Non-melanoma skin cancer in renal transplant recipients: a study in a Brazilian reference center.

BACKGROUND: Non-melanoma skin cancer (NMSC) after kidney transplantation is common and can result in significant morbidity and mortality. Their incidence and risk factors in renal transplant recipients (RTRs) vary depending on geographic location and there is a scarcity of literature describing the features of NMSC in Brazil. METHODS: NMSC data were retrospectively reviewed in charts of RTRs at the Clementino Fraga Filho University Hospital from January 2004 to December 2005, with the objectives of: 1) evaluating the occurrence of NMSC in RTRs transplanted between 2004 and 2005 at a reference center in Brazil; 2) verifying the frequency of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) in these patients according to sex, race, age, and tumor site; and 3) determining the time between transplantation and neoplasia. RESULTS: We found 202 RTRs, with 165 suitable for the study. There were 19 NMSC in eleven patients (6.67%), at a mean time of 37.7 months after transplantation. The mean follow-up time was 72.7 months. The ratio of SCC:BCC was 1.1:1. White race and age ≥40 years were associated with a higher incidence of NMSC and they appeared predominantly in sun-exposed sites. CONCLUSION: Regular dermatological follow-up of RTRs can help to make earlier diagnoses, resulting in better quality of life and lower morbidity and mortality.

Human papillomavirus detection and typification in cutaneous and mucosal lesions of HIV-seropositive patients.

High-risk human papillomavirus (HPV) in a lesion is related to an increased chance of neoplasic transformation, especially when with immunosuppression, as in HIV infection. We investigated HPV frequency in cutaneous and mucosal lesions of HIV-seropositive male patients. The frequency of malignancy, its association with the HPV type detected and some clinical variables were also assessed. A total of 38 lesions from 27 patients were studied in a period of 18 months. The biopsied fragment was submitted to HPV detection and typification, through polymerase chain reaction with generic (MY09/11) and specific (types 6, 11, 16 and 18) primers. HPV frequency was 63.2%, with detection of HPV types 6, 11 or 16 in 18 lesions and with multi-infection in three. There was low detection of high-risk HPV (type 16, 18.4%) and no HPV type 18. Of the lesions, 36.8% were already premalignant or malignant, and the frequency of moderate or severe dysplasia was higher in the study patients than that described in the HIV-seronegative population. High-risk HPV (type 16) was detected in four benign lesions and low-risk HPV (type 6) in three premalignant genital lesions. There was no significant association between the clinical variables and an increase in the prevalence of premalignant or malignant lesions.

Considerações sobre o diagnóstico diferencial entre hanseníase multibacilar e tuberculose: relato de três casos / Differencial diagnosis between lepromatous leprosy and tuberculosis: three case reports

Introdução: A hanseníase e a tuberculose são doenças endêmicas, ambas causadas por micobactérias que, na maioria das vezes, apresentam-se com quadros clínicos distintos. No entanto, o diagnóstico diferencial entre as duas micobacterioses pode ser difícil, principalmente nos casos iniciais de hanseníase virchowiana. Apresentação dos casos: são apresentados três casos de hanseníase virchowiana que foram inicialmente diagnosticados como tuberculose em uma unidade de referência para tratamento dessas doenças. Discussão: o quadro clínico inicial de hanseníase virchowiana apresentado nos três casos dificultou o diagnóstico de hanseníase, principalmente devido a não inclusão desta doença entre os diagnósticos diferenciais, comprometendo a busca ativa de sinais e sintomas mais específicos. Conclusão: São perdidas oportunidades de diagnóstico precoce de hanseníase quando a doença se apresenta com manifestações gerais mais exuberantes do que o quadro cutâneoneurológico. O diagnóstico precoce dos casos de hanseníase multibacilar é particularmente importante para o controle dos focos e conseqüente diminuição do número de casos novos da doença