Recurrent Severe Preschool Wheeze: From Prespecified Diagnostic Labels to Underlying Endotypes.

Rationale: Preschool wheezing is heterogeneous, but the underlying mechanisms are poorly understood.Objectives: To investigate lower airway inflammation and infection in preschool children with different clinical diagnoses undergoing elective bronchoscopy and BAL.Methods: We recruited 136 children aged 1-5 years (105 with recurrent severe wheeze [RSW]; 31 with nonwheezing respiratory disease [NWRD]). Children with RSW were assigned as having episodic viral wheeze (EVW) or multiple-trigger wheeze (MTW). We compared lower airway inflammation and infection in different clinical diagnoses and undertook data-driven analyses to determine clusters of pathophysiological features, and we investigated their relationships with prespecified diagnostic labels.Measurements and Main Results: Blood eosinophil counts and percentages and allergic sensitization were significantly higher in children with RSW than in children with a NWRD. Blood neutrophil counts and percentages, BAL eosinophil and neutrophil percentages, and positive bacterial culture and virus detection rates were similar between groups. However, pathogen distribution differed significantly, with higher detection of rhinovirus in children with RSW and higher detection of Moraxella in sensitized children with RSW. Children with EVW and children with MTW did not differ in terms of blood or BAL-sample inflammation, or bacteria or virus detection. The Partition around Medoids algorithm revealed four clusters of pathophysiological features: 1) atopic (17.9%), 2) nonatopic with a low infection rate and high use of inhaled corticosteroids (31.3%), 3) nonatopic with a high infection rate (23.1%), and 4) nonatopic with a low infection rate and no use of inhaled corticosteroids (27.6%). Cluster allocation differed significantly between the RSW and NWRD groups (RSW was evenly distributed across clusters, and 60% of the NWRD group was assigned to cluster 4; P < 0.001). There was no difference in cluster membership between the EVW and MTW groups. Cluster 1 was dominated by Moraxella detection (P = 0.04), and cluster 3 was dominated by Haemophilus or Staphylococcus or Streptococcus detection (P = 0.02).Conclusions: We identified four clusters of severe preschool wheeze, which were distinguished by using sensitization, peripheral eosinophilia, lower airway neutrophilia, and bacteriology.

Partial recessive IFN-γR1 deficiency: genetic, immunological and clinical features of 14 patients from 11 kindreds.

We report a series of 14 patients from 11 kindreds with recessive partial (RP)-interferon (IFN)-γR1 deficiency. The I87T mutation was found in nine homozygous patients from Chile, Portugal and Poland, and the V63G mutation was found in five homozygous patients from the Canary Islands. Founder effects accounted for the recurrence of both mutations. The most recent common ancestors of the patients with the I87T and V63G mutations probably lived 1600 (875-2950) and 500 (200-1275) years ago, respectively. The two alleles confer phenotypes that are similar but differ in terms of IFN-γR1 levels and residual response to IFN-γ. The patients suffered from bacillus Calmette-Guérin-osis (n= 6), environmental mycobacteriosis (n= 6) or tuberculosis (n= 1). One patient did not suffer from mycobacterial infections but had disseminated salmonellosis, which was also present in two other patients. Age at onset of the first environmental mycobacterial disease differed widely between patients, with a mean value of 11.25 ± 9.13 years. Thirteen patients survived until the age of 14.82 ± 11.2 years, and one patient died at the age of 7 years, 9 days after the diagnosis of long-term Mycobacterium avium infection and the initiation of antimycobacterial treatment. Up to 10 patients are currently free of infection with no prophylaxis. The clinical heterogeneity of the 14 patients was not clearly related to either IFNGR1 genotype or the resulting cellular phenotype. RP-IFN-γR1 deficiency is, thus, more common than initially thought and should be considered in both children and adults with mild or severe mycobacterial diseases.

Gut Microbiome Profiles and Associated Metabolic Pathways in HIV-Infected Treatment-Naïve Patients.

