RESUMEN
Contexto: A pandemia da doença do coronavírus (COVID-19) revelou uma miríade de manifestações sistêmicas e cutâneas possivelmente relacionadas à infecção por síndrome respiratória aguda grave ocasionada pelo coronavírus (SARS-CoV-2). O comprometimento pulmonar é a causa mais frequente de hospitalização e a progressão para síndrome respiratória aguda grave geralmente requer tratamento com ventilação mecânica na posição pronada. Períodos prolongados e repetidos de pronação aumentam o risco de complicações, incluindo úlcera de pressão, cegueira e neuropatia periférica. Descrição do caso: Relatamos três casos de complicações cutâneas relacionadas à ventilação em pronação avaliadas durante interconsultas no maior hospital terciário universitário da América Latina, e salientamos potenciais causas e medidas de prevenção. Discussão: Complicações da ventilação em pronação para tratamento da COVID-19 são provavelmente resultantes da interação entre múltiplos fatores, dentre os quais as condições clínicas do paciente, períodos prolongados na posição pronada e limitações para mudanças de decúbito. Conclusões: Medidas de prevenção para complicações da pronação e diagnóstico precoce são fundamentais para evitar aumento da morbidade e sequelas graves e irreversíveis associadas à COVID-19.
Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Enfermedades de la Piel , Pronación , Ventilación Pulmonar , SARS-CoV-2 , COVID-19RESUMEN
Abstract Generalized pustular psoriasis (von Zumbusch) is a rare and acute eruption characterized by multiple sterile pustules over an erythematous and edematous background, eventually associated with psoriasis vulgaris. Classically, it manifests as a potentially severe systemic picture and demands prompt diagnosis and intervention. The duration of each flare-up and intervals between the pustular episodes is extremely variable. Recently, genetic abnormalities have been identified mainly in the familial and early variants of this disease. The therapeutic arsenal is limited; however, new drugs being evaluated aim to control both pustular flare-ups and disease recurrences.
Asunto(s)
Humanos , Psoriasis/diagnóstico , Psoriasis/tratamiento farmacológico , Enfermedades Cutáneas Vesiculoampollosas , Exantema , Enfermedad Aguda , Enfermedad CrónicaRESUMEN
Generalized pustular psoriasis (von Zumbusch) is a rare and acute eruption characterized by multiple sterile pustules over an erythematous and edematous background, eventually associated with psoriasis vulgaris. Classically, it manifests as a potentially severe systemic picture and demands prompt diagnosis and intervention. The duration of each flare-up and intervals between the pustular episodes is extremely variable. Recently, genetic abnormalities have been identified mainly in the familial and early variants of this disease. The therapeutic arsenal is limited; however, new drugs being evaluated aim to control both pustular flare-ups and disease recurrences.
Asunto(s)
Exantema , Psoriasis , Enfermedades Cutáneas Vesiculoampollosas , Enfermedad Aguda , Enfermedad Crónica , Humanos , Psoriasis/diagnóstico , Psoriasis/tratamiento farmacológicoRESUMEN
Psoriasis is an immune-mediated dermatosis usually associated with comorbidities. Treatment varies from topicals to systemic drugs and data on susceptibility to viral infections in psoriatic patients are scarce. The objectives of this study were to analyze psoriatic patients on different therapies who were at risk for COVID-19 for seroprevalence of SARS-COV-2, pro-inflammatory cytokine profile, comorbidities and outcomes in order to unveil the immunological mechanisms involved in the anti-viral response in patients with psoriasis. Seventy-five patients with psoriasis were divided according to treatment: immunobiologics, methotrexate, topicals and acitretin. Twenty healthy controls were included. Plasma samples were collected for: IgG SARS-COV-2 (ELISA); IL-27, IL-29 and IL-18 (ELISA); and IL-1ß, IL-17A, IL-6 and TNF (cytometric array). Seropositivity for SARS-COV-2 was detected in 24 out of 75 psoriasis patients and did not relate to COVID-19 symptoms and/or hospitalization, despite associated comorbidities. Psoriasis patients who were asymptomatic for SARS-COV-2 exhibited immune imbalance with high levels of IL-18, IL-17A and IL-6, and low levels of IL-27 compared to healthy controls. Psoriasis groups showed significant increased cytokine levels only in the group with immunobiologics. Despite immune deviations and lower IL-27, which has a potential antiviral impact, psoriatic patients did not exhibit complications related to COVID-19. An understanding of this kind of proinflammatory profile of psoriatic patients and of the lack of severe outcomes for COVID-19 is essential to establish novel therapeutic approaches and preventive measures, including with regard to the concomitance of viral infections.
