Mycobacterium chelonae Cutaneous Infection: An Important Differential Diagnosis in the Immunosuppressed Patient with Chronic Ulcers.

In 2018, a 38-year-old woman was referred to our hospital with some nodules and nonhealing ulcers on her left thigh that had been present for 18 months. Her medical history included rheumatoid arthritis (RA) being treated with 20-mg prednisone for the last 8 years. There was no history of trauma, surgery, or cosmetic procedure on the leg. Physical examination revealed multiple lesions on her left thigh, including nodules, surrounded by erythema, some of them being covered with a fine white-yellowish scale and hyperpigmented macules. Central atrophy was evident in some lesions. She also had one ulcer with purulent discharge (Figure 1). An infectious disease and vasculitis were considered in the differential diagnoses. Biopsy and culture were conducted from the lesion. A Ziehl-Neelsen stain was obtained from the ulcer's discharge with visible acid-fast bacilli (Figure 2). Light microscopy examination revealed a mixed granuloma with lymphocytes, neutrophils, and giant cells in the dermis (Figure 3). The culture was positive for M. chelonae sensitive to clarithromycin. Treatment with clarithromycin was initiated (500 mg, twice a day) for 8 weeks, with healing of some of the lesions. She was advised to continue antibiotic treatment for 4 more weeks and to report to our hospital after its completion, but she never returned and was lost on follow-up.

El pelo: generalidades y enfermedades más comunes / Hair: its generalities and most common diseases

Resumen Las patologías del pelo reciben poca atención durante la formación del médico general, pero al tener alta prevalencia en la práctica clínica es importante considerar los principios básicos del crecimiento del pelo y las patologías más comunes que lo afectan, para llegar a un diagnóstico y un tratamiento correcto en cada situación.

Abstract Hair pathology is often overlooked during undergraduate medical training, however because of its high prevalence in the clinical practice it is important to know the basic principles of hair growth and the most frequent pathologies that afflict this structure and how to make an adequate diagnosis and treatment for each patient.

Tetralogía de Fallot: reporte de un caso y revisión de la literatura / Tetralogy of Fallot: Case report and literature review

La tetralogía de Fallot es una cardiopatía congénita que se caracteriza por presentar estenosis infundibular de la arteria pulmonar, cabalgamiento aórtico, comunicación interventricular e hipertrofia del ventrículo derecho. Es la cardiopatía congénita cianógena más prevalente, representando entre el 3.5 a 8% de los defectos cardiacos congénitos. Presentamos el caso de un paciente de 6 años que acudió al hospital con cianosis peribucal y acrocianosis y episodios recurrentes de crisis hipóxicas. Se le hizo un ecocardiograma con el cual se diagnóstico tetralogía de Fallot y posteriormente se le realizó una fístula de Blalock-Taussig.

Tetralogy of Fallot is a congenital cardiopathy characterized by infundiblutar stenosis of the pulmonary artery, overriding aorta, ventricular septal defect and right ventricular hypertrophy. It is the most prevalent cyanotic congenital heart defect, with a prevalence between 3.5 to 8%. We present the case of a 6-year-old male who was taken to our hospital due to perioral and distal cyanosis and paroxistic episodes of hypoxia (tet spell), who was diagnosed with tetralogy of Fallot after echocardiography and was treated with Blalock-Taussig shunt.