Úlcera de Lipschütz (LU) em adolescente, como manifestação da primoinfecção por Epstein-Barr (EBV). Relato de caso / Lipschütz ulcer (LU) in adolescent, as a manifestation of the primoinfection by Epstein-Barr (EBV). Case report

Introdução:A ulceração genital aguda, também conhecida como "Úlcera de Lipschütz”, é uma condição incomum, autolimitada, não sexualmente transmissível, caracterizada pelo início rápido de ulcerações dolorosas na vulva ou vagina inferior. Materiais e Métodos: Relatamos um caso de uma adolescente, sem vida sexual ativa com faringite e  úlceras vulvares dolorosas de ínicio súbito, além de sorologia positiva para EBV. Discussão: A úlcera de Lipschütz, tem diagnóstico essencialmente clínico e tratamento de suporte na maioria dos casos. Auto-resolução sem cicatrizes e recidivas é o curso normal. Embora as causas e mecanismos específicos ainda não sejam bem compreendidos, estudos mostraram associação com infecções virais como EBV, assim como no nosso relato. Conclusão: Ressaltamos a importância do diagnóstico acertado e diferencial nas úlceras vulvares afim de se evitar intervenções e procedimentos desnecessários e angustiantes para as pacientes. 

HPV infection and vaccination in Systemic Lupus Erythematosus patients : what we really should know

Patients with Systemic Lupus Erythematosus (SLE) are at increased risk for infections. Vaccination is a powerful tool to prevent infections, even in immunocompromised patients. Most non-live vaccines are immunogenic and safe in patients with SLE, even if antibody titres are frequently lower than those of healthy controls. Human papillomavirus (HPV) infections are more prevalent in SLE patients when compared to the healthy population. Low-risk types of this virus cause anogenital warts, while high risk types are strongly related to pre-malignant cervical abnormalities and cervical cancer. HPV vaccines have been developed to prevent these conditions. Although little is known about HPV vaccination in SLE, few studies in patients with autoimmune rheumatic diseases (AIRDs) have shown that HPV vaccines are safe, and capable to induce an immunogenic response in this group of patients. To date, available data suggest that HPV vaccines can be given safely to SLE patients. Given the increased incidence of cervical abnormalities due to HPV in SLE patients, this vaccination should be encouraged

Challenging cases in rheumatic pregnancies

This article describes three complicated cases in rheumatology and pregnancy. The first case elucidates the challenges in treating SLE in conjunction with pulmonary arterial hypertension, while the second case features an SLE-affected pregnancy with development of portal hypertension secondary to portal vein thrombosis related to APS. The third case is a pregnant woman with stable SLE who developed thrombotic microangiopathy caused by atypical haemolytic uraemic syndrome, and failed to improve despite multiple measures including biopsy and elective preterm delivery. There are grave and unique challenges for women with autoimmune disease, but adverse outcomes can sometimes be avoided with careful and multidisciplinary medical management. Pre-conception counselling with regard to medications and disease treatment should also include discussion of the advisability of pregnancy, which may be difficult for a patient, but present the best course for optimizing health outcomes