RESUMO
Cutaneous toxoplasmosis is a rare and diagnostically challenging entity. Today, the acquired form occurs predominantly in immunocompromised patients with human immunodeficiency virus or after hematopoietic stem cell transplantation. We report a case of cutaneous toxoplasmosis in a 6-year-old girl after allogeneic stem cell transplantation for immune-mediated encephalopathy, first manifesting at 16 months of age. In the post-transplant setting, she developed a rash consisting of approximately 8 scattered 34-mm round, erythematous macules and papules on her back, abdomen, and right shoulder. Sections from a biopsy of a lesion on the back revealed numerous spherules tightly packed within small cystic structures in the epidermis. The diagnosis of cutaneous toxoplasmosis was confirmed by an immunohistochemical stain for Toxoplasma gondii and polymerase chain reaction on the peripheral blood for the T. gondii genome. This case should raise awareness that acquired toxoplasmosis with cutaneous involvement can occur in the pediatric population, particularly in immunocompromised patients after stem cell transplantation. Early diagnosis and treatment of this life-threatening opportunistic infection may improve patient outcomes.
Assuntos
Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Hospedeiro Imunocomprometido , Imunossupressores/efeitos adversos , Infecções Oportunistas/parasitologia , Dermatopatias Parasitárias/parasitologia , Toxoplasma/isolamento & purificação , Toxoplasmose/parasitologia , Antiprotozoários/uso terapêutico , Biópsia , Criança , DNA de Protozoário/genética , Quimioterapia Combinada , Evolução Fatal , Feminino , Humanos , Imuno-Histoquímica , Infecções Oportunistas/diagnóstico , Infecções Oportunistas/imunologia , Reação em Cadeia da Polimerase , Dermatopatias Parasitárias/diagnóstico , Dermatopatias Parasitárias/imunologia , Fatores de Tempo , Toxoplasma/genética , Toxoplasma/imunologia , Toxoplasmose/diagnóstico , Toxoplasmose/imunologia , Resultado do TratamentoRESUMO
Keloids are the result of an overgrowth of dense fibrous tissue that usually develops after healing of a skin injury. Despite their common occurrence, keloids remain one of the most challenging dermatologic conditions to successfully treat. They are often symptomatic, do not usually regress spontaneously, and tend to recur after excision. Prevention of keloids is essential. A previous history of keloid development should be elicited. Wound closure with minimal tension and application of adjunctive therapies before abnormal healing is paramount. Education regarding wound care should be given in order to prevent infection and foreign body reactions. Elective surgery should be avoided in patients predisposed to developing keloids. In this article, we review recent advances in medical and surgical treatment of keloids.
