Young man with painful black dots on left foot

A 30-year-old previously healthy man was admitted to the emergency room due painful black dots on the left foot. On physical examination, multiple erythematous macules with central black dots on left heel (A) were observed. After topical anaesthesia (lidocaine 40mg/g cream), several spines were removed. The patient was seen in a dermatology consultation complaining of local pain 22 days later. Dermatological examination revealed local erythema, and dermoscopy showed several punctiform wounds, some centered by dark brown pinpoint dots or dashes (B). The diagnosis of injuries caused by spicules of cactus in the heel was made. The removal of the fragments from the patient's foot and the follow-up visits to dermatologist led to a successful treatment that allowed the patient to return to work promptly. He was walking on an ecologic trail in Arraial do Cabo, Rio de Janeiro, when the pain started (C). Encounters with cactus spines, needles, prickles and glochids (barbed hairs) are rarely reported. Common signs of a retained cactus spine include: sharp pain as pressure is applied to the site, and discoloration of the skin. Smaller spines of the cactus plant break off easily on contact, and the fragments frequently get embedded in the skin and soft tissues. The lesion is predominantly aseptic. The most frequently affected area by cactus spine-related injuries are extremity and non-fluctuant tender skin papules which is the most frequently presented. Dermoscopy can be useful in helping to promptly detect and remove remaining embedded spines as seen in this cactus injury. Clinicians should consider injuries by cactus's spines in the differential diagnosis of retained foreign material

Outbreak of Tinea capitis by Trichophyton tonsurans and Microsporum canis in Niterói, RJ, Brazil

18 girls from an orphanage (Orfanato Santo Antônio) in Niterói presented tinea capitis due to Trichophyton tonsurans (15 cases - 83.3%) and Microsporum canis (3 cases - 26.7%). Comments are made about clinical, mycological and therapeutic aspects of this microepidem

Dermoscopia da sarna crostosa associada à síndrome da imunodeficiência adquirida Dermoscopy of Norwegian scabies in a patient with acquired immunodeficiency syndrome

Os autores relatam o caso de uma paciente com sarna norueguesa e síndrome da imunodeficiência adquirida com baixa aderência à terapia antirretroviral. O diagnóstico definitivo foi confirmado pelo exame parasitológico direto. A dermatoscopia mostrou sulcos escabióticos e estruturas acastanhadas em asa-delta já descritas, além de uma estrutura morfologicamente semelhante a um gongolo (diplopodasímile). Esta última representa um elemento patodiagnóstico da SN não previamente descrito. Houve boa reposta clínica ao uso oral da ivermectina e ao uso tópico da vaselina com enxofre a 10%, com concomitante melhora dos parâmetros dermatoscópicos.<br>The authors report here on the case of a female patient with Norwegian (crusted) scabies and acquired immunodeficiency syndrome whose compliance with antiretroviral therapy was poor. Definitive diagnosis was confirmed by direct microscopic examination, which revealed numerous Sarcoptes scabei. Dermoscopy showed pathognomonic scabetic burrows and brownish structures in the shape of a hand-glider with a millipede-like appearance. The latter constitutes a diagnostic feature in the pathology of Norwegian scabies that has not yet been described. The patient responded well to oral ivermectin and topical vaseline with sulphur at a proportion of 10%. There was a simultaneous improvement in dermoscopic parameters

Microepidemia de tinha do couro cabeludo por Trichophyton tonsurans e Microsporum canis em Niterói, RJ, Brasil

18 meninas internas do Orfanato Santo Antônio em Niterói apresentaram tinha do couro cabeludo causada por Trichophyton tonsurans (15 casos - 83,3%) e Microsporum canis (3 casos - 26,7%). São discutidos aspectos clínicos e terapêuticos desta microepidemia18 girls from an orphanage (Orfanato Santo Antônio) in Niterói presented tinea capitis due to Trichophyton tonsurans (15 cases - 83.3%) and Microsporum canis (3 cases - 26.7%). Comments are made about clinical, mycological and therapeutic aspects of this microepidem

Clinical Manifestation, Dermoscopy, and Scanning Electron Microscopy in Two Cases of Contagious Ecthyma (Orf Nodule)

Orf is a highly contagious skin disease commonly seen in goats and sheep that can be transmitted to people who have direct contact with infected animals. Here, we report the clinical manifestation, dermoscopy, and scanning electron microscopy in two women who developed skin lesions on their hands after handling goats with wounds in the udders. Human orf is usually self-limiting and no specific treatment is needed

