Freqüência de alterações hepáticas em pacientes com esclerodermia / Frequency of hepatic abnormalities in patients with scleroderma

OBJETIVO: avaliar a freqüência das doenças hepáticas em pacientes com esclerodermia e, secundariamente, estudar a freqüência de infecção pelos vírus B e C da hepatite nesses pacientes, assim como a freqüência de auto-anticorpos séricos. MATERIAL E MÉTODOS: estudaram-se pacientes com diagnóstico de esclerodermia, localizada ou sistêmica, acompanhados no Ambulatório de Reumatologia do Hospital Santa Izabel. Como grupo de comparação, foram estudados pacientes com diagnóstico de acne vulgar. RESULTADOS: dos 65 pacientes com diagnóstico de esclerodermia incluídos nesse trabalho, 35 por cento apresentaram a gama-glutamiltransferase (gama-GT) alterada, 30 por cento tiveram a fosfatase alcalina aumentada e 17,1 por cento, a alaninoaminotransferase (ALT) acima dos valores de referência. A ALT apresentou-se mais alterada nos pacientes do que nos controles. Apenas um indivíduo dos 41 testados apresentou positividade para o anticorpo antimitocôndria enquanto 19 por cento tinham anticorpo antimúsculo liso, não se observando diferença estatística na positividade desses anticorpos entre os dois grupos. Um paciente apresentou o HBsAg positivo e outro foi positivo para o anticorpo anti-HCV. Nenhum paciente apresentou manifestações clínicas de doença hepática. CONCLUSÕES: no presente estudo, embora as alterações de enzimas hepáticas em pacientes com esclerodermia não tenham sido incomuns, não se observou nenhum caso com manifestações clínicas de doença hepática.

INTRODUCTION: to determine the frequency of hepatic disease in patients with scleroderma and, secondarily, to investigate the frequency of hepatitis B and C virus infection and determine the frequency of autoantibodies in this disease. MATERIAL AND METHODS: patients with scleroderma followed at Hospital Santa Izabel were included in the study and patients with acne vulgaris served as a comparison group. RESULTS: considering the 65 scleroderma patients, 35 percent had elevated gamma-glutamyltranspeptidase (gamma-GT), 30 percent had elevated alkaline phosphatase and 17.1 percent had alanine aminotransferase (ALT) higher than the reference range. Raised ALT levels were more common in the scleroderma patients than in the control group. Nineteen percent (19 percent) of the patients tested positive for anti-smooth muscle antibodies and only one patient had anti-mitocondria antibodies. There was no statistical difference between the two groups regarding antibody testing. Anti-HCV antibodies were observed in one patient and HBsAg was detected in another scleroderma patient. There was no patient with clinically significant hepatic disease. CONCLUSIONS: the present study showed that clinical hepatic disease did not occur in our scleroderma patients, despite the relatively increased frequency of liver enzymes abnormalities.

Phase II randomized, placebo-controlled trial of M. vaccae-derived protein (PVAC) for the treatment of psoriasis.

The treatment effect against psoriasis of an antigen (delipidated, deglycolipidated form of M. vaccae-PVAC) was investigated. One hundred and sixty-five patients were enrolled in three arms (50 or 15 microg or placebo), each receiving a total of two intradermal injections (days 0 and 21). At week 12, a 75% decrease in psoriasis area and severity index was similar among the studied groups (13, 9 and 18%, p=0.429). The overall incidence of adverse events was significantly higher in the PVAC treated groups when compared to placebo (98.2, 87.3 and 70.9%; p<0.001) largely due to local reactions that were limited for the most part to grades 1 and 2 in severity and were self-limiting. Despite its overall safety, PVAC was not clearly indicated to be superior to placebo in the treatment of psoriasis in this study.

Keloidal scleroderma.

Progressive systemic sclerosis (PSS) can involve the skin diffusely or in a limited way. Rarely cutaneous involvement can assume a hypertrophic form, described in the literature as keloidal scleroderma. The authors describe a PSS patient who presented cutaneous manifestations compatible with the diagnosis of this clinical situation. The clinical features, pathogenic mechanism and therapeutic approach are discussed and a broad review of the literature is given.

Micobacteriose cutânea atípica pós-mesoterapia / Atypical cutaneous mycobacteriosis following mesotherapy

Infecções cutâneas causadas por micobactérias de crescimento rápido não são comuns. Os aspectos clínicos, histopatológicos e bacteriológicos não são muito distintos, e seu dignóstico pode ser difícil. Apresenta-se uma paciente da Bahia, Brasil, com micobacteriose cutânea atípica por Mycobacterium fortuitum após mesoterapia para lipodistrofina regional(celulite), enfatizando-se a importância de considerar micobactérias na patogênese de doenças cutâneas crônicas