Feohifomicose subcutânea causada por Cladophialophora sp.: relato de caso

É descrito caso de feohifomicose subcutânea causada por Cladophialophora sp. O paciente, imunossuprimido, apresentou nódulo no dorso da mão direita que recidivou quatro meses após excisão. Os exames micológico e histopatológico evidenciaram hifas septadas demácias e células leveduriformes. O fungo foi identificado com base no estudo micro-macromorfológico e fisiológico.A case of subcutaneous phaeohyphomycosis caused by Cladophialophora sp. is reported. The patient, an immunosuppressed host presented a nodule on the dorsum of the right hand which relapsed four months after excision. Dematiaceous septate hyphal and yeast like elements were seen in mycological and histological examination. The isolated fungus was identified on the basis of micro-macromorphological and physiologic characteristics

Técnica da imunoperoxidase utilizando um soro hiperimune anti-Leishmania (L.) chagasi no diagnóstico da leishmaniose tegumentar americana confirmada por cultura

The present study reports the production of the rabbit anti-Leishmania (L.) chagasi hyperimmune serum, the standardization of the immunohistochemistry (IHC) technique and the evaluation of its employment in cutaneous leishmaniasis (CL) lesions diagnosed by Leishmania sp. culture isolation. Thirty fragments of active CL lesions were examined as well as 10 fragments of cutaneous mycosis lesions as control group. IHC proved more sensitive in detecting amastigotes than conventional hematoxylin-eosin (HE) stained slides: the former was positive in 24 (80%) biopsies whereas the latter, in 16 (53%) (p = 0.028). The reaction stained different fungus species causing cutaneous mycosis. Besides, positive reaction was noticed in mononuclear and endothelial cells. Nevertheless, this finding was present in the control group biopsies. It is concluded that IHC showed good sensitivity in detecting amastigotes.O presente estudo relata a produção do soro policlonal de coelho anti-Leishmania (L.) chagasi, a padronização da técnica de imunohistoquímica (IHQ) e sua aplicação em lesões de leishmaniose cutânea (LC) diagnosticadas por isolamento de Leishmania sp. em cultura. Foram examinados 30 fragmentos de lesões ativas de LC e 10 fragmentos de lesões de etiologia fúngica, utilizados como grupo controle. A IHQ mostrou-se mais sensível na detecção de amastigotas que a coloração em hematoxilina-eosina (HE), sendo positiva em 24 fragmentos de LC (80%) e ao passo que a HE foi positiva em 16 (53%) (p = 0,028). A IHQ também marcou diferentes espécies de fungos causadoras de micoses cutâneas. Adicionalmente, verificou-se positividade no citoplasma de células mononucleares e células endoteliais. Entretanto, esse achado esteve presente no grupo controle. Conclui-se que o método de IHQ apresentou boa sensibilidade na detecção de formas amastigotas

Disseminated strongyloidiasis

Strongyloidiasis is a parasitic infestation caused by the helminth Strongyloides stercoralis. It is essentially gastrointestinal and in general asymptomatic but can sometimes present with skin signs. Immunocompromised patients can develop the disseminated form of the disease due to the parasite’s opportunistic behavior, as in cases of coinfection by the human T-lymphotropic type 1 virus (HTLV-1). This article presents a case of a patient infected with HTLV-I and Strongyloides stercoraliswho developed the disseminated form. There were purpuric reticulated periumbilical lesions as well as vibices on the patient’s flanks. Histopathologic exam of a skin lesion revealed the presence of larvae in the deep reticular dermis. We emphasize the relevance of awareness regarding interaction between HTLV-1 and strongyloidiasis, besides identification of the cutaneous manifestations of the disease to reach an appropriate therapeutic diagnosis. </p

Disseminated strongyloidiasis

Strongyloidiasis is a parasitic infestation caused by the helminth Strongyloides stercoralis. It is essentially gastrointestinal and in general asymptomatic but can sometimes present with skin signs. Immunocompromised patients can develop the disseminated form of the disease due to the parasite’s opportunistic behavior, as in cases of coinfection by the human T-lymphotropic type 1 virus (HTLV-1). This article presents a case of a patient infected with HTLV-I and Strongyloides stercoraliswho developed the disseminated form. There were purpuric reticulated periumbilical lesions as well as vibices on the patient’s flanks. Histopathologic exam of a skin lesion revealed the presence of larvae in the deep reticular dermis. We emphasize the relevance of awareness regarding interaction between HTLV-1 and strongyloidiasis, besides identification of the cutaneous manifestations of the disease to reach an appropriate therapeutic diagnosis. </p

Expressão das citoceratinas em dermatoses infecto-parasitárias associadas à hiperplasia epidérmica