RESUMEN
BACKGROUND: Few prospective studies in cutaneous and systemic lupus erythematosus (CLE/SLE) assessed thalidomide-induced peripheral neuropathy (TiPN) incidence/reversibility, and most have not excluded confounding causes neither monitored thalidomide plasma levels. OBJECTIVES: To evaluate TiPN incidence/reversibility, coasting effect and its association with thalidomide plasma levels in CLE/SLE. METHODS: One-year prospective study of thalidomide in 20 CLE/SLE patients without pregnancy potential, with normal nerve conduction study (NCS), and excluded other PN causes. Thalidomide levels were determined by high-performance liquid chromatography/tandem mass spectrometry. RESULTS: Twelve patients (60%) developed TiPN: 33.3% were symptomatic and 66.6% asymptomatic. Half of this latter group developed coasting effect (TiPN symptoms 1-3 months after drug withdrawal). The main predictive factors for TiPN were treatment duration ≥6 months (p = 0.025) and cumulative dose (p = 0.023). No difference in plasma thalidomide levels between patients with/without TiPN was observed (p = 0.464). After drug withdrawal, 75% symptomatic TiPN patients improved their symptoms. Seven TiPN patients underwent an additional NCS after drug withdrawal: 42.8% worsened NCS, 14.2% was stable, and 42.8% had improved NCS. CONCLUSION: Our data provides novel evidence of coasting effect in half of asymptomatic patients with TiPN. The irreversible nature of this lesion in 25% of TiPN patients reinforces the relevance of early NCS monitoring, and suggests thalidomide use solely as a bridge for other effective therapy for refractory cutaneous lupus patients.
Asunto(s)
Lupus Eritematoso Cutáneo/tratamiento farmacológico , Lupus Eritematoso Sistémico/tratamiento farmacológico , Enfermedades del Sistema Nervioso Periférico/inducido químicamente , Talidomida/efectos adversos , Adulto , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Talidomida/sangre , Talidomida/uso terapéutico , Resultado del Tratamiento , Privación de TratamientoRESUMEN
Common clinical features of patients with Coronavirus disease-2019 (COVID-19) vary from fever, to acute severe respiratory distress syndrome. Several laboratory parameters are reported as indicators of COVID-19 severity. We hereby describe the possible novel severity biomarkers for COVID-19, CD11b+CD33+HLA-DR-CD14+ cells and CD11b+CD33+HLA-DR-CD66b+ cells.
RESUMEN
Common clinical features of patients with Coronavirus disease-2019 (COVID-19) vary from fever, to acute severe respiratory distress syndrome. Several laboratory parameters are reported as indicators of COVID-19 severity. We hereby describe the possible novel severity biomarkers for COVID-19, CD11b+CD33+HLA-DR-CD14+ cells and CD11b+CD33+HLA-DR-CD66b+ cells.
Asunto(s)
Sangre , Antígenos HLA-DR , Coronavirus , FiebreRESUMEN
Trichodysplasia spinulosa (TS) is a rare disease associated with immunosuppression and induced by a polyomavirus denominated Tricodisplasia Polyomavirus (TSPyV). We report a case of TS 6 months after kidney transplantation in a 65 years-old woman under immunosuppression therapy with prednisone, mycophenolate and tacrolimus. The patient developed follicular papules on the face with a thickening of the skin and alopecia of the eyebrows, leading to distortion of the face and a leonine appearance characteristic of the disease. The skin biopsy confirmed the clinical diagnosis and the presence of TSPyV DNA in the skin was detected. Staining for SV40 was positive. Immunosuppression was changed: mycophenolate was withdrawn, tacrolimus reduced and everolimus added. Intravenous cidofovir and later on leflunomide were added. Although the literature has reported clinical success with topical cidofovir, we were unable to use it because this drug is not available. There was an improvement of skin lesions and on cosmetic appearance. The patient had three rejections (one clinically diagnosed and two other biopsy proven), progressed with renal failure and graft loss. Retrospective analysis of stored urine and blood samples detected TSPyV DNA in some of those samples two months before the TS clinical development. This case highlights the TSPyV detection in blood and urine samples before the development of skin lesions.
Asunto(s)
Enfermedades del Cabello/virología , Trasplante de Riñón/efectos adversos , Infecciones por Polyomavirus/diagnóstico , Viremia/diagnóstico , Viremia/tratamiento farmacológico , Anciano , ADN Viral , Femenino , Enfermedades del Cabello/tratamiento farmacológico , Humanos , Terapia de Inmunosupresión/efectos adversos , Inmunosupresores , Riñón/patología , Infecciones por Polyomavirus/orina , Estudios Retrospectivos , Piel/patología , Piel/virología , Receptores de TrasplantesRESUMEN
Psoriasis is a chronic inflammatory disease that affects 1.3% of the Brazilian population. The most common clinical manifestations are erythematous, scaling lesions that affect both genders and can occur on any anatomical site, preferentially involving the knees, elbows, scalp and genitals. Besides the impact on the quality of life, the systemic nature of the disease makes psoriasis an independent risk factor for cardiovascular disease, especially in young patients with severe disease. By an initiative of the Brazilian Society of Dermatology, dermatologists with renowned clinical experience in the management of psoriasis were invited to form a work group that, in a partnership with the Brazilian Medical Association, dedicated themselves to create the Plaque Psoriasis Diagnostic and Treatment Guidelines. The relevant issues for the diagnosis (evaluation of severity and comorbidities) and treatment of plaque psoriasis were defined. The issues generated a search strategy in the Medline-PubMed database up to July 2018. Subsequently, the answers to the questions of the recommendations were devised, and each reference selected presented the respective level of recommendation and strength of scientific evidence. The final recommendations for making up the final text were worded by the coordinators.
