LARVA MIGRANS CUTÂNEA

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PATIENT WITH PSORIASIS KEEPING THE USE OF IMMUNOBIOLOGICALS AFTER TWO EPISODES OF PULMONARY TUBERCULOSIS

Os autores relatam o caso de uma paciente de 58 anos, portadora de psoríase, artrite psoriásica e doen- ça de Crohn, que na vigência de terapia com imunobiológicos, desenvolveu dois episódios de tuberculose pulmonar. Durante o tratamento do segundo episódio de tuberculose pulmonar, optou-se por reinstituir o uso do imunobiológi- co, dada a gravidade da doença de Crohn e a dificuldade do controle da psoríase com outros fármacos, evoluindo com boa resposta no controle da atividade da doença de Crohn, psoríase e artrite psoriásica. PALAVRAS-CHAVE – Psoríase; Mycobacterium tuberculosis; Artrite psoriática; Doença de Crohn; Imunobiológico. The authors report the case of a 58 years old patient, with psoriasis, psoriatic arthritis and Crohn's di- sease, who developed two episodes of pulmonary tuberculosis during the immunobiological therapy. While treating the second episode of pulmonary tuberculosis, it was decided to reinstate the use of immunobiological, given the severity of the Crohn's disease and the poor control of psoriasis with other drugs, evolving with good results in controlling the activity of Crohn's disease, psoriasis and psoriatic arthritis. KEYWORDS – Psoriasis; Mycobacterium tuberculosis; Arthritis, psoriatic; Crohn disease; Immunologic factors.

LEUKEMIA CUTIS AS A SIGN OF PROGRESSION OF MYELODYSPLASTIC SYNDROME TO ACUTE MYELOID LEUKEMIA

O envolvimento cutâneo por células leucêmicas mielóides é fenômeno raro. Os autores relatam caso de paciente, masculino, 55 anos, com síndrome mielodisplásica com lesões papulares eritemato-purpúricas na face, tronco e membros superiores e inferiores. Foi realizada biópsia de lesão que evidenciou infiltrado dérmico por blastos mielóides e imunoistoquímica positiva para mieloperoxidase, confirmando leucemia cútis. O paciente evoluiu para leucemia mieloide aguda, sendo submetido à quimioterapia inicial e depois a esquema quimioterápico de resgate, porém não obteve resposta, havendo piora do quadro hematológico e falecendo após 4 meses. O diagnóstico de leucemia cútis em paciente com síndrome mielodisplásica indica a concomitância ou iminente transformação para leucemia mieloide aguda. Seu reconhecimento precoce é importante, em vista de sua implicação terapêutica e prognóstica.Cutaneous involvement by myeloid leukemic cells is an unusual phenomenon. The authors analyze the case of a 55-year-old male patient with myelodysplastic syndrome who presented erythematous papules on the face, trunk, arms and legs. Skin biopsy showed a dermal infiltration caused by blast myeloid cells. Immunohistochemical analysis was positive for myeloperoxidase, confirming leukemia cutis. Acute myeloid leukemia was diagnosed and the patient was treated with chemotherapy and then with rescue chemotherapy but without response. The haematologic disease progressed and the patient died after four months. The diagnosis of leukemia cutis in patients with myelodysplastic syndrome is indicative of concomitant or impending acute leukemic transformation. Early recognition is essential with important therapeutic and prognostic implications

INFECÇÃO FATAL POR FUSARIUM EM CRIANÇA IMUNODEPRIMIDA

Fungal infections represent an important complication for immunosupressed patients and are associated with high morbidity and mortality. Fusarium infections have been reported with increasing frequency and can be locali- zed, locally invasive or disseminated, depending on the immune status of the host. The authors report the case of a four year old boy, with acute lymphocytic leukemia, in chemotherapy, who presented multiple erythematous nodules that evolved into bullae and central necrosis. Cultures of bullae fluid grew Fusarium spp. Despite treatment with intravenous lipid formulation of amphotericin B and voriconazole, the child died 10 days after appearance of skin lesions.KEYWORDS – Fusarium; Fusariosis; Immunocompromised Host; Leukemia, Lymphoid.As infecções fúngicas representam uma importante complicação em pacientes imunocomprometidos e estão associadas com alta morbidade e mortalidade. As infecções por Fusarium têm sido relatadas com elevada frequência e podem ser localizadas, localmente invasivas ou disseminadas, dependendo do estado imunológico do hospedeiro. Os autores relatam o caso de um menino de quatro anos de idade, com leucemia linfóide aguda, em tratamento quimioterápico, que apresentou múltiplas lesões nodulares eritematosas que evoluíram para bolhas e necrose central. As culturas de conteúdo das bolhas atestaram crescimento de Fusarium spp. Apesar de tratamento com complexo lipídico de anfotericina B e voriconazol endovenosos, a criança evoluiu para óbito após 10 dias do surgimento das lesões cutâneas.PALAVRAS-CHAVE – Criança; Fusarium; Fusariose; Imunodeprimido, Leucemia Linfóide

HISTIOCITOSE DE CÉLULAS DE LANGERHANS

The authors report a case of a young male patient who presented with erythematous and descamative lesions, with maceration, in the axillary and inguinal region, associated with erythematous ulcerated plaques in the perianal region. Histopathological examination was compatible with Langerhans cell histiocytosis, with immunohistochemical positivity for CD1a and S100, thus confirming the diagnosis. Systemic investigation revealed an extra-axial mass in supra-sellar region; he underwent chemotherapy, with a significant improvement of the cutaneous lesions. He keeps his follow-up by the Dermatology, Hematology and Endocrinology Units.Os autores descrevem o caso de um paciente masculino, jovem, apresentando lesões eritemato-descamativas, maceradas, nas regiões axilares e inguinais bilateralmente, além de placas eritematosas exulceradas no sulco interglúteo. O exame histopatológico da lesão cutânea foi compatível com histiocitose de células de Langerhans, com imuno-histoquímica positiva para CD1a e S100, confirmando o diagnóstico. Na investigação de doença sistêmica, foi observada lesão nodular extra-axial na cisterna suprasselar. O paciente foi submetido à quimioterapia sistêmica, com resolução das lesões cutâneas. Atualmente, mantém acompanhamento multidisciplinar pela Dermatologia, Hematologia e Endocrinologia

Granulomatous Reactivation during the Course of a Leprosy Infection: Reaction or Relapse

Leprosy is a serious infectious disease whose treatment still poses some challenges. Patients are usually treated with a combination of antimicrobial drugs called multidrug therapy. Although this treatment is effective against Mycobacterium leprae, the bacillus that causes leprosy, patients may develop severe inflammatory reactions during treatment. These reactions may be either attributed to an improvement in the immunological reactivity of the patient along with the treatment, or to relapse of the disease due to the proliferation of remaining bacilli. In certain patients these two conditions may be difficult to differentiate. The present study addresses the histopathology picture of and the M. leprae bacilli in sequential biopsies taken from lesions of patients who presented such reactions aiming to improve the differentiation of the two conditions. This is important because these reactions are one of the major causes of the disabilities of the patients with leprosy, and should be treated early and appropriately. Our results show that the histopathology picture alone is not sufficient, and that bacilli's counting is necessary