BACKGROUND:Cytokeratins (K) are the major structural proteins of epithelial cells andthey display the greatest heterogeneity of all intermediate filament proteins. The study of manyisolated cytokeratins by immunomarcation enables the structural verification of the cytoskeletonin many neoplastic and inflammatory diseases.OBJECTIVE:To verify the immunohistochemical pattern of cytokeratin expression in infectious andparasitic diseases associated with squamous hyperplasia.METHODS: Histological sections obtained from formalin-fixed and paraffin-embedded tissue fromcromomycosis, paracoccidioidomycosis, leishmaniasis and condylomata acuminata lesions weremarked with the DEK10, LL025, LL002and AE1antibodies by the immunoperoxidase technique (avi-dina-botina).RESULTS:Different degrees of epidermal hyperplasia were observed predominantly or exclusively inthe following four diseases: absence of immunoreactivity to DE-K10in areas of intense epidermalhyperplasia and delayed K10immunohistochemical staining in areas of moderate to discreet/-absent hyperplasia; superbasal expression pattern for K16, regardless of the degree of hyperplasiaas well as superbasal epitops discharging for LL002(C14) and AE1(C10, 14, 16, 19).CONCLUSIONS:The modifications indicate that regardless of the nature of the etiologic agent anddegree of hyperplasia, changes in keratinocyte differentiation and proliferation may occur.FUNDAMENTOS: As citoceratinas(C) são as proteínas estruturais mais importantes das células epiteliais e exibem a maior heterogeneidade dentre todas as proteínas dos filamentos intermediários. Seu estudo através de imunomarcação possibilita a análise estrutural do citoesqueleto em vários afecções neoplásicas e inflamatórias. OBJETIVOS: Verificar o padrão imuno-histoquímico da expressão das citoceratinas na epiderme de doenças infecto-parasitárias associadas à hiperplasia escamosa. MÉTODOS: Cortes histológicos obtidos de tecidos pré-fixados e incluidos em parafina à partir de lesões de cromomicose, paracoccidioidomicose, leishmaniose e condiloma acuminado foram marcados com os anticorpos DEK10, LL025, LL002 e AE1 pela técnica de imunoperoxidase (avidina-biotina). RESULTADOS: A análise de áreas com intensidade variável de hiperplasia epidérmica presentes nos fragmentos mostrou exclusivamente e/ou predominantemente nas quatro doenças: ausência de expressão da C10 nas áreas de hiperplasia intensa e retardo da expressão nas áreas de hiperplasia moderada e/ou ausente; padrão suprabasal de marcação para a C16 independentemente do grau de hiperplasia como também, liberação de epítopos suprabasais para os marcadores LL002 (C14) e AE1 (C10,14,16,19). CONCLUSÕES: As modificações indicam que, independentemente da natureza do agente etiológico e do grau de hiperplasia presente, ocorrem alterações na diferenciação e proliferação do ceratinócito

Glomeruloid hemangioma as late manifestation of POEMS syndrome

Glomeruloid hemangiomas were first described by Chan in 1990 as a cutaneous marker of POEMS syndrome (Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal proteinemia, and Skin changes). POEMS syndrome is a multisystem disease with a significant cutaneous involvement. Among its manifestations, hemangiomas are common, observed in up to one third of the patients, and, although specific, the glomeruloid subtype is very rare. The vascular endothelium growth factor (VEGF) is an angiogenic stimulation factor, which also induces increased systemic vascular permeability. Thus, a scenario of overexpression of VEGF can credibly lead to the assumption of an association between cutaneous hemangiomas and systemic manifestations, implying prognostic and therapeutic considerations and reinforcing the importance of dermatological periodical consultations for these patients. We report the case of a patient in whom glomeruloid hemangiomas marked the recurrence of POEMS syndrome, occurring before the systemic symptoms. </p

Perturbação Factícia Bolhosa Simulando Penfigoide Bolhoso: Relato de Caso e Revisão da Literatura

