RESUMO
Background: Lichen planus (LP) pemphigoides (LPP) is a very rare autoimmune bullous disorder, that is, exceptional in children. Case Report: We report a case of LP pemphigoides with severe cutaneous and mucosal involvement in an 8-year-old girl who consulted for multiple vesicular and bullous lesions associated with shiny erythematous-purple plaques. The eruption occurred 2 months after vaccination against hepatitis A virus. The diagnosis of LP pemphigoides was confirmed by histopathology and immunofluorescence examination. The patient received oral corticosteroid therapy with rapid improvement. Conclusion: To our knowledge, this is the first report of LPP following hepatitis A vaccination, among adults and children.
Assuntos
Dermatomicoses/complicações , Dermatoses do Pé/microbiologia , Dermatoses da Mão/microbiologia , Microsporum , Tinha do Couro Cabeludo/microbiologia , Antifúngicos/uso terapêutico , Pré-Escolar , Dermatomicoses/tratamento farmacológico , Dermatomicoses/microbiologia , Feminino , Dermatoses do Pé/tratamento farmacológico , Griseofulvina/uso terapêutico , Dermatoses da Mão/tratamento farmacológico , Humanos , Tinha do Couro Cabeludo/tratamento farmacológicoRESUMO
Cutaneous tuberculosis with lymphatic spread is rarely described. We report the case of a woman aged 38, immunocompetent, working in a fruit sorting center, who consulted us for ulceration of the left third finger that had persisted for four months, following a prick from a prickly pear. Physical examination revealed a nodular, erythematous, and ulcerative lesion of the left third finger, associated with inflammatory subcutaneous nodules arranged in a line along the ipsilateral upper extremity and an ipsilateral axillary lymph node. Laboratory tests and chest X-ray were normal. Pathological examination revealed granulomatous chronic inflammation without necrosis. PCR detected DNA from Mycobacterium tuberculosis. No extracutaneous tuberculosis locations were detected. A tuberculous chancre by direct inoculation was therefore diagnosed. The patient received quadruple therapy (rifampicin + isoniazid + pyrazinamide + ethambutol) for 2 months, followed by a combination therapy based on isoniazid and rifampicin for 6 months. Marked regression of the cutaneous lesions occurred after 1 month of first-line therapy. A tuberculous chancre is a rare form of cutaneous tuberculosis, with possible lymphatic spread, in immunocompromised patients but also in immunocompetent children and young adults.
Assuntos
Tuberculose Cutânea/complicações , Tuberculose dos Linfonodos/etiologia , Adulto , Feminino , Humanos , Imunocompetência , Tuberculose Cutânea/diagnóstico , Tuberculose Cutânea/tratamento farmacológico , Tuberculose dos Linfonodos/diagnóstico , Tuberculose dos Linfonodos/tratamento farmacológicoRESUMO
INTRODUCTION: Cutaneous Crohn disease is a rare cutaneous manifestation of Crohn disease in children. Herein is reported a case of persistent vulvar lymphedema revealing Crohn disease in a teenage girl. CASE REPORT: A 14-year-old girl presented with an 8-month history of persistent vulvar swelling associated with chronic macrocheilia. Dermatologic examination showed an inflammatory vulvar lymphedema, associated with perianal fissures and hypertrophic gingivitis. Vulvar skin biopsy revealed non-necrotizing granulomatous inflammation. Gastrointestinal endoscopy yielded no significant findings. The diagnosis of Crohn disease presenting as vulvar lymphedema was established. Oral metronidazole therapy resulted in partial improvement of cutaneous lesions beginning the 1st week. CONCLUSION: The originality of this case lies in the presentation of chronic macrocheilia with persistent vulvar lymphedema in a child, revealing Crohn disease without gastrointestinal involvement.
Assuntos
Doença de Crohn/diagnóstico , Linfedema/diagnóstico , Doenças da Vulva/diagnóstico , Adolescente , Biópsia , Doença Crônica , Doença de Crohn/patologia , Diagnóstico Diferencial , Feminino , Humanos , Linfedema/patologia , Doenças Raras , Pele/patologia , Vulva/patologia , Doenças da Vulva/patologiaAssuntos
Besouros , Dermatite/parasitologia , Hiperpigmentação/parasitologia , Adolescente , Adulto , Animais , Pré-Escolar , Humanos , Masculino , Dedos do PéRESUMO
BACKGROUND: Thrombotic cutaneous gangrene is a rare extra-intestinal manifestation of ulcerative colitis with a severe prognosis. CASE REPORT: A 35-year-old woman with a 7-year history of ulcerative colitis presented with extensive ecchymotic lesions that began a few hours earlier. On examination, she was febrile with multiple necrotic lesions. Skin biopsy showed multiple microthrombi in the dermal vessels. A diagnosis of thrombotic cutaneous gangrene was established. The patient was treated with heparin and systemic corticosteroids. The majority of cutaneous lesions showed improvement after 1 month. Thrombophlebitis of the left lower limb occurred subsequently. CONCLUSION: Thrombotic cutaneous gangrene is attributed to microvascular thrombosis, which arises from the hypercoagulability observed in ulcerative colitis. Complete blood and coagulation tests must be performed and early anticoagulation with heparin must be considered in order to prevent the progression of cutaneous infarction.
