Nasal cartilage destruction associated to cutaneous histoplasmosis in AIDS.

BACKGROUND: Systemic histoplasmosis is a disease of high morbidity and mortality in immunocompromised patients. Patients with AIDS get the infection through inhalation of spores, triggering a primary lung infection with a subsequent hematogenous spread to multiple organs, including the skin. Tissue necrosis have been documented in cutaneous histoplasmosis with multiple clinical manifestations that mimic other diseases. CASE PRESENTATION: We report the case of nasal cartilage destruction associated to cutaneous histoplasmosis in AIDS. A 24-year-old man, resident in Ecuadorian coast, with a history of HIV for 7 years without any treatment. In the last 3 months, he has been presenting a molluscum-like lesions on his nasal bridge with subsequent dissemination to the trunk and extremities. He was admitted to the emergency department for dyspnoea, cough, and malaise. Due to his respiratory failure, he was admitted to the intensive care unit (ICU) with mechanical ventilation. Physical examination reveals a crusted surface ulcer that involves the nose and cheeks, associated with erythematous papules, some with a crusted surface which are spread to the face, trunk, and upper limbs. The patient has a specific skin involvement with a butterfly-like ulcer appearance and destruction of the upper and lower lateral cartilage of the nose. At admission CD4 cell count was 11/mm3 with a HIV viral load of 322,908 copies. Mycological cultures identified Histoplasma capsulatum. A treatment with highly active antiretroviral therapy (HAART) was stablished, associated with liposomal amphotericin B at a dose of 3 mg/kg/day and itraconazole 200 mg twice a day for 12 months. CONCLUSIONS: Cutaneous histoplasmosis is a rare manifestation of pulmonary histoplasmosis in patients with AIDS. The cutaneous manifestations included papules, nodules, plaques, and ulcers. A histology examination is required to rule out other fungal or parasitic infections. Treatment includes highly active antiretroviral therapy (HAART), amphotericin B liposomal and itraconazole, the latest for at least 12 months.

Successful treatment of mucosal neuromas by radiofrequency ablation in a patient with multiple endocrine neoplasia type 2B.

This is the first report of mucosal neuromas being treated successfully with radiofrequency ablation in a patient with multiple endocrine neoplasia type 2B.

Extranodal NK/T-Cell Lymphoma, Nasal Type, Extranasal and Ulcerative Blister Variant, Case Report.

The extranodal natural killer (NK) T-cell lymphoma of nasal type is a form of lymphoma that falls within the WHO/EORTC 2018 classification of cutaneous T-cell lymphomas. It is characterized for being aggressive, infrequent, and destroying midline facial structures; however, it can also be in primary or secondary form at extranasal sites, such as the skin or the gastrointestinal tract, among others. We report the case of an 18-year-old patient with an extranodal NK/T-cell lymphoma located in an extranasal site. The clinical presentation is characterized for being multifocal and with erythematous-violaceous plaques that progress to hemorrhagic blisters and necrotic ulcers. Although this type of lymphoma has been reported previously by others, the presence of blisters is an atypical finding, which we believe has been described only in one case in the medical literature.

Caracterización de la autoinmunidad tiroidea en mujeres adultas con melasma / Characterization of thyroid autoimmunity in adult women with melasma

Contexto: el melasma es una dermatosis frecuente en el país; predomina en mujeres. A nivel mundial existe limitada y controversial información sobre la relación entre melasma y la autoinmunidad tiroidea; en el país no existen estudios sobre esta asociación. Si fuera el caso, pacientes con melasma tendrían un alto riesgo de padecer patologías tiroideas. Objetivo: caracterizar la asociación entre melasma y autoinmunidad tiroidea en mujeres mayores de 18 años. Diseño: estudio transversal, en mujeres mayores a 18 años de edad que acuden a consulta externa del servicio de Dermatología del Hospital San Francisco de Quito, perteneciente al Instituto Ecuatoriano de Seguridad Social IESS, en el periodo abril 2014-junio 2015, diagnosticadas de melasma. Mediciones principales: la información fue obtenida de la historia clínica electrónica de cada paciente y una entrevista personal; luego se obtuvieron muestras biológicas para determinar la presencia de anticuerpo antitiroperoxidasa, antitiroglobulina y hormona estimulante de tiroides en sangre. La asociación entre las titulaciones de anticuerpos, severidad y etiología de melasma se estimó mediante regresión logística. Resultados: el 47,17% de mujeres presentó algún trastorno tiroideo; son más prevalentes las pacientes eutiroideas con anticuerpos positivos. El 19,8% presentó titulaciones de TPO-Ac positivas mientras que el 25,5% tiene niveles positivos de TG-Ac; al comparar los resultados de este estudio con reportes disponibles, existe una mayor titulación de estos dos anticuerpos en pacientes con melasma, comparado con la población que no presenta esta dermatosis. Conclusión: no se encontró asociación estadística entre melasma y titulaciones de anticuerpos antitiroideos, sin embargo, se encontró una elevada proporción de anticuerpos incluso superior a la reportada en poblaciones sanas, siendo esta diferencia estadísticamente significativa para TG-Ac. (AU)

