Paracoccidioidomicose: lesões cutâneas, infiltrativas, sarcoidose-símile, diagnosticadas como hanseníase tuberculóide

The authors report a case of paracoccidioidomycosis misinterpreted as tuberculoid leprosy, both on clinical and histological examination. Sarcoid-like cutaneous lesion as the initial presentation is rare in young patient with paracoccidioidomycosis and can simulate other infectious or inflammatory diseases. On histology, tuberculoid granuloma presented similar difficulties. Treatment with dapsone, a sulfonamide derivative, could have delayed the presumed natural clinical course to the classical juvenile type of paracoccidioidomycosis, observed only 24 months after the patient had been treated for leprosy.Os Autores relatam um caso de paracoccidioidomicose diagnosticado como se fora hanseníase tuberculóide, tanto do ponto de vista clínico como histopatológico. Lesão cutânea de padrão sarcoídico é raramente observada como lesão inicial da paracoccidioidomicose em jovens e pode simular outras dermatoses infecciosas ou inflamatórias. O achado histológico de granuloma tuberculóide apresenta dificuldade diagnóstica similar. O tratamento realizado com dapsone, um derivado sulfamídico, pode ter retardado a evolução clínica esperada para o padrão clássico da paracoccidioidomicose tipo juvenil, o qual apenas se materializou 24 meses após a paciente ter iniciado tratamento como hanseníase

Does Radioiodine Therapy in Patients with Differentiated Thyroid Cancer Increase the Frequency of Another Malignant Neoplasm?

Objectives. To compare the frequency of another primary malignancy in patients with differentiated thyroid carcinoma (DTC) who received radioiodine therapy or not (131I). Material and Methods. 168 cases of DTC patients were retrospectively evaluated as to the frequency of another neoplasia by comparing patients with and without it, taking into account clinical, laboratory, and therapeutic parameters. Results. Another primary malignancy occurred in 8.9% of patients. Of these, 53.3% showed the malignancy before 131I and 46.7% after it. By comparing both groups, the age at the moment of diagnosis of another neoplasia was 46.1 ± 20.2 years for the group before 131I therapy and of 69.4 ± 11.4 years for the group after it (P = 0.02). Of the 148 patients treated with 131I, 4.7% developed another malignancy. The latter were older (61 ± 17 years) than those who did not show another cancer type (44.1 ± 14.2 years) (P < 0.05). Conclusion. The frequency of another neoplasia found after 131I was similar to that found before 131I

Cutaneous histoplasmosis disclosing an HIV-infection Histoplasmose cutânea reveladora de infecção pelo HIV

Histoplasmosis is a systemic mycosis endemic in extensive areas of the Americas. The authors report on an urban adult male patient with uncommon oral-cutaneous lesions proven to be histoplasmosis. Additional investigation revealed unnoticed HIV infection with CD4+ cell count of 7/mm3. The treatment was performed with amphotericin B, a 2065 mg total dose followed by itraconazole 200mg/daily plus antiretroviral therapy with apparent cure. Histoplasmosis is an AIDS-defining opportunistic disease process; therefore, its clinical diagnosis must drive full laboratory investigation looking for unnoted HIV-infection.Histoplasmose &#233; infec&#231;&#227;o sist&#234;mica end&#234;mica em extensas &#225;reas do continente Americano. Os autores relatam caso de paciente do sexo masculino, de zona urbana com les&#245;es cut&#226;neas e mucosas incomuns de histoplasmose. Investiga&#231;&#227;o adicional posterior revelou infec&#231;&#227;o subjacente pelo HIV com contagem de c&#233;lulas CD4 de 7/mm3. O tratamento foi realizado com anfotericina B, dose total de 2065 mg, seguido por itraconazol 200 mg/dia associado &#224; terap&#234;utica antirretroviral com cura aparente do quadro. Histoplasmose &#233; enfermidade oportun&#237;stica definidora da s&#237;ndrome de imunodefici&#234;ncia adquirida, portanto, diagn&#243;stico clinico de histoplasmose implica em investiga&#231;&#227;o laboratorial de infec&#231;&#227;o subjacente pelo HIV