The normal composition of the intestinal microbiota is a key factor for maintaining healthy homeostasis, and accordingly, dysbiosis is well known to be present in HIV-1 patients. This article investigates the gut microbiota profile of antiretroviral therapy-naive HIV-1 patients and healthy donors living in Latin America in a cohort of 13 HIV positive patients (six elite controllers, EC, and seven non-controllers, NC) and nine healthy donors (HD). Microbiota compositions in stool samples were determined by sequencing the V3-V4 region of the bacterial 16S rRNA, and functional prediction was inferred using PICRUSt. Several taxa were enriched in EC compared to NC or HD groups, including Acidaminococcus, Clostridium methylpentosum, Barnesiella, Eubacterium coprostanoligenes, and Lachnospiraceae UCG-004. In addition, our data indicate that the route of infection is an important factor associated with changes in gut microbiome composition, and we extend these results by identifying several metabolic pathways associated with each route of infection. Importantly, we observed several bacterial taxa that might be associated with different viral subtypes, such as Succinivibrio, which were more abundant in patients infected by HIV subtype B, and Streptococcus enrichment in patients infected by subtype C. In conclusion, our data brings a significant contribution to the understanding of dysbiosis-associated changes in HIV infection and describes, for the first time, differences in microbiota composition according to HIV subtypes. These results warrant further confirmation in a larger cohort of patients.

Endogenous transplacental transmission of Neospora caninum in successive generations of congenitally infected goats.

Neospora caninum is a protozoan that is considered an important agent of reproductive disorders in ruminants worldwide, and vertical transmission is the main form of infection and maintenance of neosporosis in herds. In goats, there have been no studies that have evaluated the transmission of N. caninum between successive generations. Thus, the objective of this study was to evaluate, through IFAT and PCR, the endogenous transplacental transmission of N. caninum in up to five generations of six families of dairy goats naturally infected by the parasite and whether it was possible for dairy goats to become free of infection over successive generations. Ninety-five serum samples from positive animals and 75 samples from negative animals were analyzed for N. caninum. Of the 95 samples analyzed, 93 contained anti-N. caninum antibodies (97.8 %). Titers of anti-N. caninum antibodies varied (increasing or decreasing) in the offspring; however, with an increase in the number of the goat generations, the offspring tended to have lower titers (p = 0.021) at the day of birth. Reproductive disorders such as abortions, stillbirth or fetal retention occurred at a rate of 10.4 % and were not influenced by the mother's titer of anti-N. caninum antibodies at the day of parturition or abortion. The results showed that infection by N. caninum persists throughout generations in congenitally infected goats.

Dermoscopic features of clear cell acanthoma.

Clear cell acanthoma is an uncommon type of benign epithelial tumor. Typically, it is a solitary lesion found on the lower limbs. It presents as a nodule or small plaque with slow and well-defined growth. Diagnosis used to be clinical and histopathological, but the advent of dermoscopy has led to an increase in diagnostic accuracy. We describe a case in which dermoscopy proved highly useful for diagnosis of the lesion.

Psychiatric admission and readmission in a general hospital of Porto Alegre: sociodemographic, clinic, and use of Network for Psychosocial Care characteristics. / Internações e reinternações psiquiátricas em um hospital geral de Porto Alegre: características sociodemográficas, clínicas e do uso da Rede de Atenção Psicossocial.

INTRODUCTION: The revolving door phenomenon is characterized by repeated and frequent psychiatric readmissions. OBJECTIVE: We aim to investigate sociodemographic, clinic, and follow-up characteristics in health services associated to psychiatric admissions and readmissions of inpatients in a general hospital of Porto Alegre. METHODS: It is a cross-sectional study with a sample of 96 participants. RESULTS: More than half of the sample (53.1%) were female, 51% were single, and the average age was 44.3 years old. From clinic data, 36% (n = 35) of the users were in their first admission, and 36% (n = 35) met the criteria for frequent readmission. The results show that users with frequent readmissions significantly mentioned fewer people on whom they could rely. Alternatively, users in first admission lived with a significant larger number of people than the rest of the sample and had, with less frequency, bond with health services other than hospitals, using hospitals as an entrance door to mental health care. Regarding follow-up in the network, 34.4% of the sample did not visit often NPC services before admission, and only 4.1% used psychosocial rehabilitation services. CONCLUSION: We highlight the importance of hospitals as an articulation point in the network, and as strategic to connect with NPC services. In spite of international literature investigation and registration of the frequent psychiatric readmission phenomenon, we notice it is a field that needs greater investigation in Brazil.

