Hansen's disease in a general hospital: uncommon presentations and delay in diagnosis.

BACKGROUND: The question was raised as to why 'obvious' signs of leprosy, Hansen's disease (HD), are often missed by medical doctors working in a HD endemic area. METHODS: This study describes a small sample of patients who were diagnosed with HD during their hospital admission and not before. The discussion is whether the typical early signs and symptoms of HD are just not recognized, or whether unusual presentations confuse the attending physician. RESULTS: A total of 23 HD patients were hospitalized during the study period, of which 6 (26%) were only diagnosed with HD during their admission. All were classified as lepromatous leprosy (LL) with a history of signs and symptoms of HD. In nearly all patients, a suspicion of HD might have been raised earlier if a careful history and dermato-neurological examination had been done. CONCLUSIONS: Multibacillary (MB) HD, especially close to the lepromatous end of the spectrum, may mimic other diseases, and the patient can not be diagnosed without a biopsy or a slit skin smear examination. Clinicians working in a HD endemic area (Rio de Janeiro) do not always include HD in their differential diagnosis, especially when the clinical presentation is unusual. HD should be considered in all patients with skin lesions not responding to treatment, especially when they have neurological deficits, and live or have lived in an HD endemic area. Due to the increase in global travel and immigration, doctors in low endemic areas need to consider HD as a possible diagnosis.

Lyme disease in Rio de Janeiro, Brazil.

Five patients living in Rio de Janeiro, Brazil, were found to have Lyme disease. These are among the first known cases in South America.

Determination of different populations of blood lymphocytes in Brazilian patients with hanseniasis.

The number of B and T lymphocytes were determined in the blood of 35 Brazilian patients with leprosy: 19 lepromatous (L), 9 borderline (B), 4 tuberculoid (T), and 3 indeterminate (I) and also in a control group of 30 normal individuals. The results, were as follows. B lymphocytes, no differences between the patients with hanseniasis and the control group; T lymphocytes, there was an evident depletion in the patients with L compared to the control group and patients with T; and the average of T lymphocytes in B and I was lower than that seen in the control group and in patients with T. Despite this alteration they approach to what is found in the patients with T and the control group.

An induction of the late hypersensitivity reaction to DNCB in patients with different clinical forms of hanseniasis in Brazil.

One hundred and twenty Brazilian patients with several forms of hanseniasis were tested with DNCB. The results were the following: 1) the sensitization of patients with hanseniasis to DNCB was lower than that seen in the general population; 2) the sensitization of the borderline and virchowian forms of hanseniasis were lower than that seen in the indeterminate and tuberculoid forms.

[Comparative ecology of tuberculosis and hanseniasis as they coincide endemically in tropical countries]. / Ecologia comparada da tuberculose e da hanseníase-tal como se cruzam, endêmicas, en terras tropicais.

The authors discuss the several aspects of the co-sensibilization in the infections produced by M. Tuberculosis and M. hanseniae. Attention is called to Rabello's pioneer works written in 1935 and the subsequent works written by several Argentinian and Brazilian authors. Special emphasis is made to the experimental works in animals by Azulay. The authors discuss the aspects of competitiveness, protection and the crossed granulomatosis answers to the infections.

[A new classification of photodermatoses]. / Uma nova classificação das fotodermatoses.

The authors present a new classification for photodermatosis in five groups: 1. Primary toxic photodermatosis that means lesions produced in all human beings by non-ionized radiation. 2. Photodermatosis induced by drugs, with two subgroups--phototoxic and photoalergic--according to the mechanism of action of the drug. 3. Idiopathic photodermatosis in which the photonic effects are known but the chromophores are unknown; four conditions are included here polymorphous actinic eruption, solar urticaria, actinic reticuloid and hidroa vacciniforme. 4. Miscelanea group which includes several conditions of unknown mechanism which are not included in the other groups, such as: actinic cheilitis, actinic poikiloderma, actinic ceratoses, epitheliomas, melanomas and others. 5. Conditions precipitated or aggravated by solar radiation with two sub-groups: hereditary (xeroderma pigmentosum, Hartnup's syndrome and other) and acquired (lupus erythematosus, pellagra and other). In group 1, the authors propose the designation of actinic elastotic dermatosis to unify different conditions described by several authors such as: diffuse elastosis, citrein skin, cutis rhomboidalis, and others.

Autoaggressive hanseniasis.

I have given the name autoaggressive hanseniasis to a syndrome with immunopathologic and clinical pictures resembling autoaggressive systemic diseases observed in some cases of lepromatous and borderline hanseniasis. It is probably caused by B cell stimulation by antigenic complex of Mycobacterium leprae plus autologous tissue, along with a dysfunction of the T-suppressor lymphocytes.

Primary visceral virchowian (lepromatous) hanseniasis.

A case of primary visceral virchowian hanseniasis is presented. The onset and symptoms of the disease made one think that it was a lymphoma because of the severe enlargement of the liver, spleen, and lymph nodes. Biopsies of the liver, lymph nodes, and bone marrow revealed virchowian infiltration with acid-fast bacilli and globi. The skin was free of lesions and negative to bacilli, and there were no neural symptoms.

