Uso de lopinavir/ritonavir associado com ergotamina resultando em amputação de pé: comunicação breve

Mulher de 32 anos infectada pelo HIV 1, vinha utilizando zidovudina/lamivudina 300/150 mg um comprimido duas vezes ao dia e lopinavir/ritonavir 200/50 mg dois comprimidos duas vezes ao dia e profilaxia com sulfametoxazol-trimetoprim 800/160 mg uma vez ao dia, sem profilaxia com macrolídeos. A paciente apresentou enxaqueca severa com prescrição da associação tartarato de ergotamina 1 mg, cafeína 100 mg, paracetamol 220 mg, sulfato de hiosciamina 87,5 mcg, sulfato de atropina 12,5 mcg, dois comprimidos na crise, seguido de um comprimido a cada 30 minutos, com no máximo seis comprimidos ao dia. A paciente ingeriu seis comprimidos em um dia, surgindo uma dor em tornozelo esquerdo três dias depois, que evoluiu para ergotismo e amputação do pé.A 32-year-old female, was diagnosed in 2004 with a C1 HIV1 infection, using zidovudine/lamivudine 300/150 mg BID and lopinavir/ritonavir 400/100 mg BID, in addition to prophylaxis with trimethoprim-sulfamethoxazole 800/160 mg QD, but no prophylaxis with macrolide antibiotics. The patient presented with a severe headache and was prescribed two capsules of the anti-migraine drug Ormigrein™, which contained ergotamine tartrate 1 mg, caffeine 100 mg, paracetamol 220 mg, hyoscyamine sulfate 87.5 mcg, and atropine sulfate 12.5 mcg. Afterwards she was prescribed one capsule of Ormigrein every 30 minutes for a total of six capsules a day. The patient took the medication as prescribed but developed a pain in her left ankle three days later, which evolved to the need for amputation

RRH: síndrome de envenenamento por 200 ferroadas de abelhas africanizadas

Envenoming syndrome from Africanized bee stings is a toxic syndrome caused by the inoculation of large amounts of venom from multiple bee stings, generally more than five hundred. The incidence of severe toxicity from Africanized bee stings is rare but deadly. This report reveals that because of the small volume of distribution, having fewer stings does not exempt a patient from experiencing an unfavorable outcome, particularly in children, elderly people or underweight people.A síndrome de envenenamento por ferroadas de abelhas africanizadas é causada pela inoculação de uma grande quantidade de peçonha por múltiplas ferroadas de abelhas, geralmente acima de quinhentas. A incidência de uma intoxicação severa por ferroadas de abelhas africanizadas é rara, porém letal. Este relato de caso aponta que, devido a um menor volume de distribuição do veneno, um número menor de ferroadas por abelhas africanizadas não exime o paciente de apresentar envenenamentos com desfecho desfavorável, principalmente em crianças, idosos e pessoas com baixo peso

Secondary syphilis presenting as a corymbiform syphilide: case report and review

It is essential that healthcare providers are familiar with the full spectrum of clinical presentations of syphilis. A rare manifestation of secondary syphilis is the corymbiform (or corymbose) arrangement, in which a central greater papule is surrounded by smaller satellite lesions. Very few reports of corymbiform syphilis are available in current biomedical databases. We present the case of a 28 year-old HIV-infected male patient on regular, successful antiretroviral therapy who developed an asymptomatic corymbiform maculopapular lesion in the medial aspect of the right thigh. There were also a few brownish macular lesions on the left sole. New serological tests for syphilis (which had been negative in the past) were reactive. The coymbiform lesion slowly regressed and the non-treponemal test reverted to negative after benzathine penicillin G treatment. A review of the literature is provided. This is the first report of corymbiform syphilis in an HIV-infected patient

Prevalence of asymptomatic urethritis by Chlamydia trachomatis and Neisseria gonorrhoeae and associated risk factors among males living with HIV-1