INTRODUÇÃO: O fenômeno da porta giratória é caracterizado por repetidas e frequentes reinternações psiquiátricas. OBJETIVO: Investigar as características sociodemográficas, clínicas e de acompanhamento em serviços da Rede de Atenção Psicossocial (RAPS) associadas às internações e às reinternações psiquiátricas de usuários de um hospital geral de Porto Alegre. MÉTODOS: Estudo transversal realizado com uma amostra de 96 participantes. RESULTADOS: Mais da metade da amostra (53,1%) era do sexo feminino, 51% eram solteiros e a idade média foi de 44,33 anos. Dos dados clínicos, 36,5% (n = 35) dos usuários estavam em sua primeira internação e 36,5% (n = 35) preencheram o critério para reinternação frequente. Os resultados mostraram que usuários com reinternações frequentes referiam um número significativamente menor de pessoas com as quais consideravam que poderiam contar. Já os usuários de primeira internação viviam com um número significativamente maior de pessoas que o restante da amostra e possuíam, com menor frequência, vínculo com serviço de saúde, utilizando o hospital como porta de entrada para o cuidado em saúde mental. Em relação ao acompanhamento na rede, 34,4% da amostra não frequentava nenhum serviço da RAPS antes da internação à época do estudo e somente 4,1% fazia uso de serviços de reabilitação psicossocial. CONCLUSÃO: Destacamos a importância do hospital como ponto articulador da rede e estratégico para realizar a ponte com os serviços da RAPS. Apesar de a literatura internacional investigar e registrar o fenômeno da porta giratória, percebe-se que esse é um campo que necessita de maiores investigações no território brasileiro.

Atuação da psicologia em um centro de terapia intensiva dedicado para COVID-19: relato de experiência / The psychologist's work within a COVID intensive care unit: an experience report

As reestruturações necessárias nos serviços de saúde em decorrência da pandemia da COVID-19 geraram impactos na assistência aos pacientes hospitalizados, em especial àqueles gravemente afetados pela doença. A atuação da psicologia em Unidades de Terapia Intensiva dedicadas a esses pacientes requer a ampliação de ferramentas clínicas que possibilitem o atendimento às demandas psicológicas nesse contexto. Esse artigo discute, a partir de um relato de experiência, as atividades desenvolvidas pela equipe de psicologia em um Centro de Terapia Intensiva voltado ao tratamento da COVID-19: atendimento remoto a familiares, atendimento aos pacientes, visitas virtuais e presenciais. As intervenções realizadas, em consonância com o referencial teórico utilizado, indicam os seguintes benefícios: fortalecimento das conexões entre paciente, família e equipe; atenuação do sofrimento provocado pela situação de isolamento; prevenção de agravos em saúde mental relacionados ao luto complicado e à vivência de experiências traumáticas. Espera-se que as inovações nas práticas desenvolvidas sigam contribuindo para qualificar a atenção a pacientes críticos após a pandemia.(AU)

The reorganization needed in health care services due to the COVID-19 pandemic generated a substantial impact on the assistance of hospital patients, especially those who are severely affected by the disease. The psychologist's work in Intensive Care Units, dedicated to these specific patients, requires the amplification of clinical tools that enable the assistance of the psychological demands in this context. In an experience report format, this article discusses the activities developed by the psychological team in an Intensive Care Unit dedicated to the treatment of COVID-19 patients such as: families' remote support, direct patient´s psychological care and virtual and face to face visits. The interventions, in accordance with the theoretical background used, indicate the following benefits: strengthening of the connection between patient, family and health care teams, attenuation of suffering provoked by isolation, the prevention of the aggravation of mental health problems related to complicated mourning processes and the experience of traumatic situations. It is hoped that the innovative developed practices can continue to contribute to qualify the assistance of critically ill patients after the pandemic.(AU)

