Multiple cutaneous telangiectasias after the use of trastuzumab: a case report

We aim to report a particular case of cutaneous telangiectasias on the arms after immunotherapy with trastuzumab plus paclitaxel to treat breast cancer. New oncology therapies reflect a major advance in cancer treatment. They greatly increase survival; however, they still cause certain adverse cutaneous events that should be taken into account for their proper management.

Síndrome de Peutz-Jeghers, telangiectasias y prolapso de la válvula mitral. Presentación de caso y asesoramiento genético / Peutz-Jeghers syndrome, telangiectasias, and mitral valve prolapse. Case presentation and genetic counseling

Introducción: El síndrome de Peutz-Jeghers se caracteriza por hiperpigmentación mucocutánea y hamartomas gastrointestinales que pueden aparecer desde el estómago hasta el ano. Tiene un patrón de herencia autosómico dominante y expresividad variable. El diagnóstico se basa en los hallazgos clínicos y la apariencia histológica de los pólipos. No ha sido reportado hasta ahora asociación de esta entidad a telangiectasias y prolapso de la válvula mitral. Objetivo: Describir los hallazgos que permitieron establecer el diagnóstico de Síndrome de Peutz-Jeghers en un paciente y brindar asesoramiento genético. Presentación del caso: Paciente masculino de 36 años de edad con antecedentes de prolapso de la válvula mitral que acude a consulta de genética clínica con su esposa para solicitar asesoramiento genético, debido a que tienen una hija con diagnóstico de Síndrome de Peutz-Jeghers y desean conocer el riesgo de tener otro hijo afectado. Al examen físico se observa mácula hiperpigmentada en labio inferior y varias de estas en encías. Con tales hallazgos y el antecedente de tener la hija Síndrome de Peutz-Jeghers se emite el mismo diagnóstico en el padre. Como dato de interés se constatan en este individuo múltiples telangiectasias en tórax, cuello y espalda. Los estudios realizados en busca de la causa de estas fueron negativos. Conclusiones: Los antecedentes y los hallazgos encontrados en el paciente permitieron realizar el diagnóstico de Peutz-Jeghers y brindar asesoramiento genético. Se presenta el primer reporte de esta enfermedad asociada a telangiectasias y prolapso de la válvula mitral en la literatura científica(AU)

Introduction: Peutz-Jeghers syndrome is characterized by mucocutaneous hyperpigmentation and gastrointestinal hamartomas that can appear from the stomach to the anus. It has an autosomal dominant inheritance pattern and variable expressiveness. The diagnosis is based on clinical findings and histological appearance of the polyps. No association between this entity and telangiectasias and mitral valve prolapse has been reported so far. Objective: To describe the findings that made it possible to establish the diagnosis of Peutz-Jeghers syndrome in a patient and to provide genetic counseling. Case presentation: Thirty-six-year-old male patient with a history of mitral valve prolapse who attends a clinical genetics consultation with his wife to request genetic counseling due to the fact that their daughter was diagnosed with Peutz-Jeghers Syndrome and they want to know about the risk of having another affected child. On physical examination, a hyperpigmented macule on the lower lip and several of these on the gums were observed. With such findings and the antecedent of having a daughter with Peutz-Jeghers syndrome, the same diagnosis is made in the father. As data of interest, multiple telangiectasias on the thorax, neck and back were found in this individual. The studies carried out to identify the same cause were negative. Conclusions: The history and findings in this patient allowed us to make the diagnosis of Peutz-Jeghers syndrome as well as to provide genetic counselling. The first report of this disease associated with telangiectasias and mitral valve prolapse is presented in the scientific literature(AU)

Ophthalmologic alterations in cutis marmorata telangiectatica congenita: a series of cases / Alterações oftalmológicas na cutis marmorata telangiectásica congênita: uma série de casos

ABSTRACT Cutis marmorata telangiectasia congenita is a rare cutaneous vascular disorder that may be associated with different systemic manifestations like body asymmetry, cutaneous, ophthalmologic, vascular, and neurological manifestations. We describe ophthalmologic alterations found in three patients with cutis marmorata telangiectatica congenita highlighting the rare retinal manifestations.

RESUMO A Cutis marmorata telangiectasica congênita é uma desordem vascular cutânea rara que pode estar associada a diferentes manifestações sistêmicas, como assimetria corporal, alterações cutâneas, oftalmológicas, vasculares e neurológicas. Descrevemos alterações oftalmológicas encontradas em três pacientes com cutis marmorata telangiectasia congênita, destacando as raras manifestações retinianas.

