Myxoid Onychomatricoma-A New Case.

Onychomatricoma is a slow-growing, benign neoplasm of the nail matrix with several histological variants. With only 2 cases previously reported, the term "myxoid onychomatricoma" has been used by some authors to describe a rare variant, known to have a fibromixoid component. We present a case of a 51-year-old Caucasian woman with a 1-year history of thickening and discoloration of the right thumbnail, who was initially misdiagnosed as onychomycosis. After performing a magnetic resonance imaging that showed a tumor with several filamentous projections, an onychomatricoma was suspected and a total distal plaque avulsion was performed. Histology revealed a biphasic tumor with an epithelial component and a prominent myxoid stroma. Immunohistochemical staining was then used, confirming the diagnosis. Considering these findings, we believe that our case meets the diagnostic description of "myxoid onychomatricoma" and is, therefore, a new case of this rare histological variant.

Extragenital Gonorrhoea in Men Who Have Sex with Men: A Retrospective Study in a STI Clinic in Lisbon, Portugal.

INTRODUCTION: Recent studies worldwide reveal a significant prevalence of extragenital infections by Neisseria gonorrhoeae among men who have sex with men. We aimed to analyse the frequency and characteristics of extragenital gonococcal infections diagnosed in men who have sex with men in a walk-in Sexually Transmitted Infection clinic in Lisbon, Portugal. MATERIAL AND METHODS: We conducted a cross-sectional, retrospective study of the anorectal and/or oropharyngeal Neisseria gonorrhoeae infections in men who have sex with men, diagnosed in our Sexually Transmitted Infection clinic between January 2014 and December 2016. RESULTS: We found extragenital infection in 87 cases of gonorrhoea identified in men who have sex with men in this period, including: 49 cases of anorectal disease, 9 of oropharyngeal disease, 13 cases of infection at both extragenital sites, and 16 of simultaneous extragenital and urogenital gonorrhoea. Patients' ages ranged from 17 to 64 years (median: 28 years). Forty-seven (54%) of the patients did not present with any extragenital symptoms. Thirty (35%) were human immunodeficiency virus-1-positive. DISCUSSION: Since most extragenital Neisseria gonorrhoeae infections are asymptomatic, they may be missed and go untreated unless actively investigated. Current international guidelines recommend the screening of gonorrhoea at extragenital sites in men who have sex with men because anorectal and oropharyngeal infections constitute a potential disease reservoir, and may facilitate transmission and/or acquisition of human immunodeficiency virus infection. CONCLUSION: Our results highlight the relevance of testing men who have sex with men for Neisseria gonorrhoeae at extragenital sites, regardless of the existence of local complaints. The implementation of adequate screening programmes in Portugal should be considered. We also reinforce the need to raise awareness in the population regarding the adoption of prophylactic measures against transmission of sexually transmitted infections during anal and/or oral sexual exposure.

Introdução: Estudos internacionais recentes revelam uma prevalência significativa de infeções extragenitais por Neisseria gonorrhoeae em homens que têm sexo com homens. Pretendemos analisar a frequência e caraterísticas das infeções gonocócicas extragenitais diagnosticadas em homens que têm sexo com homens numa consulta aberta de Infeções Sexualmente Transmissíveis em Lisboa, Portugal. Material e Métodos: Conduzimos um estudo observacional transversal, retrospetivo, das infeções anorrectais e/ou orofaríngeas por Neisseria gonorrhoeae em homens que têm sexo com homens, diagnosticadas na nossa consulta de Infeções Sexualmente Transmissíveis entre janeiro de 2014 e dezembro de 2016. Resultados: Detetámos infeção extragenital em 87 dos casos de gonorreia identificados em homens que têm sexo com homens no período analisado, incluindo: 49 casos de doença anorrectal, 9 de doença orofaríngea, 13 casos de infeção em ambas as localizações extragenitais, e 16 de gonorreia simultaneamente extragenital e urogenital. A idade dos doentes variou entre 17 e 64 anos (mediana: 28 anos). Quarenta e sete (54%) dos doentes não apresentavam qualquer sintoma extragenital. Trinta (35%) tinham também infeção pelo vírus da imunodeficiência humana-1. Discussão: Dado que a maioria das infeções extragenitais por Neisseria gonorrhoeae são assintomáticas, estas podem não ser diagnosticadas, e não tratadas, se não pesquisadas ativamente. Em várias normas de orientação clínica internacionais atuais é recomendado o rastreio da gonorreia em localizações extragenitais em homens que têm sexo com homens, visto que as infeções anorrectais e orofaríngeas constituem potenciais reservatórios da doença e podem facilitar a transmissão e/ou aquisição de infeção pelo vírus da imunodeficiência humana. Conclusão: Os nossos resultados apontam para a relevância de testar os homens que têm sexo com homens para a presença de Neisseria gonorrhoeae em localizações extragenitais, independentemente da existência de sintomas locais. A implementação de programas de rastreio adequados em Portugal deverá ser considerada. Relevamos também a necessidade de sensibilizar a população para a adoção de medidas profiláticas contra a transmissão de infeções sexualmente transmissíveis durante o contacto sexual anal e/ou oral.

Granuloma Glutaeale Infantum: A Re-emerging Complication of Diaper Dermatitis.

Granuloma gluteale infantum is a rare nodular complication of irritant diaper dermatitis. The association of this condition with the widespread use of nondisposable cloth diapers has been increasingly recognized. We present the case of an 18-month-old girl with granuloma gluteale infantum. Our aims are to emphasize the importance of clinical recognition of this re-emerging complication of diaper dermatitis and to point out the potential role of topical calcineurin inhibitors as a treatment option.

De novo HIV infection diagnoses in a Department of Dermatology and Venereology in Lisbon, Portugal.

Background Portugal has the highest prevalence rate of HIV infection in Western Europe. The proportion of patients with a late diagnosis, carried out in full-blown AIDS stage, remains high. Skin and mucous membrane manifestations are not rare in these patients. Objective A demographic, clinical, and laboratorial characterization of patients with de novo HIV infection diagnosis made in the Department of Dermatology and Venereology of a central hospital in Lisbon, Portugal. Methods Retrospective review of medical records of adult patients newly diagnosed with HIV infection (reactive immunoassay for antibodies to HIV-1/HIV-2 or HIV p24 antigen) in the Dermatology and Venereology Department of a Portuguese central hospital in the period between January 2005 and December 2013. Results During the study period, 97 new cases were diagnosed, 70 men and 27 women. The median age at diagnosis was 36 years. Of the total, 50 cases were diagnosed with a concomitant sexually transmitted infection (STI), more frequently syphilis and ano-genital HPV infection. The remaining 47 patients were diagnosed with other dermatological conditions such as prurigo nodularis, psoriasis, and Kaposi's sarcoma. The duration of complaints that lead to medical attention ranged from <1 week to 8 years, being significantly lower in patients diagnosed with a concomitant STI ( p < 0.01). Basal viral load was also lower in this group of patients ( p < 0.05). Of all the new diagnosed cases, 80% of patients are currently retained in care. Conclusion This study grants a descriptive overview of de novo HIV infection diagnoses performed by dermatovenereologists in a central hospital in Lisbon, Portugal. As in the past, the importance of Dermato-Venereology for HIV infection diagnosis remains present in daily clinical practice.