Assuntos
Colite Ulcerativa/diagnóstico , Colite Ulcerativa/patologia , Pele/patologia , Trombose/diagnóstico , Trombose/patologia , Corticosteroides/uso terapêutico , Adulto , Biópsia , Colite Ulcerativa/tratamento farmacológico , Quimioterapia Combinada , Feminino , Gangrena/diagnóstico , Gangrena/tratamento farmacológico , Gangrena/patologia , Heparina/uso terapêutico , Humanos , Necrose , Pele/irrigação sanguínea , Pele/efeitos dos fármacos , Trombose/tratamento farmacológicoAssuntos
Dedos , Leishmaniose Cutânea/diagnóstico , Doença Crônica , Edema/parasitologia , Humanos , Lactente , MasculinoRESUMO
INTRODUCTION: Bowel-associated dermatosis-arthritis syndrome (BADAS) is characterized by combined pustular skin eruption and arthralgia. It may be associated with inflammatory bowel disease or bowel bypass surgery. We report a case of BADAS in a patient with ulcerative colitis. CASE REPORT: A 39-year-old woman was being treated for a severe flare-up of ulcerative colitis present over the preceding 2 months and treated with prednisone, azathioprine and cyclosporine. She was also presenting a cutaneous eruption and arthralgia that had begun three days earlier. Dermatological examination revealed profuse vesicular and pustular lesions. Biopsy specimens showed mature neutrophilic infiltrate within the dermis. A diagnosis of BADAS was made and the same treatment was maintained. Systemic symptoms were resolved but the vesicular lesions were superseded by hypertrophic scars. DISCUSSION: Bowel-associated dermatosis-arthritis syndrome consists of a vesiculopustular eruption associated with arthralgia and/or arthritis and fever, as was the case in our patient. The histological picture is characterized by abundant neutrophilic infiltrate in the superficial dermis. The clinical and histological features and the course of BADAS allow this entity to be classified within the spectrum of neutrophilic dermatoses. Treatment chiefly involves systemic corticosteroids.
Assuntos
Artralgia/etiologia , Colite Ulcerativa/complicações , Dermatopatias Vesiculobolhosas/etiologia , Adulto , Feminino , Humanos , Doenças RarasRESUMO
INTRODUCTION: Neutrophilic dermatosis may have various clinical presentations but share common histopathological manifestations with an aseptic infiltrate of polymorphonuclears neutrophils. Neutrophilic dermatosis of the hands is a recently described disorder of which we present a case. CASE REPORT: A 60-year-old woman, without significant past medical history, presented with an acute and painful eruption of both hands with fever. Clinical examination showed erythematous edematous lesions surmounted by pustules that covered the thenar eminences of both hands. The patient was also presenting inflammatory joint pain. Histological findings were predominantly neutrophilic infiltration in the dermis with leukocytoclastic debris. A diagnosis of neutrophilic dermatosis was made and all the lesions disappeared rapidly without relapse under oral prednisone (0.5mg/kg/j). CONCLUSION: The eruption observed in our patient was clinically and histologically suggestive of neutrophilic dermatosis of the hands, confirming the existence of a homogenous entity which is still debatable if it constitutes a separate entity or a localized variant of Sweet syndrome.
Assuntos
Dermatoses da Mão , Síndrome de Sweet , Feminino , Dermatoses da Mão/patologia , Humanos , Pessoa de Meia-Idade , Síndrome de Sweet/patologiaRESUMO
Mycetoma are inflammatory pseudotumors, due to infection by bacterial (Actinomycetoma) or fungal (Eumycetoma) agent. A retrospective study was conducted during 34 years. Our aim was to study epidemiologic, clinic, therapeutic and microbiologic characteristics. Eighteen patients were assessed. Sex-ratio H/F was 2. The mean age was 43.6 years. Principal localization was the feet. Our study was characterized by majority of actinomycetoma found in 15 cases (Actinomadura madurae in 14 cases and Nocardia sp. in one case). Eumycetoma were diagnosed in 3 cases (Madurella mycetomatis in two cases and Pseudallesheria in one case). All patients received medical treatment associated with surgical treatment in 11 cases.