Malformación vascular oculta: telangiectasia capilar. Reporte de un caso / Occult vascular malformation: capillary telangiectasia. A case report

RESUMEN: La telangiectasia capilar es una alteración vascular caracterizada por una colección de capilares dilatados que carecen de componente muscular y elástico; se presenta entre el parénquima cerebral normal y constituye el 16 a 20% de todas las malformaciones vasculares intracraneales; ocupa el segundo lugar en frecuencia. Su localización más habitual es la protuberancial; es asintomática, excepto cuando se acompaña de otras malformaciones vasculares o son parte de síndromes de tipo vascular. Su diagnóstico, en casi todos los casos se lo efectúa por los hallazgos incidentales de los estudios de imagen realizados por otras causas. Aunque la telangiectasia capilar pasa desapercibida tanto en la tomografía axial computarizada (TAC) como en la resonancia magnética nuclear (RMN) sin contraste, con el gadolinio endovenoso se observa una lesión hiperintensa, irregular, con apariencia de "cepillo", sin definición individual de los vasos. Se presenta el caso de un paciente de 1 año 2 meses de edad, previamente sano, que ingresó con sintomatología de meningoencefalitis y estatus convulsivo. Se realizó los estudios de resonancia magnética simple, contrastada y angiorresonancia, en los cuales se identificó, de manera incidental, telangiectasia capilar protuberancial, visible únicamente en el estudio contrastado. Se realiza una revisión bibliográfica de dicha patología.Palabras claves: telangiectasia capilar, malformaciones vasculares, resonancia magnética.

ABSTRACT: Capillary telangiectasia is defined as a collection of dilated capillary vessels, without muscular and elastic components, situated within otherwise normal brain parenchyma and accounts for 16-20% of all intracranial vascular malformations, representing the second most common one. It is most frequently found in the pons and it has an asymptomatic natural course, except when the lesions are associated with other vascular malformations or are part of a vascular syndrome. Most are diagnosed as incidental findings in imaging studies performed for other causes. Capillary Telangiectasia is invisible in Computed Tomography and Magnetic Resonance without contrast, however, after intravenous administration of Gadolinium, it will present as a hyperintense, irregular, "brush-like" enhancing lesion, without individual definition of the vessels. We describe the case of a 1 year and 2 months old patient, previously healthy, who presented with signs of meningo-encephalitis and epileptic status. A Magnetic Resonance Image with and without contrast and an angioresonance were performed, in which, as an incidental finding, a pontine Capillary Telangiectasia, visible only in contrasted images was found. A bibliographic review of said pathology is presented in this article.Keywords:capillary telangiectasia, vascular malformations, magnetic resonance.

Uso de tartarato de brimonidina para resolução de matting telangiectásico: relato de caso / Use of brimonidine tartrate to resolve telangiectatic matting: case report

Resumo A escleroterapia é, atualmente, o tratamento de escolha para telangiectasias e veias reticulares, apresentando nível de recomendação 1ª pela diretriz europeia para escleroterapia. Os efeitos colaterais mais comuns desse procedimento são a hiperpigmentação e o matting telangiectásico, sendo este último um dos mais temidos em virtude do dano estético e da dificuldade de tratamento. O matting se refere a vasos com diâmetro inferior a 0,2 mm que podem surgir esporadicamente ou em áreas bem definidas, principalmente nos membros inferiores. Este relato apresenta um caso de matting tratado com o uso de tartarato de brimonidina tópico.

Abstract Sclerotherapy is currently the treatment of choice for telangiectasias and reticular veins, with grade 1A recommendation in the European Guideline for sclerotherapy. The most common side effects of this procedure are hyperpigmentation and telangiectatic matting, the second of which provokes great concern because of the esthetic damage and the difficulty of treatment. Matting refers to vessels with a diameter of less than 0.2 mm, which may emerge irregularly or in well-defined areas, especially on the lower limbs. This report presents a case of matting treated with topical Brimonidine Tartrate.