Objectives The increase in HIV transmissibility in non-ulcerative sexually transmitted infection is already well-established. It is estimated that symptomatic carriers of N. gonorrhoeae and C. trachomatis have a relative risk of 4.8-fold and 3.6-fold, respectively, for the sexual acquisition of HIV. This type of evaluation for asymptomatic urethritis is necessary to reinforce strategies to combat HIV transmission. This study aims to assess the prevalence of patients with asymptomatic urethritis among men diagnosed with HIV-1 and determine the risk factors associated with this infection. Methods We enrolled a total of 115 male patients aged 18 years or older who have been diagnosed with HIV infection and have no symptoms of urethritis or other sexually transmitted infections and who have been evaluated between May and August 2015 in a follow-up visit at the Immunology Outpatient Clinic of a Brazilian University Hospital. Results Four asymptomatic patients were positive for C. trachomatis and were considered asymptomatic carriers of urethritis. Prevalence was 3.47%. Patients who were positive for C. trachomatis urethritis had a lower mean age (p = 0.015). Conclusion The presence of asymptomatic sexually transmitted infection is a challenge in clinical practice. We recommend that, in outpatient practice, the habit of inquiring on previous sexual behavior to obtain more information about risks and associations with asymptomatic sexually transmitted infection, a routine physical examination and complementary tests to detect STI pathogens should be performed to discard these conditions. The development of rapid tests for this purpose should also be encouraged

Chlamydia trachomatis asymptomatic urethritis recurrence among males living with HIV-1

A prevalence of 3.47% of asymptomatic Chlamydia trachomatis urethritis has been previously reported among males living with HIV infection in Brazil. This study aims to assess the recurrence of C. trachomatis urethritis three years later in the same cohort of patients and analyze associated risk factors. A total of 115 male patients diagnosed with HIV infection, with no symptoms of urethritis and observed since May of 2015 in followup visits were enrolled. They had urine samplers tested by PCR for C. trachomatis and N. gonorrhoeae between February and March 2018. Results: Three of the four patients who had asymptomatic C. trachomatis urethritis three years before were recurrently positive for C. trachomatis urethritis. Two new patients were diagnosed as positives, accounting for a total asymptomatic C. trachomatis urethritis prevalence of 4.34%. The prevalence during the whole study was 5.21%. The relative risk for a new urethritis episode among those previously diagnosed with urethritis is RR=41.62 (95% CI: 9.42-183.84), p < 0.01. Patients who presented asymptomatic urethritis anytime and who were recurrently positive for C. trachomatis had a lower mean age (p<0.01). Married individuals were protected regarding asymptomatic urethritis [p<0.01, OR = 0.04 (0.005-0.4)] and had lower risk to develop recurrence [p<0.01, RR = 0.86 (0.74-0.99)]. Illicit drugs users had risk associated to asymptomatic urethritis [p=0.02, OR= 5.9 (1.03-34)] and higher risk to develop recurrence [p<0.01, RR=1.1 (1-1.22)]. Conclusion: The recurrence of asymptomatic C. trachomatis urethritis after treatment among males living with HIV infection in Brazil can be considered high and should not be neglected

Primeiro caso de leishmaniose visceral humana de transmissao autoctone no centro urbano do Rio de Janeiro: relato de caso

Visceral leishmaniasis is an anthropozoonosis that is caused by protozoa of the genus Leishmania, especially Leishmania (Leishmania) infantum, and is transmitted to humans by the bite of sandflies of the genus Lutzomyia, such as Lutzomyia longipalpis. There are many reservoirs, including Canis familiaris. It is a chronic infectious disease with systemic involvement that is characterized by three phases: the initial period, the state period and the final period. The main symptoms are fever, malnutrition, hepatosplenomegaly, and pancytopenia. This article reports a case of a patient diagnosed with visceral leishmaniasis in the final period following autochthonous transmission in the urban area of Rio de Janeiro. The case reported here is considered by the Municipal Civil Defense and Health Surveillance of Rio de Janeiro to be the first instance of autochthonous visceral leishmaniasis in humans in the urban area of this city. The patient was discharged and is undergoing a follow-up at the outpatient clinic, demonstrating clinical improvement.A leishmaniose visceral é uma antropozoonose causada por protozoários do gênero Leishmania, principalmente Leishmania (Leishmania) infantum e transmitida ao homem pela picada do flebotomíneo do gênero Lutzomyia, destacando-se no Brasil a Lutzomyia longipalpis. Os animais reservatórios são muitos, tendo o cão doméstico (Canis familiaris) como principal reservatório. Trata-se de uma doença infecciosa crônica, de envolvimento sistêmico e caracterizado por três fases: período inicial, período de estado e período final. As principais manifestações são febre, hepatoesplenomegalia, desnutrição e pancitopenia. Este artigo tem como objetivo relatar o caso de paciente diagnosticada com leishmaniose visceral em período final, de transmissão autóctone na área urbana da cidade do Rio de Janeiro. O caso relatado neste artigo é considerado, após investigação, pela Secretaria Municipal de Saúde e Defesa Civil do Rio de Janeiro como o primeiro caso autóctone de leishmaniose visceral em humanos na área urbana da cidade do Rio de Janeiro. O tratamento oferecido foi eficaz e a paciente encontra-se em acompanhamento ambulatorial

Dermatofitose disseminada e síndrome da imunodeficiência adquirida: revisão de literatura e apresentação de experiência clínica

Introdução: Dermatofitoses são infecções comuns, causadas pelas espécies fúngicas Microsporum, Epidermophyton ou Trichophyton, que acometem preferencialmente a pele da região interdigital, da virilha e do couro cabeludo. Apesar de não causar doenças graves, em pacientes portadores do vírus da imunodeficiência humana, a infecção se manifesta e evolui de forma exuberante, normalmente com lesões extensas e disseminadas. Objetivo: Fazer revisão de literatura sobre dermatofitose em pessoas vivendo com vírus da imunodeficiência humana e apresentar a experiência na atenção clínica em uma paciente vivendo com o vírus e dermatofitose extensa e disseminada. Métodos: A revisão de literatura sobre o tema baseou-se nos dados do Pubmed/National Library of Medicine, dos Estados Unidos, utilizando-se as palavras-chave dermatofitose, dermatofitose e AIDS, dermatofitose e vírus da imunodeficiência humana, e dermatofitose e imunodeficiência, de 1988–2022. Descreveu-se a experiência clínica na abordagem de uma paciente vivendo com vírus da imunodeficiência humana, a qual desenvolveu AIDS e apresentou lesões cutâneas disseminadas. Por raspado, foram coletadas amostras da lesão e submetidas à cultura, e constatou-se crescimento de fungos do gênero Trichophyton sp. Realizou-se também biópsia da lesão, corada pelo método da metenamina de prata de Grocott-Gomori. Resultados: Foram encontrados 1.014 artigos, dos quais apenas 34 apresentaram correlação direta com nosso trabalho, e foram utilizados para discorrer sobre os principais temas narrados neste artigo. Apresentou-se experiência clínica na abordagem de uma paciente com vírus da imunodeficiência humana/AIDS e baixa adesão ao tratamento antirretroviral, exibindo lacerações eritematoescamosas extensas e disseminadas, com diagnóstico clínico de Tinea corporis, manifestando-se com quadro clínico usualmente não encontrado em pacientes imunocompetentes. O diagnóstico foi confirmado por exames laboratoriais com isolamento do fungo Trichophyton sp. Tratada com fluconazol via oral, a paciente apresentou remissão parcial das infecções aos dois meses e completa aos seis meses. Também foi exaustivamente estimulada a usar corretamente a medicação antirretroviral prescrita. Conclusão: A dermatofitose em pacientes com vírus da imunodeficiência humana pode se apresentar de forma extensa e disseminada. O tratamento antifúngico é eficaz, com remissão do quadro. A terapia antirretroviral é importante adjuvante para melhor recuperação dos enfermos

150 YEARS ON CANCER CHALLENGING: WHAT DOES IT MEAN, WHERE ARE WE?

Abstract: Introduction: Cancer comes from Latin language where it means crab. Onco comes from Greek language meaning mass, bulk or tumor. Tumors are classified on biological features as low-grade, intermediate or high-grade malignancy according to tumor cell differentiation. There have been about three hundred thousands of new cancer cases reported per year in Brazil. Tumorigenesis mechanisms, complexity and conflicts: Cancer has been considered a genetic disease caused by mutations in genes governing cell growth or chromosomal events as amplifications, deletions, inversions or translocations. Single nucleotide polymorphisms (SNPs) have been considered associated with cancer. It has been identified 1.42 million polymorphisms in the human genome. Epigenetic gene modulation may be a key mechanism in cancer development and metastasis. Chromatin-histone complex may be modified by phosphorylation, acetylation, methylation and/or ADP-ribosylation. MicroRNAs may be incorporated in mRNA targets and influence several biological processes as development, differentiation and apoptosis. Apoptosis is a way cells undergo programm deaths by activation of extrinsic cell surface death-mediating receptor, activation of mitochondrial mediated intrinsic pathway or non-apoptotic forms of cell death. In cancer there seems be failure, loss or absence of forms of cell death and overactivation of kinase growth factor receptors. Treatment and Prevention: Surgery is the better method to cure patients with solid tumors confined to local disease. Ionizing radiation may be administered as an isolated local form of cure, but also to extend limits of a treated region. Prevention depends on educational strategies, chemopreventive agents or early diagnosis for solid tumors. Advanced forms of cancer presentation are rarely cured and depend on combination of surgery, irradiation, chemotherapy and biological agents. Conclusion: At 150 years on cancer challenging, we do not know what it does really mean, nor even cure, effective treatment or prevention has been achieved. Descriptors: Cancer a non solved problem. Tumorigenesis complex and conflicts mechanisms. Cancer treatment and prevention

150 YEARS ON CANCER CHALLENGING: WHAT DOES IT MEAN, WHERE ARE WE?

Abstract: Introduction: Cancer comes from Latin language where it means crab. Onco comes from Greek language meaning mass, bulk or tumor. Tumors are classified on biological features as low-grade, intermediate or high-grade malignancy according to tumor cell differentiation. There have been about three hundred thousands of new cancer cases reported per year in Brazil. Tumorigenesis mechanisms, complexity and conflicts: Cancer has been considered a genetic disease caused by mutations in genes governing cell growth or chromosomal events as amplifications, deletions, inversions or translocations. Single nucleotide polymorphisms (SNPs) have been considered associated with cancer. It has been identified 1.42 million polymorphisms in the human genome. Epigenetic gene modulation may be a key mechanism in cancer development and metastasis. Chromatin-histone complex may be modified by phosphorylation, acetylation, methylation and/or ADP-ribosylation. MicroRNAs may be incorporated in mRNA targets and influence several biological processes as development, differentiation and apoptosis. Apoptosis is a way cells undergo programm deaths by activation of extrinsic cell surface death-mediating receptor, activation of mitochondrial mediated intrinsic pathway or non-apoptotic forms of cell death. In cancer there seems be failure, loss or absence of forms of cell death and overactivation of kinase growth factor receptors. Treatment and Prevention: Surgery is the better method to cure patients with solid tumors confined to local disease. Ionizing radiation may be administered as an isolated local form of cure, but also to extend limits of a treated region. Prevention depends on educational strategies, chemopreventive agents or early diagnosis for solid tumors. Advanced forms of cancer presentation are rarely cured and depend on combination of surgery, irradiation, chemotherapy and biological agents. Conclusion: At 150 years on cancer challenging, we do not know what it does really mean, nor even cure, effective treatment or prevention has been achieved. Descriptors: Cancer a non solved problem. Tumorigenesis complex and conflicts mechanisms. Cancer treatment and prevention

An unusual case of bacillary angiomatosis in the oral cavity of an AIDS patient who had no concomitant tegumentary lesions – case report and review

Bacillary angiomatosis (BA) is an angioproliferative disease of immunocompromised patients that usually presents as vascular tumors in the skin and subcutaneous tissues. It is caused by chronic infections with either Bartonella henselae or B. quintana. Oral cavity BA is exceedingly rare and even rarer without simultaneous cutaneous disease. We report herein the case of a 51-year-old HIV-infected man who presented severe odynophagia and an eroded lesion on the hard palate that progressed to an oronasal fistula. No cutaneous lesions were recorded. Doxycycline led to complete resolution. To the best of our knowledge, only six previous cases of oral BA without tegumentary disease have been previously reported and none of them progressed to fistula