[Transient acantholytic dermatosis. Presentation of a case]. / Dermatose acantolítica transitória. Apresentação de um caso.

A case of DAT is presented and the literature is reviewed. The authors verify the limitation of the present therapeutics and they discuss the possible pathogenic mechanism. They also say that "unspecific" lesions resistant to conventional therapy, and mostly localized in the trunk of middle-aged patients may suggest the diagnosis of DAT if biopsy is performed in these cases there probably will be a higher incidence of the disease. As far as we know this is the first brazilian case of DAT reported.

[Data and commentaries on 4060 mycologic tests made on skin scales, hair and nails]. / Dados e comentários sobre 4060 exames micológicos realizados em escamas de pele, pêlos e unhas.

The authors had studied the results obtained from the mycologic analysis of skin scales, hair and nails at the Mycology Laboratory of the Clinic Pathology Service of Hospital Universitário-Universidade Federal do Rio de Janeiro, in the period of june, 1978 to may, 1983. The incidence of superficial mycoses were reported as well the incidence of Candida sp. and dermatophytes in the differents areas of the skin. The results had been compared with the current litterature.

[Disseminated mycosis fungoides]. / Micose fungoide disseminada.

A case of mycosis fungoides (MF) that began with cutaneous eritemato-papular lesions leading to death with neurological symptoms is reported. Cutaneous histophatology was typical to MF and the liquoric citology showed Sézary cells. Necropsy evidenced extra-cutaneous dissemination of the tumor involving lymphnodes, heart, digestive system, bladder, liver, bone marrow and leptomeninges. The uncommon clinical manifestations and evolution are discussed.

[Hypersensitivity syndrome caused by phenytoins and phenobarbital]. / Síndrome de hipersensibilidade às fenitoinas e ao fenobarbital.

Recently we have seen three patients with a clinically characteristic hypersensitivity reaction to phenytoin two to four weeks after they started these therapy. The picture simulated a severe infectious exanthem; it was characterized by a generalized erythematous macular eruption, massive edema of the face, fever, generalized lymphadenopathy and hepatic involvement. The laboratory findings revealed leukocytosis with atypical lymphocytes, eosinophilia and altered liver function. Involution of the eruption was characterized by exfoliation similar to that observed in scarlet fever. There was prompt and good response to treatment with systemic steroids.

Xeroderma pigmentosum. Tratamento com 5-fluorouracil topico - acompanhamento de 15 anos. / Xeroderma pigmentosum Treatment with topical 5-fluorouracil follow-up of 15 years

A eficacia do 5-fluorouracil topico no xeroderma pigmentoso foi avaliada em observacao de 15 anos, apos a terapia. A medicacao foi empregada em aplicacoes diarias, durante 30 dias, em areas expostas, provocando intenso eritema, prurido, dor e maceracao superficial. Apos a suspensao do tratamento, o processo reacional regrediu, em 2 semanas, notando-se desaparecimento das ceratoses e esmaecimento acentuado das efelides, principalmente na face, onde as alteracoes eram mais severas. Com excecao de um espinalioma no labio inferior, area nao incluida no tratamento, outras modificacoes nao foram constatadas durante o longo periodo de acompanhamento

Tratamento das dermatomicoses com ketoconazole por via oral - estudo multicentrico. / Treatment of dermatomycosis with ketoconazole by oral route - multicenter study

Neste estudo foram incluidos 148 doentes, sendo 65 com pitiriase versicolor e 83 com dermatofitoses, submetidos a tratamento com ketoconazole por via oral. A dose diaria foi de 200mg (um comprimido) durante duas a quatro semanas para os casos de pitiriase versicolor e de quatro a oito semanas para os de dermatofitoses. O tratamento determinou, nos doentes de pitiriase versicolor, cura clinica e micologica em 50 (78,1%), apenas cura clinica em dois (3,1%) e cura micologica em um (1,6%). Nos doentes com dermatofitoses, em 69 (84,1%) houve cura clinica e micologica, quatro (4,9%) apresentaram cura micologica e cinco (6,1%) tiveram apenas cura clinica. Efeitos colaterais foram observados em 11 doentes (7,4%), sendo que dois necessitaram abandonar o tratamento por intolerancia (um teve nauseas de grau moderado e outro, nauseas, vomitos e tonturas de grau moderado, ambos no 1o. dia de tratamento).O ketoconazole por via oral demonstrou ser bastante eficaz no tratamento de pitiriase versicolor e de dermatofitoses

Observacao clinica com a fluorandrenolida em fita oclusiva. / Clinical evaluation of occlusive flurandrenolide tape

Os autores fazem um estudo aberto sobre o uso de fluorandrenolida sob oclusao, apresentada numa concentracao de 4 mcg/cm2 de fita cirurgica, adesiva, plastica e transparente. Avaliam 32 pacientes portadores de diversas dermatoses principalmente neurodermatite circunscrita a psoriase, concluindo pela eficacia, seguranca e comodidade de uso desta nova forma medicamentos