance within the first 3 hours of injury. Secondary infections and necrosis were observed in 8.9% and 3.8%, respectively. Work-related injuries [odds ratio (OR) 4.1, confidence interval (CI); 1.87-9.13] and >24 hours from a sting until receiving medical care (OR; 15.5, CI; 6.77-35.40) were independently associated with the risk of secondary bacterial infection. CONCLUSIONS: In this study, work-related injuries and >24 hours from being stung until receiving medical care were independently and significantly associated with the risk of secondary infection. The frequency of infection following sting injuries was 9%. The major factor associated with the risk of secondary bacterial infection was a time period of >24 hours from being stung until receiving medical care