La necesaria reestructuración de los servicios de salud como consecuencia de la pandemia COVID-19 ha repercutido en la atención de los pacientes hospitalarios, especialmente en los afectados gravemente por la enfermedad. El trabajo de la psicología en las Unidades de Cuidados Intensivos dedicadas a estos pacientes requiere la ampliación de herramientas clínicas que permitan atender las demandas psicológicas de este contexto. Este artículo analiza, a partir de un relato de experiencia, las actividades desarrolladas por el equipo de psicología en un Centro de Cuidados Intensivos enfocado al tratamiento del COVID-19: atención remota a familiares, atención a pacientes, visitas virtuales y presenciales. Las intervenciones realizadas, en consonancia con el referencial teórico utilizado, señalan los siguientes beneficios: fortalecimiento de las conexiones entre paciente, familia y equipo; mitigación del sufrimiento causado por la situación de aislamiento; prevención de agravios en salud mental relacionados al duelo complicado y experiencias traumáticas. Se espera que las innovaciones en las prácticas desarrolladas continúen contribuyendo para calificar la atención de los pacientes críticos pasada la pandemia.(AU)

Barreiras invisíveis e rotas alternativas: uma análise sobre (i)mobilidade urbana e produção de subjetividades / Invisible barriers and alternative routes: an analysis about urban (in)mobility and production of subjectivities / Barreras invisibles y caminos alternativos: un análisis sobre (in)movilidad urbana y producción de subjetividades

Promover a mobilidade urbana saudável nas grandes cidades é um desafio, em especial em regiões marcadas por desigualdades socioeconômicas, onde fatores físico-estruturais somam-se a questões subjetivas (barreiras invisíveis) que inibem ou dificultam o deslocamento da população pelo território. O objetivo do estudo foi problematizar os modos pelos quais a mobilidade urbana é afetada por barreiras invisíveis em uma região da cidade de Porto Alegre. Para realizar essa investigação foi utilizado um método qualitativo de pesquisa-intervenção e a análise dos dados foi realizada a partir de algumas ferramentas teóricas de Michel Foucault. Os resultados encontrados permitem pensar que as barreiras invisíveis de mobilidade estão relacionadas aos modos de subjetivação existentes em contextos urbanos específicos, ligados às relações de poder engendradas na cidade contemporânea, às sensações de isolamento e exclusão, à atmosfera de medo e insegurança e aos processos de segregação (re)produzidos localmente.

Promote healthy urban mobility in big cities is a challenge, especially in regions with social-economic inequities. Places where infrastructural factors add to subjective issues (invisible barriers) that inhibit or hinder people's journeys around the territory. The aim of the study was to investigate how urban mobility is affected by invisible barriers in a region of Porto Alegre city in the South of Brazil. A qualitative method of intervention research was used and the analysis was produced using concepts of Michel Foucault. Findings permit to relate invisible mobility barriers with the existing modes of subjectivation in particular urban contexts. Those are connected to power relations engendered in contemporary urban life, to the feeling of exclusion and isolation, to the fear atmosphere and insecurity and to segregation processes (re)produced locally.

Promover la movilidad urbana saludable en las grandes ciudades es un desafío, especialmente en regiones marcadas por desigualdades socioeconómicas, donde factores físico-estructurales se suman a cuestiones subjetivas (barreras invisibles) que inhiben o dificultan el desplazamiento de la población por el territorio. El objetivo del estudio fue problematizar los modos por los que la movilidad urbana es afectada por barreras invisibles en una región de la ciudad de Porto Alegre (Brasil). Para realizar esta investigación se utilizó un método cualitativo de pesquisa-intervención y los análisis fueron elaborados a partir de algunos conceptos teóricos de Michel Foucault. Los resultados encontrados permiten pensar que las barreras invisibles de movilidad están relacionadas con los modos de subjetivación existentes en contextos urbanos específicos, vinculados a las relaciones de poder engendradas en la ciudad contemporánea, a los sentimientos de aislamiento y exclusión, a la atmósfera de miedo e inseguridad y a los procesos de segregación (re)producidos localmente.

