Mycobacterium chelonae Cutaneous Infection: A Challenge for an Internist.

Cutaneous infections caused by the Mycobacterium chelonae complex show a heterogeneous clinical presentation, which varies according to the patient's immune status. Most standard antimycobacterials have no effect against these species. Clarithromycin alone was shown to provide adequate treatment, although resistance has been reported. Consequently, the literature supports multi-drug therapy to combat resistant strains. Here, we describe the case of a 59-year-old man under systemic immunosuppressive therapy who developed cutaneous lesions whose evolution was highly suggestive of atypical infection. LEARNING POINTS: Mycobacterium chelonae is a ubiquitous species of mycobacteria found in the environment; cutaneous infections by the M. chelonae complex show a heterogeneous clinical presentation.The combination of linezolid and clarithromycin has been used in some cases, with rapid clinical resolution and less or no relapse observed after long-term follow-up.Internal Medicine is the appropriate speciality to treat particularly complex or multisystem diseases, such as infections in immunocompromised patients.

Ramsay Hunt Syndrome in a Patient with Ulcerative Colitis Treated with Infliximab.

Ramsay Hunt syndrome is a rare complication of herpes zoster that results from reactivation of varicella-zoster virus in the geniculate ganglion of the VII cranial nerve. Immunosuppression can lead to reactivation of latent varicella-zoster virus, resulting in herpes zoster. Here, we present a case of Ramsay Hunt syndrome in a patient with ulcerative colitis under treatment with infliximab. LEARNING POINTS: Ramsay Hunt syndrome is a rare form of herpes zoster and characterized by the presence of otalgia, facial palsy, vertigo and vesicular rash in the external ear or on the oropharynx.Treatment with TNF inhibitors increases the risk of its development.Although not generally recommended, vaccination may reduce the risk of herpes zoster recurrence during TNF inhibitor therapy.

Política de saúde para imigrantes e refugiados no município de São Paulo: relato do processo participativo para a definição das ações de saúde / Health policy for immigrants and refugees in the city of São Paulo: report of the participatory process for the definition of health actions

O Município de São Paulo (MSP) tem em sua formação demográfica grande participação de imigrantes. Atualmente observa-se preponderância de imigrantes e refugiados bolivianos, chineses, coreanos, haitianos, sírios e de países da África - em grande parte vivendo em situação de vulnerabilidade. Muitos fugiram de conflitos ou catástrofes e tem agregado ao sofrimento, a dor da perda de familiares e amigos, seus lares e cotidiano. Para estas populações – mais de 150 mil pessoas – a luta por uma vida digna no MSP é permeada por barreiras linguísticas e culturais, xenofobia, falta de documentação, emprego e habitação...