Micetoma por Actinomadura madurae: relato de dois casos

Actinomadura madurae mycetoma was diagnosed in two patients by the dermatologic outpatient clinic of the Clementino Fraga Filho University Hospital (UFRJ) and the Antonio Pedro University Hospital (UFF). The first case was a 27-year-old negro male from the out-skirsts of Rio de Janeiro, who was injured prior to the onset of the disease in 1988. The affected left foot showed swelling, nodules, sinus tracts, purulent discharge containing grains, and serious bone involvement with lytic lesions. Histo-logical examination showed deeply basophylic stained grains with typical widefringed borders. The mycological examination revealed an actinomycete identified as A. madurae by culture. Oral tetracycline for six months did not improve the clinical-radiological picture and the patient was submitted to amputation. The second case was a 70-year-old white male, with previous injury en 1974, which occurred in Pernambuco State. Enlargement of the right foot draining sinuses formation with discharge of pus and grains. In tissue sections the grains were large and surrounded by amorphous eos-inophylic clubs radially oriented. There was discrete improvement by tetracycline and sulfonamide. No follow-up.São relatados dois casos de micetoma por Actinomadura madurae, atendidos no Hospital Universitário Clementino Fraga Filho (UFRJ), em 1990, e no Hospital Universitário Antonio Pedro (UFF), em 1984. Caso 1: paciente masculino, pardo, de 27 anos, iniciou o quadro em 1988, após traumatismo no pé esquerdo, com aumento de volume com nódulos apresentando fistulas drenando secreção e grãos branco-amarelados. A radiografia mostrou lesões líticas nos ossos do tarso e 2º e 3º metatarsianos do pé esquerdo. O exame histopatológico evidenciou grãos basofílicos recobertos por franja eosinofílica, arredondados, medindo até 1mm. Ao exame micológico foi isolado em cultivo A. madurae. Diante do fracasso de outras tentativas, foi instituida terapêutica com tetraciclina oral por 6 meses; contudo, como não houve resolução do quadro clínico-radiológico, foi indicada a amputação do membro. Caso 2: paciente masculino, branco, de 70 anos, iniciou quadro em 1974, após traumatismo no pé direito, que evoluiu com aumento de volume e fístulas. Ao exame histopatológico, grãos basofílicos com franjas eosinofílicas ao redor, tamanho grande, de 1 a 2mm de diâmetro, características de A. madurae. Discreta melhora com tetraciclina e sulfamídicos. Sem controle posterior. O primeiro caso adquiriu a infecção no Rio de Janeiro e o segundo caso a adquiriu em Pernambuco. Além de aspectos clínicos, diagnósticos e terapêuticos, é comentada a ocorrência dos micetomas nas Américas, destacando a freqüência dos actinomicetomas por A. madurae

Clinical Manifestation, Histopathology, and Imaging of Traumatic Injuries Caused by Brazilian Porcupine (Sphiggurus villosus) Quills

Injuries to humans caused by porcupines are rare. However, they may occur due to the proximity of urban areas and the animal’s habitat in areas such as the Floresta da Tijuca in Rio de Janeiro. Outdoor sports and leisure activities in areas close to forests or in the rain forest are also relevant for incidents of this kind and a better knowledge of the local forest fauna would prevent such undesirable accidents. Porcupine quills have microscopic barbs at their tips which facilitate skin penetration, but hampering their removal. Once the spines are lodged in tissue, the microscopic backward-facing deployable barbs at the tips cause trauma if anyone tries to remove them. Local haemorrhage and an inflammatory response to the contaminated foreign body occur. Depending on the time lapse in removing the spines either septic or sterile foreign body reactions may occur. There is also the risk of migration of the spines, where fatal cases have been reported in human and veterinary medicine. Herein we report two unusual cases of accidents involving humans and the South American porcupine. The Sphiggurus villosus spines removed from scalp skin were also documented through Scanning Electron Microscopy

Acute paracoccidioidomycosis with duodenal and cutaneous involvement and obstructive jaundice

Paracoccidioidomycosis (PCM) is the most widespread endemic mycosis in LatinAmerica. If PCM is not diagnosed and treated early and adequately, the endemic fungal infection could result in serious sequelae. We report a case of PCM with duodenal and cutaneous involvement simulating cholangitis that was initially misdiagnosed as a lymphoproliferative disease. Clinicians should consider acute paracoccidioidomycosis in the differential diagnosis of jaundice and/or signs/symptoms of cholangitis developing in young patients from paracoccidioidomycosis endemic regions. Keywords: Paracoccidioidomycosis, Paracoccidioides, Cholangiti