Segmental odontomaxillary dysplasia: report of a case emphasizing histopathological, immunohistochemical and scanning electron microscopic features.

Segmental odontomaxillary dysplasia (SOD) is a rare developmental disorder of the maxilla, and there is little information on its morphological features. Thus, the present article describes a case of SOD focusing on its histopathological, immunohistochemical and scanning electron microscopic features. Several dental abnormalities were present, including numerous dentin and pulp defects, altered composition of hard tissue, and proliferation of myofibroblasts in the pulp and the soft tissue surrounding affected teeth. This myofibroblastic proliferation was identified for the first time in SOD and may be involved in both bone and tooth resorption mechanisms.

Dermoscopic features of clear cell acanthoma

Abstract: Clear cell acanthoma is an uncommon type of benign epithelial tumor. Typically, it is a solitary lesion found on the lower limbs. It presents as a nodule or small plaque with slow and well-defined growth. Diagnosis used to be clinical and histopathological, but the advent of dermoscopy has led to an increase in diagnostic accuracy. We describe a case in which dermoscopy proved highly useful for diagnosis of the lesion.

Hybrid Clinical and Histopathological Pattern in Annular Lesions: An Overlap between Annular Elastolytic Giant Cell Granuloma and Granuloma Annulare?

Annular elastolytic giant cell granuloma (AEGCG) is a rare granulomatous skin disease of unclear pathogenesis which belongs to the group of disorders in the skin and elastic fibers with similar clinical features of granuloma annulare (GA). This case report is intended to describe a rare hybrid pattern in histopathology demonstrating coexistence of AEGCG and GA. An endocrine disease, such as diabetes mellitus (DM), could contribute to the coexistence of both lesions, and this possibility must be included in the medical investigation.

Localized scleroderma associated with chronic hepatitis C.

Hepatitis C virus has been associated with various skin conditions, such as porphyria cutanea tarda and lichen planus, as an example. The objective of this paper is based on the description of a case of localized morphea, which came years after the discovery of hepatitis C, as well as a discussion of possible relations between both diseases.

Internações e reinternações psiquiátricas em um hospital geral de Porto Alegre: características sociodemográficas, clínicas e do uso da Rede de Atenção Psicossocial / Psychiatric admission and readmission in a general hospital of Porto Alegre: sociodemographic, clinic, and use of Network for Psychosocial Care characteristics

RESUMO: Introdução: O fenômeno da porta giratória é caracterizado por repetidas e frequentes reinternações psiquiátricas. Objetivo: Investigar as características sociodemográficas, clínicas e de acompanhamento em serviços da Rede de Atenção Psicossocial (RAPS) associadas às internações e às reinternações psiquiátricas de usuários de um hospital geral de Porto Alegre. Métodos: Estudo transversal realizado com uma amostra de 96 participantes. Resultados: Mais da metade da amostra (53,1%) era do sexo feminino, 51% eram solteiros e a idade média foi de 44,33 anos. Dos dados clínicos, 36,5% (n = 35) dos usuários estavam em sua primeira internação e 36,5% (n = 35) preencheram o critério para reinternação frequente. Os resultados mostraram que usuários com reinternações frequentes referiam um número significativamente menor de pessoas com as quais consideravam que poderiam contar. Já os usuários de primeira internação viviam com um número significativamente maior de pessoas que o restante da amostra e possuíam, com menor frequência, vínculo com serviço de saúde, utilizando o hospital como porta de entrada para o cuidado em saúde mental. Em relação ao acompanhamento na rede, 34,4% da amostra não frequentava nenhum serviço da RAPS antes da internação à época do estudo e somente 4,1% fazia uso de serviços de reabilitação psicossocial. Conclusão: Destacamos a importância do hospital como ponto articulador da rede e estratégico para realizar a ponte com os serviços da RAPS. Apesar de a literatura internacional investigar e registrar o fenômeno da porta giratória, percebe-se que esse é um campo que necessita de maiores investigações no território brasileiro.