Context: Melasma is a common dermatosis in the country; predominates in women. Globally there is limited and controversial information on the relationship between melasma and thyroid autoimmunity. In the country there are no studies on this association. If it were the case, patients with melasma would have a high risk of suffering thyroid pathologies. Objective: to characterize the association between melasma and thyroid autoimmunity in women older than 18 years. Material and methods: cross-sectional study in women older than 18 years of age who attend an outpatient clinic of the Dermatology Service of the Hospital San Francisco de Quito, belonging to the Ecuadorian Institute of Social Security IESS, in the period April 2014-June 2015, diagnosed as melasma . Main measurements: information was obtained from the electronic medical record of each patient and a personal interview; then biological samples were obtained to determine the presence of antithyroperoxidase antibody, antithyroglobulin and thyroid stimulating hormone in blood. The association between antibody titers, severity and etiology of melasma was estimated by logistic regression. Results: 47.17% of women presented with thyroid disorder; euthyroid patients with positive antibodies are more prevalent. 19.8% had positive TPO-Ac titers while 25.5% had positive levels of TG-Ac. When comparing the results of this study with available reports, there is a greater titration of these two antibodies in patients with melasma, compared to the population that does not present this dermatosis. Conclusion: No statistical association was found between melasma and antithyroid antibody titres. However, a high proportion of antibodies were found to be even higher than that reported in healthy populations, and this difference was statistically significant for TG-Ac.(AU)

Hallazgos dermatoscópicos del xantogranuloma juvenil / Dermoscopic findings of juvenile xanthogranuloma

El xantogranuloma juvenil es una enfermedad benigna fibrohistiocítica poco frecuente, que forma parte del diverso grupo de desórdenes proliferativos histiocíticos de células no-Langerhans. Se presenta principalmente de forma congénita o antes del primer año de edad, aunque también se han descripto casos aislados en adultos.Presentamos cuatro pacientes sin antecedentes patológicos de importancia, que acudieron a la consulta externa por presentar lesiones papulosas asintomáticas, amarillo-anaranjadas, en las que se encontraron hallazgos dermatoscópicos e histopatológicos característicos de xantogranuloma juvenil.

Juvenile xanthogranulomais a rare, benign fibrohistiocytic disease that belongs to the wide group of non-Langerhans cell histiocytoses. It develops congenitally or before the first year of life; however there are few cases reported in adults.We present four patients with no significant medical history, who attended because of asymptomatic, yellowish-orange papularcutaneous lesions that were dermatoscopic and histopathologically consistent with juvenile xanthogranuloma.

Liquen plano hipertrófico infantil generalizado / Generalized infant hypertrophic lichen planus

El liquen plano hipertrófico generalizado es una enfermedad inflamatoria autolimitada, subaguda o crónica, de origen desconocido, que afecta la piel, las mucosas y los anexos. Clínicamente se caracteriza por pápulaspoligonales, pruriginosas, violáceas o grisáceas, que confluyen formando placas con superficie hiperqueratósica de aspecto verrugoso. Es extremadamente raro en niños y su incidencia mundial es menor al 1%. Comunicamos el caso clínico de un paciente en edad pediátrica con liquen plano hipertrófico generalizado, cuyo interés radica en la peculiar edad de aparición.

Generalized hypertrophic lichen planus is a self-limited subacute or chronic inflammatory disease of unknown etiology that affects the skin, mucous membranes and skin appendages. It is characterized by pruritic, polygonal, purple or grayish papules that converge to form hyperkeratotic plaques with a warty surface. It is extremely rare in children, with a global incidence less than 1%.We report the case of a pediatric patient with generalized hypertrophic lichen planus, the interest of the case lies in reporting the particular age of onset.