Factitious disorder in dermatology is a dermatosis occuring with increasing frequency all over the world. Prevalence is reported around 2% in dermatology clinics but it is probably underdiagnosed, since the patient is not usually aware of its self-inflicted nature. When manifested by bullous lesions, it can be confused with autoimmune bullae. We report the case of a 59-year-old patient accompanied by psychiatry for severe depression with psychotic symptoms, dissociative amnesia, Munchausen syndrome and fibromyalgia who developed tense blisters on the dorsum of her left foot. The findings of the first histopathological examination suggested bullous pemphigoid and treatment with prednisone was performed. Due to the persistence and fixed location of the lesions, psychiatric history and negative direct immunofluorescence, a new histopathological examination was performed and interpreted as a case of bullous factitious disorder.A perturbação factícia na dermatologia é uma dermatose que vem ocorrendo com maior frequência na população mundial. A prevalência em torno de 2% reportada nas clínicas dermatológicas é provavelmente é subdiagnosticada, já que o paciente não costuma estar ciente da sua natureza autoinfligida. Quando se manifesta por lesões bolhosas, pode ser confundida com doenças bolhosas autoimunes. Relata-se o caso de uma paciente de 59 anos acompanhada pela psiquiatria por depressão grave com sintomas psicóticos, amnésia dissociativa, síndrome de Munchausen e fibromialgia, que desenvolveu bolhas tensas no dorso do pé esquerdo. Os achados do primeiro exame histopatológico sugeriam penfigoide bolhoso, sendo realizado tratamento com prednisona. Devido à persistência e localização fixa das lesões, aos antecedentes psiquiátricos e à imunofluorescência direta negativa, novo exame histopatológico foi realizado e interpretado como um caso de perturbação factícia bolhosa

PRURIGO AS A MARKER FOR CUTANEOUS HTLV

Introdução: O prurigo ainda não foi definitivamente associado à infecção pelo HTLV. Entretanto, há relatos de casos com aparecimento dessas lesões anos antes de surgimento de Leucemia Linfoma de Células T do Adulto(LLTA), como pródromo da neoplasia.Caso Clínico: feminina, portadora de HTLV-1. Apresentava pruridermia, xerodermia, pápulas hipercrômicas, com superfície ceratósica ou crostosa, nos membros inferiores. Exame histopatológico de lesão confirmou a impressão de prurigo nodular. Paciente vem sendo tratada com hidroxizine, corticoide tópico e hidratantes, mantendo prurido. Continua em acompanhamento clínico regular, sem indícios de neoplasia hematológica até o momento.Discussão: o prurigo nodular tem relação com alguns desencadeantes. A literatura consultada não indica a infecção pelo HTLV como um fator de risco estabelecido. Porém já foram comunicados casos de prurigo com anos de evolução antes do aparecimento de LLTA, ratificando a importância de sorologia para HTLV, biópsia cutânea e investigação de sangue periférico nestes casos.Introduction: prurigo has not been definitively linked to HTLV. However, there are reports of cases with onset of these lesions years before onset of adult T cell leukemia lymphoma (ATLL), as prodrome of neoplasia. Case Report: A female carrier of HTLV-1 presented pruridermia, xeroderma, hyperchromic papules, with crusted or ceratosic surface on lower limbs. Histopathological examination of the lesion confirmed the impression nodular prurigo. Patient has been treated with hydroxyzine, topical steroids and moisturizers, keeping itching. She continues in regular clinical follow without evidence of hematologic malignancy yet. Discussion: The nodular prurigo is related to some trigger. The literature does not indicate HTLV infection as a risk factor established, but there are cases report of prurigo with years of evolution before the appearance of ATLL, confirming the importance of serology for HTLV, skin biopsy and investigation of peripheral blood in these cases

Leucemia/linfoma de células T do adulto associado a infecção pelo HTLV-1 em adolescente brasileiro

We present the case of a 15-year-old patient infected with HTLV-1 who developed a cutaneous T-cell lymphoma, confirmed by histopathological and immunohistochemical examination, as well as clinically and hematologically confirmed leukemia. The patient died 3 months after initial presentation of the disease. The rarity of the disease in this age group justifies the present report.Apresentamos o caso de um adolescente de 15 anos de idade com infecção pelo HTLV-1 que desenvolveu linfoma cutâneo de células T, confirmado por exame histopatológico e imunohistoquímico, assim como leucemia, diagnosticada por exame clínico e avaliação de sangue periférico. O paciente morreu 3 meses após o início da doença. A raridade da doença nesta faixa etária justifica o relato de caso

Glomeruloid hemangioma as late manifestation of POEMS syndrome

Glomeruloid hemangiomas were first described by Chan in 1990 as a cutaneous marker of POEMS syndrome (Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal proteinemia, and Skin changes). POEMS syndrome is a multisystem disease with a significant cutaneous involvement. Among its manifestations, hemangiomas are common, observed in up to one third of the patients, and, although specific, the glomeruloid subtype is very rare. The vascular endothelium growth factor (VEGF) is an angiogenic stimulation factor, which also induces increased systemic vascular permeability. Thus, a scenario of overexpression of VEGF can credibly lead to the assumption of an association between cutaneous hemangiomas and systemic manifestations, implying prognostic and therapeutic considerations and reinforcing the importance of dermatological periodical consultations for these patients. We report the case of a patient in whom glomeruloid hemangiomas marked the recurrence of POEMS syndrome, occurring before the systemic symptoms. </p