Disseminated cryptococcosis with skin lesions: report of a case series.

Cryptococcosis is a common fungal infection in immunocompromised patients, caused by genus Cryptococcus, presenting with meningitis, pneumonia, and skin lesions. Cutaneous presentation can be varied, but specifically in solid organ transplant recipients (iatrogenically immunocompromised), cryptococcosis should always be considered in the differential diagnosis of cellulitis-like lesions, since the delay in diagnosis leads to worse prognosis and fatal outcome. We report four cases of cryptococcosis with cutaneous manifestation not only for its rarity, but also to emphasize the important role of the dermatologist in the diagnosis of this disease.

Vancomycin-associated linear IgA disease mimicking toxic epidermal necrolysis.

Linear IgA dermatosis is a rare subepidermal autoimmune blistering disease characterized by linear deposition of IgA along the basement membrane zone. In the last three decades, many different drugs have been associated with the drug-induced form of the disease, especially vancomycin. We report a case of vancomycin-induced linear IgA disease mimicking toxic epidermal necrolysis. The aim of this work is to emphasize the need to include this differential diagnosis in cases of epidermal detachment and to review the literature on the subject and this specific clinical presentation.

New drugs, new challenges for dermatologists: mucocutaneous ulcers secondary to everolimus.

Everolimus, a mammalian target of rapamycin inhibitor, is an emerging drug, which is being increasingly applied in oncology and solid organ transplantation. Oral ulcers are a frequent side effect associated with this immunosupressor. We report the case of a renal transplant recipient who developed disfiguring oral and perianal ulcers secondary to everolimus's toxicity. This is probably the first report of perianal involvement. Dermatologists need to be aware of the potential mucocutaneous adverse effects related to these new drugs that are becoming evermore common in our clinical practice.

Disseminated cryptococcosis with skin lesions: report of a case series

Abstract Cryptococcosis is a common fungal infection in immunocompromised patients, caused by genus Cryptococcus, presenting with meningitis, pneumonia, and skin lesions. Cutaneous presentation can be varied, but specifically in solid organ transplant recipients (iatrogenically immunocompromised), cryptococcosis should always be considered in the differential diagnosis of cellulitis-like lesions, since the delay in diagnosis leads to worse prognosis and fatal outcome. We report four cases of cryptococcosis with cutaneous manifestation not only for its rarity, but also to emphasize the important role of the dermatologist in the diagnosis of this disease.

Vancomycin-associated linear IgA disease mimicking toxic epidermal necrolysis

Abstract Linear IgA dermatosis is a rare subepidermal autoimmune blistering disease characterized by linear deposition of IgA along the basement membrane zone. In the last three decades, many different drugs have been associated with the drug-induced form of the disease, especially vancomycin. We report a case of vancomycin-induced linear IgA disease mimicking toxic epidermal necrolysis. The aim of this work is to emphasize the need to include this differential diagnosis in cases of epidermal detachment and to review the literature on the subject and this specific clinical presentation.

New drugs, new challenges for dermatologists: mucocutaneous ulcers secondary to everolimus

Everolimus, a mammalian target of rapamycin inhibitor, is an emerging drug, which is being increasingly applied in oncology and solid organ transplantation. Oral ulcers are a frequent side effect associated with this immunosupressor. We report the case of a renal transplant recipient who developed disfiguring oral and perianal ulcers secondary to everolimus's toxicity. This is probably the first report of perianal involvement. Dermatologists need to be aware of the potential mucocutaneous adverse effects related to these new drugs that are becoming evermore common in our clinical practice.

Hidrosadenite da vulva: caso exuberante com resolução cirúrgica / Hidradenitis suppurativa of the vulva: case lush with surgical resolution

Contexto: A hidrosadenite é uma doença cutânea crônica e recorrente, com prevalência estimada de 1% e mais comum no sexo feminino. Apesar de se tratar de entidade há muito tempo conhecida, a dificuldade terapêutica ainda é uma realidade. Relato de caso: Apresenta-se um caso de hidrosadenite em paciente de 49 anos envolvendo os grandes lábios bilateralmente, a qual foi submetida à exérese ampla com fechamento por primeira intenção, obtendo-se excelente resultado terapêutico e estético. Discussão: A hidrosadenite é causa de grande transtorno psicológico e social, com prejuízo na qualidade de vida. As possibilidades terapêuticas variam desde antibióticos tópicos e sistêmicos, medicamentos com ação antiandrogênica, retinoides sistêmicos, imunossupressores e, mais recentemente, os antagonistas do fator de necrose tumoral, o uso de tecnologias como o laser e a terapia fotodinâmica até drenagens intermitentes, exéreses parciais e cirurgia radical. A abordagem cirúrgica ampla com margens, associada à cicatrização por segunda intenção, é a preferida de vários autores, porém, o fechamento primário pode estar indicado em casos selecionados.Conclusões: Apesar dos diversos estudos, ainda não existem tratamentos padronizados e com resposta clínica previsível. Cabe ao médico conseguir individualizar cada paciente na busca do melhor tratamento, baseando-se nas evidências existentes até hoje na literatura.

Perfusão isolada de membro com hipertermia na trataento das metástases em trânsito do melanoma cutâneo / Hyperthermic isolated limb perfusion in the treatment of in-transit melanoma metastases

OBJETIVO: Avaliar a casuística do Setor de Tumores Cutâneos da Disciplina de Cirurgia Plástica da Escola Paulista de Medicina/ Universidade Federal de São Paulo em relação à Perfusão Isolada de Membro (PIM) para o tratamento das metástases em trânsito do melanoma cutâneo, bem como os resultados conseqüentes, comparando-os com a literatura internacional. MÉTODO: De maio de 1993 a abril de 2007, 41 pacientes portadores de metástases em trânsito do melanoma cutâneo submeteram-se a 44 PIM. Por meio da observação de seus prontuários, foram avaliados quanto à toxicidade regional e sistêmica, e resposta tumoral após a PIM. Após a coleta dos resultados, procedeu-se a comparação com a literatura internacional e as posteriores conclusões. RESULTADOS: Houve 43,2 por cento de respostas completas, 36,4 por cento de respostas parciais e 20,4 por cento sem resposta ao tratamento proposto. A toxicidade regional aguda descrita foi, de modo geral, restrita a edema e eritema discretos, não havendo nenhum caso de complicação sistêmica grave. CONCLUSÃO: Os dados obtidos nessa casuística corroboram os descritos pela literatura internacional, demonstrando a importância e a possibilidade da PIM para o controle locoregional das metástases em trânsito do melanoma cutâneo também na realidade brasileira.

BACKGROUND: To evaluate our cases at the Skin Tumors Sector of Plastic Surgery Division at Federal University of São Paulo in relation to Isolated Limb Perfusion (ILP) for the treatment of in transit melanoma metastases, as well as the results, comparing them with international literature. METHODS: From May 1993 until April 2007, 41 patients with in transit metastases of skin melanoma were submitted to 44 ILP. Medical registry observations were evaluated in terms of regional and systemic toxicity and tumoral response after ILP. The obtained results were compared with international literature and posterior conclusions were done. RESULTS: We observed 43.2 percent of complete responses, 36.4 percent of partial responses and 20.4 percent of no responses after the procedures. Acute regional toxicity was in general restricted to slight erythema or edema, and there was no single case of serious systemic complication. CONCLUSION: The obtained data are in accordance with international literature demonstrating the importance and the possibility of ILP for locoregional control of in transit metastases of skin melanoma also in Brazilian reality.