Necrosis cutánea por warfarina / Warfarin-Induced skin necrosis

La necrosis cutánea por warfarina aparece entre 0.01-0.1% de los pacientes, afecta más a mujeres con obesidad y antecedentes de enfermedad tromboembólica luego del quinto día de su inicio. Se debe a un imbalance transitorio de los sistemas anticoagulante y procoagulante, caracterizado por flictenas hemorrágicas en zonas con tejido graso. Reportamos el caso de una necrosis cutánea por warfarina con un desenlace fatal. (Acta Med Colomb 2012; 37: 138-141).

Warfarin-induced skin necrosis appears between 0.01% to 0.1% of patients. It affects mostly women with obesity and a history of thromboembolic disease after the fifth day of its administration, and is caused by a transient imbalance of procoagulant and anticoagulant systems, characterized by hemorrhagic blisters in areas with fatty tissue. (Acta Med Colomb 2012; 37: 138-141). We report the case of a warfarin-induced skin necrosis with fatal outcome.

Enfermedad granulomatosa crónica: a propósito de un caso / Chronic granulomatous disease: a case report

La enfermedad granulomatosa crónica es una enfermedad hereditaria rara producida por un defecto en el metabolismo de oxidación de las células fagocíticas, que afecta la capacidad microbicida y da como resultado una tendencia a presentar infecciones recurrentes por hongos y bacterias en la piel y en las superficies epiteliales. Se presenta un caso clínico.

Nontuberculous mycobacteria infection after mesotherapy: preliminary report of 15 cases.

BACKGROUND: Mesotherapy is an increasingly used technique which is currently causing several mycobacterial infections owing to contaminated substances being injected, and also to poor aseptic measures being held by nonprofessional practitioners. PATIENTS AND METHODS: We collected 15 cases of nontuberculous mycobacteria (NTM) infection after mesotherapy in a 6-month period. RESULTS: All patients were female with ages ranging from 19 to 52 years; the main substances injected were procaine and lecithin, and the time between mesotherapy and the appearance of the lesions varied between 1 and 12 weeks. Clinical lesions were mostly nodules and abscesses, which were localized in the abdomen and buttocks in the majority of cases. The main patient complaint was local pain but some presented with systemic symptoms such as fever and malaise. Biopsies reported granulomatous chronic inflammation in the majority of cases. Skin cultures were positive for NTM and Mycobacterium chelonae. DISCUSSION AND CONCLUSIONS: Mesotherapy not performed with quality controlled substances can be a predisposing factor for NTM infection.

Effect of imiquimod in anogenital warts from HIV-positive men.

BACKGROUND: HIV-positive patients have unpredictable local immune responses even with severe systemic immunosuppression and data reported to date is insufficient to predict the effect of imiquimod in HIV-positive patients. OBJECTIVE: To evaluate the efficacy of 5% topical imiquimod in HIV-positive male patients with anogenital warts (AGW) and to elucidate its effect on recurrence. STUDY DESIGN: Open-label clinical trial. RESULTS: Of the 43 patients enrolled, 86% completed treatment. Patients' mean age was 34 years (range: 19-50). Thirty-one patients were receiving highly active antiretroviral therapy (HAART) therapy. At week 16, 10 patients completely cleared lesions and 21 patients had a wart size reduction > or =50%. At 20 weeks of therapy, 17 patients achieved total clearance whereas 14 patients had a >50% wart reduction. Clearance was not influenced by CD4-counts, HIV-viral load, previous therapy, or wart localization. Of the patients who experienced a complete clearance, five (29%) had a recurrence. Mean time of recurrence was 14.4 weeks. Erythema, pruritus, and burning sensation were the most frequent local skin reactions. CONCLUSIONS: Topical 5% imiquimod is safe and may benefit HIV-positive patients with anogenital warts particularly when it is used for up to 20 weeks. It is also useful to decrease wart recurrence.