Necrotizing fasciitis of breast in postpartum period: case report / Fasciíte necrotizante de mama no puerpério: relato de caso

Necrotizing fasciitis is an aggressive infection that affects subcutaneous and superficial fascia by necrosis, more often found in the abdominal wall, perineum and extremities. Rare cases have been described in the breast and the literature points to breastfeeding and previous breast procedures as risk factors for this condition. We present a 27-year-old patient in postpartum period who presented a right nipple fissure associated to breastfeeding, that evolved to a local aggressive infection with extensive necrosis of fascia and mammary parenchyma characterized as necrotizing fasciitis. Our aim is to highlight the importance of early diagnosis, especially to differentiate from puerperal mastitis which has a different pathophysiology and treatment, as well as the need for appropriate therapy consisting of surgical debridement and broad spectrum antibiotics in order to avoid further complications and death

Fasciíte necrotizante é uma infecção agressiva que acomete o subcutâneo e fáscias superficiais por necrose, mais frequentemente encontrada em parede abdominal, períneo e extremidades. Raros casos foram descritos na mama e a literatura aponta a amamentação e procedimentos mamários prévios como fatores de riscos para essa condição. Apresentamos uma paciente no puerpério, de 27 anos, que apresentou uma fissura no mamilo direito associada à amamentação e que evoluiu com infecção local agressiva, com necrose extensa de fáscias e parênquima mamário caracterizada como fasciíte necrotizante. O trabalho visa apresentar a importância do diagnóstico precoce, principalmente com diferenciação para as mastites puerperais que possuem fisiopatologia e tratamento distintos, assim como a necessidade do tratamento adequado com desbridamento cirúrgico e antibioticoterapia de amplo espectro para evitar maiores complicações e o óbito

Maternal immunomodulation of the offspring's immunological system.

The mother's and the offspring's immunological system are closely related thus one can influence the other. This hypothesis drove our aim to study the impact of the mother's immunological status over the immunological response of their offspring. For this, female mice tolerant or allergic to peanuts were exposed or not to a challenge diet containing peanuts during the gestation-lactation period (TEP/AEP; TNEP/ANEP, respectively). After weaning the offspring was submitted to the peanut allergy or peanut tolerization protocol and then challenged with a peanut diet. Our results showed that when the offspring is submitted to the allergy induction protocol, they behave differently depending on their mother's immunological status. Offspring born to TEP mothers produced the lowest antibody titters while those born to AEP mothers produced the highest antibody titters compared to mice born to TNEP and ANEP. On the other hand when the offspring was submitted to the tolerization protocol all groups presented low antibody titers with no significant difference between groups, independent of the mothers immunological status and/or contact with peanuts during the gestation-lactation period. The analysis of the histological profile of the offspring correlates well to the serological response. In other words, offspring born to TEP mothers and submitted to the allergy induction protocol presented a normal histological profile, while the offspring born to AEP mothers produced the worst gut inflammation. These results indicate that mothers, exposed to the antigen (by the oral route) during gestation, actively influence the immune response of their offspring. This work sheds some light on the importance of the immunomodulation induced by dietary antigens during gestation and their influence on the immunological response of their offspring. However, more work is needed to elucidate the molecular and cellular components of this regulatory phenomenon.

[Pulmonary blastoma]. / Blastoma pulmonar.

Pulmonary blastoma is a rare primary lung tumor with poor prognosis that commonly presents at a younger age than the non-small cell lung cancer. Classically they are large, symptomatic tumors with lymph nodal metastasis and carry poor prognosis. Pathological examination revealed features suggesting a biphasic tumor with mesenchymal and epithelial components. Over 200 cases have been reported so far worldwide since the first description of the tumor in 1945. Authors present a case of pulmonary blastoma with literature revision.