ABSTRACT: Introduction: The revolving door phenomenon is characterized by repeated and frequent psychiatric readmissions. Objective: We aim to investigate sociodemographic, clinic, and follow-up characteristics in health services associated to psychiatric admissions and readmissions of inpatients in a general hospital of Porto Alegre. Methods: It is a cross-sectional study with a sample of 96 participants. Results: More than half of the sample (53.1%) were female, 51% were single, and the average age was 44.3 years old. From clinic data, 36% (n = 35) of the users were in their first admission, and 36% (n = 35) met the criteria for frequent readmission. The results show that users with frequent readmissions significantly mentioned fewer people on whom they could rely. Alternatively, users in first admission lived with a significant larger number of people than the rest of the sample and had, with less frequency, bond with health services other than hospitals, using hospitals as an entrance door to mental health care. Regarding follow-up in the network, 34.4% of the sample did not visit often NPC services before admission, and only 4.1% used psychosocial rehabilitation services. Conclusion: We highlight the importance of hospitals as an articulation point in the network, and as strategic to connect with NPC services. In spite of international literature investigation and registration of the frequent psychiatric readmission phenomenon, we notice it is a field that needs greater investigation in Brazil.

The therapeutic benefit of allopurinol in the treatment of foreign body granulomas caused by polymethylmethacrylate microspheres.

Injectable polymethylmethacrylate (PMMA) microspheres are nonbiodegradable and too large for macrophage phagocytosis. There are several complications possible to happen, like chronic nonspecific inflammatory reactions, lip stiffness, infection, and granulomas. The occurrence of granulomas can lead to a not aesthetic result, making some extreme changes in the patient's life. The objective of this case report is to describe the successful treatment of foreign body granulomas caused by polymethylmethacrylate microspheres using allopurinol, an innovative therapy for this condition.

O outro lado da porta giratória: apoio comunitário e saúde mental / The other side of the revolving door: community support and mental health / El otro lado de la puerta giratoria: apoyo comunitario y salud mental

A Reforma Psiquiátrica tem como princípio fundamental o cuidado em liberdade e prevê a internação breve em hospital geral apenas quando esgotados os recursos extra-hospitalares. No entanto, as múltiplas reinternações em unidades psiquiátricas ainda são comuns no cotidiano hospitalar. O foco desse estudo está no que acontece para além dos portões do hospital, analisando elementos da vida comunitária dos portadores de sofrimento psíquico e se essas experiências se relacionam de alguma forma com a frequente necessidade de hospitalização. Para tanto, buscou-se investigar a percepção sobre apoio comunitário em usuários com alto número de internações, comparando com a de usuários de primeira internação, na unidade psiquiátrica de um hospital geral de Porto Alegre. Os resultados mostraram que a comunidade é uma potente fonte de ajuda em situações de crise, porém, usuários com múltiplas internações têm essas redes enfraquecidas e um afastamento maior da Atenção Básica, em relação aos usuários de primeira internação. Dessa forma, a família se torna a principal fonte de apoio, o que gera sobrecarga, e o hospital ganha um status diferenciado na vida desses usuários, considerado a única alternativa em situações de crise.

The Psychiatric Reform has, as a fundamental principle, the treatment carried out outside the hospital, considering that the hospitalization should be an option only when the extra-hospital resources are not effective enough. However, multiple psychiatric readmissions are still frequent. The present study focuses on what happens outside of the hospital doors, analyzing elements of the community life of people who suffer from mental disorders,questioning if those experiences are related to the frequent necessity of hospitalization. Therefore, the perception of community support was investigated in patients with a high number of readmissions, in comparison with patients in their first hospitalization, in a general hospital in Porto Alegre (Brazil). The results showed that the community is a powerful source of help in crisis situations; nevertheless, the readmitted patients have weaker social bonds and a longer distance from the Atenção Básica (Primary Care), in comparison with the other group. For that reason, the family becomes the main source of support, what leads to an overburden for the relatives, and the hospital acquires a special status for these people, who see the hospital as the only alternative in a situation of crisis.

La Reforma Psiquiátrica tiene como principio fundamental el cuidado en libertad, con la posibilidad de recurrir a breves hospitalizaciones en hospital general, solamente cuando los recursos comunitarios resultan insuficientes. Sin embargo, los múltiples ingresos en unidades psiquiátricas siguen siendo comunes en la rutina de los hospitales. El enfoque de este estudio se radica en lo que sucede más allá de las puertas del hospital, haciendo un análisis de los elementos de la vida comunitaria de las personas con sufrimiento mental, y si esas experiencias están relacionadas de alguna manera con la frecuente necesidad de hospitalización. Con este fin, hemos tratado de investigar la percepción de apoyo comunitario en pacientes con alto número de ingresos, en comparación con pacientes en su primera hospitalización en la unidad psiquiátrica de un hospital general en Porto Alegre (Brasil). Los resultados mostraron que la comunidad es una poderosa fuente de ayuda en situaciones de crisis, pero los pacientes con múltiples ingresos han debilitado estas redes y están más lejos de la Atención Primaria, en comparación con el otro grupo. Por lo tanto, la familia se convierte en su principal fuente de apoyo, lo que genera sobrecarga, y el hospital recibe un status diferente en la vida de esos pacientes, considerado la única alternativa en situaciones de crisis.

As diversas apresentações da sífilis secundária: relato de casos / The diverse presentation of secondary syphilis: case reports

JUSTIFICATIVA E OBJETIVOS: Na última metade do século XX, o advento da penicilina e a maior atenção às iniciativas que visam prevenção das doenças sexualmente transmissíveis representaram um grande avanço no combate à sífilis. No entanto, a sua prevalência no Brasil ainda é elevada e constitui um importante problema de saúde pública. O objetivo deste estudo foi relatar a apresentação da variedade das manifestações clínicas da sífilis secundária, incluindo formas incomuns e reflexos de sua associação com o vírus da imunodeficiência humana (HIV). RELATO DOS CASOS: São apresentados e discutidos quatro casos de lues secundária tratados com penicilina benzatina, sendo cada um com clínica peculiar: lesões palmo-plantares em conjunto com pápulas disseminadas pelo corpo, sifilides elegantes, sífilis maligna precoce e alopécia. Sintomatologia sistêmica também é discutida quando presente, assim como a relação entre a coinfecção com o HIV e provas laboratoriais. CONCLUSÃO: Observou-se neste estudo a capacidade de polimorfismo das lesões dermatológicas da sífilis secundária reforçando a expressão que a doença recebe de "o grande imitador" e destaca a necessidade de refamiliarização para com as diversas formas clínicas do secundarismo das lues.

BACKGROUND AND OBJECTIVES: In the last half of 20th century, the advent of penicillin and more attention to initiatives aimed at prevention of sexually transmitted diseases represent a major breakthrough in the fight against syphilis. However, the prevalence of syphilis in Brazil is still high and so it is an important public health problem. The main purpose of these reports is the presentation of the variety of clinical manifestations of secondary syphilis, including unusual presentations and aspects of its association with human immunodeficiency virus (HIV). CASE REPORTS: Presented and discussed four cases of secondary syphilis treated with penicillin G benzathine, each with thefollowings presentations: palmoplantar papules and disseminated lesions, syphilids elegant, early malignant syphilis and alopecia. Systemic symptoms when present are also discussed, as well as the relationship between co-infection with HIV and laboratory tests. CONCLUSION: The study reflects the polymorphism of the skin lesions of secondary syphilis enhancing the expression that the disease was "the great imitator" and highlights the need to re-familiarization with the various forms of secondary syphilis.