Asunto(s)
Psoriasis/diagnóstico , Psoriasis/terapia , Corticoesteroides/uso terapéutico , Antralina/uso terapéutico , Anticuerpos Monoclonales/uso terapéutico , Brasil , Inhibidores de la Calcineurina/uso terapéutico , Comorbilidad , Ciclosporina/uso terapéutico , Fármacos Dermatológicos/uso terapéutico , Dermatología , Combinación de Medicamentos , Femenino , Humanos , Masculino , Metotrexato/uso terapéutico , Fototerapia/métodos , Psoriasis/epidemiología , Índice de Severidad de la Enfermedad , Sociedades Médicas , Factores de Tiempo , Vitamina D/análisisRESUMEN
The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize producers to assist the reasoning and decision-making of doctors. The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient.
Asunto(s)
Anticuerpos Monoclonales/administración & dosificación , Etanercept/administración & dosificación , Factores Inmunológicos/administración & dosificación , Psoriasis/tratamiento farmacológico , Anticuerpos Monoclonales/efectos adversos , Brasil , Toma de Decisiones Clínicas , Etanercept/efectos adversos , Humanos , Factores Inmunológicos/efectos adversos , Psoriasis/patología , Factores de Riesgo , Índice de Severidad de la Enfermedad , Factores de Tiempo , Resultado del TratamientoRESUMEN
The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize producers to assist the reasoning and decision-making of doctors. The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient.
Asunto(s)
Anticuerpos Monoclonales/administración & dosificación , Fármacos Dermatológicos/administración & dosificación , Inmunosupresores/administración & dosificación , Psoriasis/tratamiento farmacológico , Acitretina/administración & dosificación , Acitretina/efectos adversos , Anticuerpos Monoclonales/efectos adversos , Brasil , Toma de Decisiones Clínicas , Ciclosporina/administración & dosificación , Ciclosporina/efectos adversos , Fármacos Dermatológicos/efectos adversos , Humanos , Inmunosupresores/efectos adversos , Metotrexato/administración & dosificación , Metotrexato/efectos adversos , Psoriasis/patología , Índice de Severidad de la Enfermedad , Factores de Tiempo , Resultado del TratamientoRESUMEN
Abstract: Psoriasis is a chronic inflammatory disease that affects 1.3% of the Brazilian population. The most common clinical manifestations are erythematous, scaling lesions that affect both genders and can occur on any anatomical site, preferentially involving the knees, elbows, scalp and genitals. Besides the impact on the quality of life, the systemic nature of the disease makes psoriasis an independent risk factor for cardiovascular disease, especially in young patients with severe disease. By an initiative of the Brazilian Society of Dermatology, dermatologists with renowned clinical experience in the management of psoriasis were invited to form a work group that, in a partnership with the Brazilian Medical Association, dedicated themselves to create the Plaque Psoriasis Diagnostic and Treatment Guidelines. The relevant issues for the diagnosis (evaluation of severity and comorbidities) and treatment of plaque psoriasis were defined. The issues generated a search strategy in the Medline-PubMed database up to July 2018. Subsequently, the answers to the questions of the recommendations were devised, and each reference selected presented the respective level of recommendation and strength of scientific evidence. The final recommendations for making up the final text were worded by the coordinators.
Asunto(s)
Humanos , Masculino , Femenino , Psoriasis/diagnóstico , Psoriasis/terapia , Fototerapia/métodos , Psoriasis/epidemiología , Sociedades Médicas , Factores de Tiempo , Vitamina D/análisis , Índice de Severidad de la Enfermedad , Brasil , Comorbilidad , Antralina/uso terapéutico , Metotrexato/uso terapéutico , Ciclosporina/uso terapéutico , Corticoesteroides/uso terapéutico , Fármacos Dermatológicos/uso terapéutico , Dermatología , Combinación de Medicamentos , Inhibidores de la Calcineurina/uso terapéutico , Anticuerpos Monoclonales/uso terapéuticoRESUMEN
The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize producers to assist the reasoning and decision-making of doctors. The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient.
Asunto(s)
Humanos , Psoriasis/tratamiento farmacológico , Fármacos Dermatológicos/administración & dosificación , Inmunosupresores/administración & dosificación , Anticuerpos Monoclonales/administración & dosificación , Psoriasis/patología , Factores de Tiempo , Índice de Severidad de la Enfermedad , Brasil , Metotrexato/administración & dosificación , Metotrexato/efectos adversos , Resultado del Tratamiento , Ciclosporina/administración & dosificación , Ciclosporina/efectos adversos , Acitretina/administración & dosificación , Acitretina/efectos adversos , Fármacos Dermatológicos/efectos adversos , Toma de Decisiones Clínicas , Inmunosupresores/efectos adversos , Anticuerpos Monoclonales/efectos adversosRESUMEN
The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize producers to assist the reasoning and decision-making of doctors. The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient.