Sarcoidosis and molecular mimicry--important etiopathogenetic aspects: current state and future directions.

Sarcoidosis is a disease of uncertainty in terms of its cause, presentation, and clinical course. The disease has a worldwide distribution and affects all ages, races, and both sex. Sarcoidosis of the skin may have an extremely heterogeneous clinical presentation, so that the definitions of 'great imitator' and 'clinical chameleon' have long been used. The factors that influence clinical picture and severity of the disease are probably linked to the etiopathogenesis of sarcoidosis, which continues to be shrouded in mystery. The current state of the art on the pathogenesis of sarcoidosis is that it is an immunological response in a genetically susceptible individual to an as-yet undefined antigenic stimulus. How exposure occurs in genetically predisposed patients is not completely clear, but the most likely explanation is that these agents or antigens are either inhaled into the lungs or enter through contact with the skin, as these are the common target organs that are constantly in contact with the environment. An autoimmune etiology of sarcoidosis could possibly occur through a process of molecular mimicry of infectious or other environmental antigens to host antigens. This could lead to a cross-mediated immune response and induction of autoimmune disease. This molecular mimicry may probably be responsible for the heterogeneous clinical presentations of the disease. Several investigations and studies have provided valuable evidence on the etiopathogenesis of sarcoidosis, which may lead to the future development of targeted and innovative treatment strategies. Nevertheless, we are still a long way from unravelling the underlying cause of this mysterious disease.

Elaioconiosis--case report.

Elaioconiosis is a work-related acneiform dermatosis which affects the exposed skin of individuals working with oils or greases. Its incidence has decreased with the introduction of personal protective equipment, personal hygiene measures and the cleaning of work clothes. Although not a rare disease, elaioconiosis is seldom reported in the literature, particularly in Brazil. Sufferers need to take time off work to proceed with the prolonged treatment to resolve the lesions caused by this condition.

Case for diagnosis.

A fifty-five year old Caucasian male presented with infiltrated plaques and nodules on the left leg. The lesions had been present for 6 months. He presented associated cardiopathy, nephropathy and endocrinopathy. Histopathological and immunohistochemical examinations confirmed the diagnosis of cutaneous diffuse B cell lymphoma. CD 20, CD 79a and Ki-67 were positive. Chemotherapy with cyclophosphamide, adriamycin and vincristine promoted partial remission.

Caso para diagnóstico / Case for diagnosis

Paciente do sexo masculino de 55 anos com placas e nódulos infiltrados exuberantes em membro inferior esquerdo há seis meses. Cardiopatia, nefropatia e endocrinopatia associadas. O exame histopatológico, acrescido da imunoistoquímica, confirma linfoma cutâneo difuso de células B. Marcadores CD-20, CD-79a e Ki-67 foram positivos. A quimioterapia com ciclofosfamida, adriamicina e vincristina promoveu remissão parcial.

A fifty-five year old Caucasian male presented with infiltrated plaques and nodules on the left leg. The lesions had been present for 6 months. He presented associated cardiopathy, nephropathy and endocrinopathy. Histopathological and immunohistochemical examinations confirmed the diagnosis of cutaneous diffuse B cell lymphoma. CD 20, CD 79a and Ki-67 were positive. Chemotherapy with cyclophosphamide, adriamycin and vincristine promoted partial remission.

Elaioconiose: relato de caso / Elaioconiosis: case report

Elaioconiose é uma dermatose ocupacional do tipo acneiforme que afeta as áreas expostas de trabalhadores que lidam com óleos ou graxas. Atualmente, com o uso dos equipamentos de proteção individual, medidas de higiene pessoal e lavagem dos uniformes de trabalho, sua incidência diminuiu. Apesar de não ser uma doença rara, é pouco relatada na literatura, principalmente na nacional. Seu tratamento é lento e para a resolução das lesões, requer o afastamento do trabalhador de suas atividades laborativas.

Elaioconiosis is a work-related acneiform dermatosis which affects the exposed skin of individuals working with oils or greases. Its incidence has decreased with the introduction of personal protective equipment, personal hygiene measures and the cleaning of work clothes. Although not a rare disease, elaioconiosis is seldom reported in the literature, particularly in Brazil. Sufferers need to take time off work to proceed with the prolonged treatment to resolve the lesions caused by this condition.

Lymphogranuloma venereum: "a clinical and histopathological chameleon?".

Lymphogranuloma venereum is an infection caused by a variety of the bacterium Chlamydia trachomatis. Both genital and extragenital manifestations of the disease can cause serious differential diagnostic difficulties, indirectly leading to progression and dissemination of the infection. This work describes cases of patients with lymphogranuloma venereum showing atypical clinical and/or histopathological findings. It also focuses on alternative therapeutic approaches, such as surgical excision at stage 1, that may lead to a positive outcome. It is not completely clear whether histopathological findings of lymphogranuloma venereum can reveal progression or changes in the course of the disease over time, as is the case in other diseases. We conclude that both clinical and histopathological observations in a larger number of patients are needed in order to further evaluate the findings presented in this article.

Lymphogranuloma venereum: "a clinical and histopathological chameleon?" / Linfogranuloma venéreo: "um camaleão clínico e histopatológico?"

Lymphogranuloma venereum is an infection caused by a variety of the bacterium Chlamydia trachomatis. Both genital and extragenital manifestations of the disease can cause serious differential diagnostic difficulties, indirectly leading to progression and dissemination of the infection. This work describes cases of patients with lymphogranuloma venereum showing atypical clinical and/or histopathological findings. It also focuses on alternative therapeutic approaches, such as surgical excision at stage 1, that may lead to a positive outcome. It is not completely clear whether histopathological findings of lymphogranuloma venereum can reveal progression or changes in the course of the disease over time, as is the case in other diseases. We conclude that both clinical and histopathological observations in a larger number of patients are needed in order to further evaluate the findings presented in this article.

Linfogranuloma venéreo é uma infecção causada por um tipo específico da bactéria Chlamydia trachomatis. Manifestações genitais e extragenitais da doença podem causar uma série de dificuldades no diagnóstico diferencial, indiretamente levando a progressão ou disseminação da infecção. Este trabalho apresenta casos de pacientes com linfogranuloma venéreo cujos achados clínicos e/ou histopatológicos são atípicos, além de abordar métodos de terapia alternativos, tais como excisão cirúrgica na fase 1, os quais podem trazer um resultado positivo. Ainda não se sabe se achados histopatológicos do linfogranuloma venéreo podem revelar progressão ou mudanças no curso da doença ao longo do tempo, como ocorre com outras enfermidades. Concluímos que observações clínicas e histopatológicas devem envolver um número maior de pacientes a fim de avaliar os resultados clínicos deste trabalho.

Severe aphthous stomatitis associated with oral calcineurin and mTOR inhibitors.

BACKGROUND: Aphthous stomatitis, a common mucocutaneous disorder, is a well accepted complication of sirolimus therapy. This association has been reported less frequently with tacrolimus. CASE: We present an 11-year old male with Budd-Chiari syndrome who experienced profound worsening of chronic aphthous ulcers after immunosuppressive therapy was changed from tacrolimus to sirolimus. CONCLUSION: Since these drugs are used widely in the pediatric transplantation population, this report serves to heighten awareness of this debilitating phenomenon, and to stress the importance of exercising caution when sirolimus and tacrolimus are administered in combination to pediatric patients.

Polymethylmethacrylate facial implant: a successful personal experience in Brazil for more than 9 years.

BACKGROUND: Synthetic permanent fillers for soft-tissue augmentation have acquired an important role in cosmetic improvement of patients with facial aging, facial atrophic scars, or lipoatrophy leading to facial defects. Polymethylmethacrylate (PMMA) is a filler introduced to the market as one option for long-lasting treatment. PMMA microspheres are purified, and the particles are larger than 20 microm. The product used as a filler has proven to be safe, effective, and long lasting. OBJECTIVE: To determine the efficacy and safety of PMMA as a facial filler. METHODS: Two hundred sixty-six patients (aged 17-72; 154 women) received injections of PMMA to correct facial defects. The number of sessions ranged from one to four, with an interval of 40 to 60 days between applications. RESULTS: Seventy-nine subjects (30%) had facial atrophy related to HIV infection, 159 (60%) had photoaging signs with deep wrinkles and atrophic areas, 25 (9%) had depressive scars from acne process, and three (1%) had residual depressions from lupus profundus. The results were satisfactory and long lasting. Side effects were transient. No late complications were observed. CONCLUSION: PMMA used for the treatment of atrophy, depressions, and facial wrinkles has been shown to be effective, long lasting, safe, and gratifying to patients and physicians.

Conventional and polarized dermoscopy features of dermatofibroma.

OBJECTIVE: To evaluate dermoscopic features and patterns of dermatofibromas using conventional and polarized light dermoscopy. DESIGN: Dermatofibromas were imaged using conventional nonpolarized contact dermoscopy (NPD), polarized contact dermoscopy (PCD), and polarized noncontact dermoscopy, followed by evaluation and comparison of dermoscopic features of the lesions. SETTING: Dermatology clinic specializing in pigmented lesions. Patients Fifty patients with dermatofibromas. RESULTS: The most common features of dermatofibromas observed with NPD and PCD were central white scarlike patches (37 [74%] and 42 [84%], respectively), brown globulelike structures (21 [42%] and 22 [44%]), vascular structures (24 [48%] and 22 [44%]), and a peripheral fine pigmented network (36 [72%] for both). A newly described feature observed with PCD was a central white patch characterized by shiny white streaks. With polarized noncontact dermoscopy, the most characteristic feature was a central pink hue or "vascular blush" (44 [88%]) and visibility of blood vessels (41 [82%]). The most common pattern identified with NPD and PCD was the combination of a peripheral pigmented network and a central white patch in 28 (56%) and 31 (62%) of lesions, respectively. With polarized noncontact dermoscopy, the most common pattern was a central pink hue with a peripheral pigmented network (23 [46%]). There was good to excellent agreement when comparing NPD with PCD images, but there was a variable level of agreement when polarized noncontact dermoscopy images were compared with NPD and PCD images. CONCLUSIONS: Conventional and polarized light dermoscopy are not equivalent but may be complementary. This study highlights some salient differences. We were able to identify new dermoscopic features and patterns not previously described with conventional dermoscopy. These new criteria can aid in the diagnosis of dermatofibroma.

Predominant dermoscopic patterns observed among nevi.

BACKGROUND: It has been clinically observed that patients' "normal" moles resemble each other. Whether this concept is applicable to dermoscopic practice has not been sufficiently studied. OBJECTIVE: To investigate whether physicians evaluating dermoscopic images would identify common dermoscopic profiles of nevi within individual patients. METHODS: Images of 205 nevi belonging to 18 patients were evaluated by 2 dermatologists for dermoscopic global pattern, color, and specific structures. We defined dermoscopic patterns as dominant if seen in >or= 40% of the patient's nevi; a minor pattern was defined as 20 to 39%. RESULTS: A dominant pattern was seen in 15 patients (83%). In 13 (72%) of the patients, >or= 80% of the nevi were classified into one, two, or three global patterns. The reticular global pattern was the most prevalent dominant pattern, seen in 9 patients (50%); the homogeneous pattern was the most prevalent minor pattern, seen in 16 patients (89%). CONCLUSION: Individuals tend to have one to three predominant dermoscopic nevus global patterns.

Leishmaniose tegumentar americana associada à AIDS: relato de quatro casos / American cutaneous leishmaniasis associated with HIV/AIDS: report of four clinical cases

A co-infecção leishmaniose tegumentar americana e AIDS é de relato recente na literatura, observando-se diversidade quanto ao comportamento clínico e imunológico destes pacientes. Relatamos quatro casos acompanhados no Hospital Universitário de Brasília, com diagnóstico de infecçäo por parasitas do gênero Leishmania e pelo vírus da imunodeficiência humana, ilustrando diferentes apresentaçöes clínicas, evoluções e respostas terapêuticas

[American cutaneous leishmaniasis associated with HIV/AIDS: report of four clinical cases]. / Leishmaniose tegumentar americana associada à AIDS: relato de quatro casos.

The co-infection American cutaneous leishmaniasis and AIDS has recently been described in the literature, observing differences between the clinical and immunological behavior of these patients. Four cases are reported here, attended at the Brasilia University Hospital, with diagnoses of infection by Leishmania species and immunodeficiency virus, with a view to illustrating the clinical presentations, course and therapeutic responses.

Sarcoma de Kapois clássico: relato de caso

O sarcoma de Kaposi (SK) é neoplasia rara, inicialmente descrita por Moritz Kaposi em 1872. São relatados quatro formas clinicopatológicas peculiares. O interesse em todos os aspectos dessa doença vem aumentando gradualmente pela emergência do vírus da imunodeficiência humana (HIV), que freqëntemente se associa ao sarcoma de Kaposi. Apesar de descobertas recentes importantes, o manuseio do SK permanece um desafio. O desconhecimento de sua patogênese impede o desenvolvimento de um tratamento eficaz. Os autores relatam um caso da forma clássica do sarcoma de Kaposi, enfatizando os aspectos clínicos, diagnósticos e terapêuticos