Hepatic necrosis associated with drug-induced hypersensitivity syndrome.

Drug-induced hypersensitivity syndrome (DIHS; also known as drug reaction with eosinophilia and systemic symptoms [DRESS]) is a life-threatening condition first described by Chaiken et al. in 1950. It is characterized by extensive mucocutaneous rash; fever; lymphadenopathy; hepatitis; hematological abnormalities; damage to several organs such as kidney, heart, lungs, and pancreas; and possible reactivation of human herpesvirus-6 (HHV-6) or other herpes virus. Rare and severe cases may present hepatic necrosis, and about 15% of them result in death or liver transplantation. A hallmark of this syndrome is the late onset of symptoms after the drug exposure. The most common culprit drugs are the aromatic anticonvulsants (in almost 30% of the cases) and the antibiotics (which in some series represent 20% of the cases). The authors report a case of a 41-year-old female who presented to the emergency department with erythroderma, acute hepatitis, acute pancreatitis and acute renal failure, and was then treated with corticosteroid after the diagnosis of DIHS/DRESS. A specific culprit drug could not confidently be determined due to the presence of multiple drugs used by the patient. The clinical and laboratory outcome was apparently satisfactory, but unexpectedly, on the sixth day of hospitalization, the patient complained of nonspecific malaise, drowsiness, which progressed in a few hours with signs and symptoms of hepatic failure, refractory shock, and death. The autopsy findings showed submassive hepatic necrosis, and the immediate cause of death was attributed to hepatic failure.

Generalized pustular psoriasis in childhood.

Generalized pustular psoriasis is a rare form of psoriasis consisting of a generalized eruption of sudden onset with erythema and sterile pustules. In children, generalized pustular psoriasis is even more uncommon and may present as a severe and potentially life-threatening disorder. In this study, we present demographics, clinical aspects, treatment response, and follow-up of seven children with generalized pustular psoriasis. Retrospective study reviewing the records of seven children with generalized pustular psoriasis including age, gender, age of onset, presence of scalp and nail involvement, family history, concomitant diseases, precipitating factors, treatment modalities, and outcome. Age of first symptoms ranged from 1 month to 11 years. All patients received systemic retinoids at one time of the follow-up period. Other treatment modalities included immunosuppressive drugs, biologics, phototherapy, and sulfasalazine. Two patients presented with severe constitutional illness, secondary infection and septic shock, including one fatal outcome. All further cases have remained free of recurrences for a mean period of up to 3 years. In our study, generalized pustular psoriasis presented a wide clinical spectrum in children ranging from mild, asymptomatic outbreaks to more severe, life-threatening episodes. One fatality was observed. Children generally responded well to systemic retinoids. Further studies and long-term follow-up periods are needed to define potential trigger factors, efficacy and safety of different treatment modalities in children with generalized pustular psoriasis.

Human T-cell lymphotropic virus type 1 infective dermatitis emerging in adulthood.

BACKGROUND: Infective dermatitis (ID) is a rare dermatologic condition of childhood that has been linked to human T-cell lymphotropic virus type 1 (HTLV-1). OBJECTIVE: To analyze the clinical and laboratory features associated with adult-onset ID linked to HTLV-1. METHODS: From December 1995 to December 2007, four patients with ID were followed in the dermatology outpatient clinic of the "Hospital das Clínicas" of the University of São Paulo Medical School, São Paulo, Brazil. Epidemiologic data were collected and dermatologic examination was performed. Patients were submitted to histopathologic, hematologic, virologic, and immunologic investigations. RESULTS: All patients had a diagnosis of ID according to previously established criteria, despite being adults. HTLV-1 infection was demonstrated by enzyme-linked immunosorbent assay, Western blotting assays, and polymerase chain reaction. The male to female ratio was 1 : 3 and the median age at diagnosis was 42 years. The cutaneous manifestations were erythematous, scaly, and crusted lesions in all patients, and ichthyosis in three of the four cases. Histopathologic study showed lymphocytic epidermotropism in two cases. The median proviral load was 281 copies/10,000 peripheral blood mononuclear cells. Immunodeficiency was not observed in any case. The therapies used were antimicrobials, corticosteroids, and phototherapy. CONCLUSIONS: Although many authors have considered ID to be a form of childhood dermatitis, we have described four cases that fulfilled the major criteria for ID, except for onset in adulthood.

[Psoriasis in childhood and adolescence].

Psoriasis is a chronic, immunologically mediated, recurrent and universal inflammatory disorder. Approximately one third of adults refer onset before 16 years of age. The sooner the onset, the worse is the prognosis. In children, lesions may be physically disfiguring, leading to psychological impairment and evident loss of quality of life. Systemic therapy used in psoriasis, as well as phototherapy, has limited use in children due to accumulative effects of drugs, low acceptance, and risk of teratogenicity. In this section, we discuss the main clinical aspects of psoriasis in childhood and adolescence, differential diagnosis, therapeutic options, and prognosis.