Cutaneous collagenous vasculopathy: light and transmission electron microscopy

Abstract Cutaneous collagenous vasculopathy is a rare acquired idiopathic microangiopathy characterized by progressive development of diffuse asymptomatic telangiectasias and histologically by accumulation of collagen type IV around the affected vessels. It is diagnosed by its clinical history, confirmed by light microscopy with collagen-specific immunostaining. We report a case of a patient with extensive acquired telangiectasias on the left arm, clinically resembling unilateral nevoid telangiectasia. Dilated blood vessels with thickened walls were observed in the dermis. Immunohistochemistry with collagen IV antibodies revealed marked collagen deposition around the vessels, confirming the diagnosis. Transmission electron microscopy observed duplicate and triplicate vascular basal membrane associated with deposition of amorphous material around the membranes.

Estudio Retrospectivo: Características Clínicas de la Esclerosis Sistémica en Pacientes de los Hospitales Vicente Corral Moscoso y José Carrasco Arteaga. Enero 2008 ­ Junio 2015 / Retrospective Research: Clinical Features of Systemic Sclerosis in Patients from Vicente Corral Moscoso and José Carrasco Arteaga Hospitals. January 2008 - June 2015

INTRODUCCIÓN: La esclerosis sistémica es una patología crónica del tejido conectivo; de etiología desconocida y caracterizada por presentar vasculopatía, autoinmunidad y fibrosis. Genera importantes repercusiones socio sanitarias y hasta la actualidad no tiene cura. El objetivo de la presente investigación fue determinar las características clínicas de esa enfermedad en la población local. MÉTODOS: Se realizó un estudio de tipo descriptivo retrospectivo. El universo incluyó a 58 pacientes diagnosticados de esclerosis sistémica en el Hospital Vicente Corral Moscoso y José Carrasco Arteaga durante el período comprendido entre Enero 2008 ­ Julio 2015. La información fue recopilada de las historias clínicas digitales y se realizó estadística descriptiva utilizando el programa SPSS versión 20.0. RESULTADOS: La esclerosis sistémica fue más común en el sexo femenino (relación hombre ­ mujer: 1/8.6), el subtipo limitado fue la forma de presentación principal. Las manifestaciones clínicas más frecuentes fueron las cutáneas (93.1%), seguidas de las osteomusculares (84.5%) y el fenómeno de Raynaud (81%). Los anticuerpos antinucleares fueron positivos en más del 70% de los pacientes. CONCLUSIÓN: La esclerosis sistémica es una enfermedad crónica con afección multiorgánica. El conocimiento de las distintas manifestaciones clínicas de esta patología en la población local, facilitará el diagnóstico oportuno y la instauración de un tratamiento apropiado, con el objetivo de mejorar la calidad de vida del paciente y prevenir complicaciones.(au)

BACKGROUND: Systemic sclerosis is a chronic connective tissue disease; of unknown etiology and characterized by vasculopathy, autoimmunity and fibrosis. The aim of this study was to determine the clinical features of this pathology in local population. METHODS: A retrospective descriptive study was performed. The universe included 58 patients with systemic sclerosis at Vicente Corral Moscoso Hospital and Hospital of Specialties José Carrasco Arteaga during January 2008 - July 2015. The information was compiled from medical records; descriptive statistics were performed using the statistical program SPSS version 20.0. RESULTS: Systemic sclerosis was more common in the females (male - female ratio: 1/8.6), the limited subtype was the main presentation form. The most frequent clinical features were skin disorders (93.1%), followed by osteomuscular manifestations (84.5%) and Raynaud's syndrome (81%). Antinuclear antibodies were positive in more than 70% of patients. CONCLUSION: Systemic sclerosis is a chronic entity with multisystem involvement. The knowledge of the different clinical manifestations will facilitate the opportune diagnosis and the establishment of an appropriate treatment; with the purpose of improve the quality of life and preventing complications.(au)

Síndrome de solapamiento: polimiositis-esclerodermia. Presentación de un caso / Polymyosis-Sclerosis Overlap Syndrome. Case report and review of literature

Introducción: en el síndrome de solapamiento o superposición existen simultáneamente manifestaciones clínicas o serológicas de dos o más enfermedades autoinmunes sistémicas. Afectan al 5 por ciento de la población con predominio en mujeres. Presentación del Caso: hombre de 48 años, sin antecedentes patológicos personales. Acude con dolor en ambas manos, inflamación en las articulaciones metacarpo e interfalángicas proximales, bilateral y simétrica, acompañada de rigidez matinal que duraba casi todo el día desde hace 4 meses. Se le diagnostica artritis reumatoidea y se inicia tratamiento que abandonó. Luego aparece un cuadro que es interpretado como un solapamiento por lo que es ingresado con un cuadro clínico florido. En los exámenes de laboratorio: las transaminasas, la creatín fosfoquinasa, el lactato deshidrogenasa, se encontraban elevadas. Por la clínica y los complementarios se diagnosticó Síndrome de Solapamiento de polimiosistis-esclerodermia. Se comenzó tratamiento con inmunosupesores. El paciente evolucionó desfavorablemente y falleció. Discusión: el diagnóstico de este caso se realizó por las manifestaciones clínicas como fascie esclerodérmica, signo de sal y pimienta, fibrosis de predominio distal en ambas manos, telangiectasias peribucales. Los diagnósticos diferenciales son las enfermedades autoinmunes sistémicas cuando se presentan como cuadros únicos. El tratamiento de primera línea y el pronóstico dependen de las enfermedades que se solapen(AU)

Introduction: In the syndrome of overlap or overlap there are simultaneously clinical or serological manifestations of two or more systemic autoimmune diseases. They affect 5 percent of the population with predominance in women. Case Presentation: A 48-year-old man with no personal pathological history. He came with pain in both hands, inflammation in the metacarpal and interphalangeal proximal joints, bilateral and symmetrical, accompanied by morning stiffness that lasted almost all day for 4 months. He was diagnosed with rheumatoid arthritis and started treatment that he abandoned. Then a picture appears that is interpreted as an overlap so it is entered with a florid clinical picture. In laboratory tests: transaminases, creatine phosphokinase, lactate dehydrogenase, were elevated. Clinical and complementary diagnosis of Polymyosis-Sclerosis Overlap Syndrome was diagnosed. Treatment with immunosupers was started. The patient evolved unfavorably and died. Discussion: The diagnosis of this case was made by clinical manifestations such as sclerodermic fascia, salt and pepper sign, predominantly distal fibrosis in both hands, perioral telangiectasias. Differential diagnoses are systemic autoimmune diseases when presented as single frames. First-line treatment and prognosis depend on overlapping diseases(AU)

Trichothiodystrophy: a case report of childhood glaucoma associated with non-acquired systemic disease / Tricotiodistrofia: relato de caso de glaucoma infantil associado a doença sistémica não adquirida

ABSTRACT Trichothiodystrophy belongs to a group of rare genetic diseases characterized by DNA repair anomalies. Ocular manifestations can occur in 50% of cases, including cataract, refractive errors, strabismus, microcornea, microphthalmia, dry eye, and pigmentary macular changes. We report a case of childhood glaucoma in a patient with trichothiodystrophy who underwent trabeculectomy in the left eye. To our knowledge, this is the first clinical report of childhood glaucoma associated with trichothiodystrophy.

RESUMO A tricotiodistrofia pertence a um grupo de doenças genéticas raras caracterizadas por anomalias da reparação do DNA. Manifestações oculares podem ocorrer em 50% dos casos, incluindo catarata, erros refrativos, estrabismo, microcórnea, microftalmia, olho seco e alterações maculares pigmentares. Relatamos um caso de glaucoma infantil em um paciente com tricotiodistrofia submetido à trabeculectomia no olho esquerdo. No nosso conhecimento, este é o primeiro caso descrito de glaucoma infantil associado à tricotiodistrofia.

Glicose como causa e tratamento de necrose cutânea / Glucose as a cause of and treatment for cutaneous necrosis

A escleroterapia continua sendo um dos procedimentos mais executados pelos cirurgiões vasculares brasileiros. O conhecimento das suas complicações é imprescindível para que possamos evitá-las. Os efeitos colaterais graves desse método de tratamento para as telangiectasias dos membros inferiores são raros e frequentemente associados a um erro técnico ou à dosagem injetada. São predominantemente locais, apresentando-se, algumas vezes, como uma situação de difícil resolução. Relatamos um caso de formação de necrose cutânea após escleroterapia química com glicose hipertônica (75%) e sua cicatrização utilizando preparação tópica contendo vaselina e glicose 60%, cujo resultado estético foi satisfatório

Sclerotherapy remains one of the procedures most frequently performed by Brazilian vascular surgeons. Knowledge of its complications is indispensable to enable us to avoid them. The severe side effects of this method of treatment for telangiectasias of the lower limbs are rare and are often associated with technical errors or the dose injected. Complications are predominantly local, but are sometimes difficult to resolve. We report a case of formation of cutaneous necrosis after chemical sclerotherapy using hypertonic glucose (75%), which healed when treated with a topical preparation containing vaseline and 60% glucose, with satisfactory esthetic results

Dermoscopy in the diagnosis of juvenile xanthogranuloma

Abstract: Juvenile xanthogranuloma is the most common form of non-Langerhans cell histiocytosis. It manifests clinically as a red-yellow papule, usually showing spontaneous remission. The diagnosis is based on clinical and histological findings. We report the use of dermoscopy ("setting sun" pattern) as an adjuvant tool in the diagnosis of juvenile xanthogranuloma in a female patient presenting with a 2-month history of a pre-auricular papule.

Principais causas de condenação de fígado bovino em estabelecimento sob Serviço de Inspeção Federal na Zona da Mata mineira / Main causes of bovine liver condemnation in an abattoir under the Federal Inspection Services in the Zona da Mata of the state of Minas Gerais

Neste trabalho, foi avaliada a prevalência das principais causas de condenação de fígado bovino em abatedouro frigorífico sob Serviço de Inspeção Federal, situado na Zona da Mata mineira. Para obtenção dos dados, foram consultadas fichas relativas ao movimento mensal de abate de bovinos e de causas de condenação, no período compreendido entre 2007 e 2013, no referido estabelecimento. Durante esse período, foram abatidos 150.752 bovinos, e a prevalência de condenação hepática entre os anos variou de 9,38% a 14,09%. As principais patologias envolvidas foram abscesso, telangiectasia e fasciolose, responsáveis por 32,03%, 29,20% e 21,95% das condenações, respectivamente. Além disso, foi observada tendência de redução na frequência de condenação por abscesso (3,26%) e telangiectasia (0,68%) ao ano e, em contraposição, aumento por fasciolose de 3,40% ao ano. Conclui-se que as patologias responsáveis pelas condenações de fígado bovino foram abscesso, telangiectasia e fasciolose e que a inspeção post mortem tem grande importância no monitoramento da saúde e da produção animal e na qualidade da carne a ser comercializada.(AU)

The aim of the present study was to evaluate the frequency of the main causes for condemnation of bovine liver in an abattoir/cold store under the Federal Inspection Services, located in the Zona da Mata of the state of Minas Gerais, between 2007 and 2013. Study data was collated from forms containing information about the number of cattle slaughtered per month and the causes for liver condemnation at the studied abattoir. During the period under study, 150,752 cattle were slaughtered, and the frequency of liver condemnation varied between 9.38% and 14.09% from year to year. The main pathologies that led to liver condemnation were abscesses, telangiectasis, and fasciolosis, which were responsible for 32.03%, 29.20%, and 21.95% of the condemnations, respectively. The frequency of condemnation because of abscesses and telangiectasis showed a trend of decline, 3.26% and 0.68% per year, respectively. The frequency of condemnation because of fasciolosis, however, showed a trend of increase by 3.40% per year. This study shows the usefulness of post mortem inspection of animal health and production monitoring.(AU)

Degeneración hepatocerebral adquirida reporte de caso y revisión de la literatura / Acquired hepatocerebral degeneration. case report and literature review

Acquired hepatocerebral degeneration also termed acquired hepatolenticular degeneration, cirrhosis-related Parkinsonism o pseudo-Wilson is a rare, progressive and chronic neurological syndrome that occurs in patients with chronic liver disease, particularly in those with surgically or spontaneously induced portosystemic shunts. The clinical features of this pathological entity include extrapyramidal signs, ataxia, cognitive decline and neuropsychiatric changes, such as delirium, apathy, lethargy and emotional instability. Brain Magnetic Resonance Imaging classically shows symmetrical T1-weighted hyperintensities in the globus pallidus, substantia nigra and periaqueductal gray matter. Although its pathogenesis is not completely elucidated, it is postulated that the excess manganese accumulation and deposition in the basal ganglia, leading to dysfunctional dopaminergic system in this anatomical location, would have a key role in triggering the disease. Orthotopic liver transplantation is the mainstay of treatment and is considered effective by reducing motor and cognitive alterations. Other therapeutic alternatives that have reported symptomatic improvement are the use of bromocriptine or levodopa and portosystemic shunts occlusion. In this article, we report a case of a 63-year-old woman with clinical manifestations over the course of one year, characterized by cognitive decline, chorea, gait and language disturbances. She was examined with plasma levels of copper and ceruloplasmin, which excluded the possibility of Wilson´s Disease, its main differential diagnosis. Neuroimaging revealed T1-weighted hyperintensity in the pallidum, confirming suspected diagnosis of acquired hepatocerebral degeneration.