RESUMO
We report a cluster of cutaneous leishmaniasis due to Leishmania major in four immunocompetent travelers returning from Western Turkmenistan and having atypical and/or multiple lesions. Treatments with pentamidine or fluconazole were effective. Physicians should be aware that some virulent strains of L major currently circulate in Central Asia.
Assuntos
Antiprotozoários/administração & dosagem , Crioterapia/métodos , Leishmania major/isolamento & purificação , Leishmaniose Cutânea/etnologia , Pele/parasitologia , Adulto , Análise por Conglomerados , Feminino , França/epidemiologia , Humanos , Injeções Intramusculares , Leishmaniose Cutânea/parasitologia , Leishmaniose Cutânea/terapia , Masculino , Pessoa de Meia-Idade , Suíça/epidemiologia , Turcomenistão/etnologia , Reino Unido/epidemiologiaAssuntos
Nanismo Hipofisário/diagnóstico , Adolescente , Hormônio Adrenocorticotrópico/sangue , Nanismo Hipofisário/sangue , Estradiol/sangue , Feminino , Hormônio Foliculoestimulante/sangue , Hormônio do Crescimento/sangue , Humanos , Hormônio Luteinizante/sangue , Imageamento por Ressonância Magnética , Somatomedinas/análise , Síndrome , Tireotropina/sangueRESUMO
UNLABELLED: We report an exceptional case of cutaneous necrosis due to the coexistence of 4 thrombophilic factors, inherited and acquired. We would like to draw attention to these unrecognized associations. CASE REPORT: A 72-year-old woman was admitted with a 5 month history of necrotic nonhealing, painful ulcer of both legs and recently a purple toe. She had a history of 3 deep venous thromboses of the leg complicated by pulmonary embolism. A skin biopsy of the ulcer and purple toe showed only thrombosis in the dermal vessel. Laboratory findings showed a circulating lupus anticoagulant, positive anticardiolipin antibodies, antinuclear antibodies (1/320 dilution) and an anti Sm. Moreover, activated protein C resistance associated with factor V Leiden mutation and hyperhomocysteinemia was found; protein S was transiently low. With iloprost, oral anticoagulant, vitamin B12 and folic acid, the evolution was good, with healing of ulcer. COMMENTS: cutaneous necrosis can reveal hypercoagulable states, sometimes complex. We find 4 thrombophilic factors in our case, i.e. antiphospholipid antibodies, factor V Leiden, protein S deficiency and hyperhomocysteinemia. This is exceptional but highlights the role of several constitutional and acquired thrombophilic factors in the genesis of thrombosis. Extended protein C pathway disturbances could explain the mechanism that leads to cutaneous necrosis, in this patient, with an antiphospholipid syndrome. This case shows that it is necessary in some circumstances to make a complete hemostatic laboratory search to detect several thrombophilic factors. If they are present they can justify an oral anticoagulant treatment and a familial screening.