Psoríase na infância e na adolescência / Psoriasis in childhood and adolescence

A psoríase é doença inflamatória crônica, imunologicamente mediada, recorrente e de caráter universal. Aproximadamente um terço dos adultos acometidos refere início da doença antes dos 16 anos de idade. Quanto mais precoce, mais grave tende a ser a evolução do quadro. Em crianças, as lesões podem ser fisicamente desfigurantes, causando prejuízos psicológicos e evidente comprometimento da qualidade de vida. As medicações sistêmicas utilizadas na psoríase, bem como a fototerapia, têm indicação limitada na infância, devido aos efeitos cumulativos das drogas, à baixa aceitação e ao risco de teratogenicidade. Nesta seção, discutiremos as principais manifestações clínicas da psoríase na infância e na adolescência, bem como os diagnósticos diferenciais, opções terapêuticas e prognóstico.

Psoriasis is a chronic, immunologically mediated, recurrent and universal inflammatory disorder. Approximately one third of adults refer onset before 16 years of age. The sooner the onset, the worse is the prognosis. In children, lesions may be physically disfiguring, leading to psychological impairment and evident loss of quality of life. Systemic therapy used in psoriasis, as well as phototherapy, has limited use in children due to accumulative effects of drugs, low acceptance, and risk of teratogenicity. In this section, we discuss the main clinical aspects of psoriasis in childhood and adolescence, differential diagnosis, therapeutic options, and prognosis.

Evolução da moléstia de Hansen (MH) em onze doentes com HIV+ e AIDS* / The evolution of Hansen's disease in eleven patients with AIDS

A Moléstia de Hansen(MH) e a AIDS são importantes problemas de saúde pública no Brasil. Este trabalho visa verificar a incidência de co-infecção pelo HIV e AIDS num grupo de doentes de hanseníase. Foram examinados 620 doentes de hanseníase, com ou sem estado reacional....(AU(

The Hansen disease (HD) and AIDS are important problems of public health in Brazil. This work aims to verify the incidence of co-infection for HIV and AIDS in a group of patients with Hansen'disease...

Prevalência de transtornos mentais comuns em populações atendidas pelo Programa Saúde da Família (QUALIS) no Município de São Paulo, Brasil / Prevalence of common mental disorders in a population covered by the Family Health Program (QUALIS) in São Paulo, Brazil

Vários países apresentam crescimento da prevalência dos transtornos mentais comuns (TMC). Poucos casos são diagnosticados e tratados adequadamente porque os serviços tradicionais de saúde raramente estão preparados para lidar com esse problema. O Programa Saúde da Família (PSF), implementado no Brasil desde 1995/1996, representa um novo modelo de atenção com potencial para melhor atuação nesses casos. Este estudo objetiva investigar a prevalência de TMC segundo a cobertura PSF e certos fatores de risco sóciodemográficos. Um inquérito de saúde e acesso a serviços foi realizado de janeiro a março de 2001 em áreas periféricas do Município de São Paulo, parcialmente cobertas pelo PSF, e incluiu o rastreamento de TMC em 2.337 indivíduos maiores de 15 anos de idade. Não se observou diferença significante na prevalência de TMC segundo a cobertura PSF. A prevalência foi significantemente maior nas mulheres (RP = 1,34), idosos (RP = 1,56) e nas categorias de menor renda (RP = 2,64) ou de menor escolaridade (RP = 2,83). Os TMC se mostraram associados a indicadores de desvantagem social, implicando a necessidade de focalização do problema e dos grupos de risco específicos para maior impacto da atenção.

Prevalência de transtornos mentais comuns em populações atendidas pelo Programa Saúde da Família (QUALIS) no Município de São Paulo, Brasil / Prevalence of common mental disorders in a population covered by the Family Health Program (QUALIS) in São Paulo, Brazil

Vários países apresentam crescimento da prevalência dos transtornos mentais comuns (TMC). Poucos casos são diagnosticados e tratados adequadamente porque os serviços tradicionais de saúde raramente estão preparados para lidar com esse problema. O Programa Saúde da Família (PSF), implementado no Brasil desde 1995/1996, representa um novo modelo de atenção com potencial para melhor atuação nesses casos. Este estudo objetiva investigar a prevalência de TMC segundo a cobertura PSF e certos fatores de risco sóciodemográficos. Um inquérito de saúde e acesso a serviços foi realizado de janeiro a março de 2001 em áreas periféricas do Município de São Paulo, parcialmente cobertas pelo PSF, e incluiu o rastreamento de TMC em 2.337 indivíduos maiores de 15 anos de idade. Não se observou diferença significante na prevalência de TMC segundo a cobertura PSF. A prevalência foi significantemente maior nas mulheres (RP = 1,34), idosos (RP = 1,56) e nas categorias de menor renda (RP = 2,64) ou de menor escolaridade (RP = 2,83). Os TMC se mostraram associados a indicadores de desvantagem social, implicando a necessidade de focalização do problema e dos grupos de risco específicos para maior impacto da atenção(AU)

[Prevalence of common mental disorders in a population covered by the Family Health Program (QUALIS) in São Paulo, Brazil]. / Prevalência de transtornos mentais comuns em populações atendidas pelo Programa Saúde da Família (QUALIS) no Município de São Paulo, Brasil.

The prevalence of common mental disorders has increased in many countries. Cases are often not identified and adequately treated because traditional health care services are rarely prepared to deal with this problem. The Family Health Program (FHP) has been implemented in Brazil since 1995-1996 and provides a new primary health care model with the potential for better care for these patients. This study investigates common mental disorders prevalence according to FHP coverage and associated socio-demographic factors. A large health and health care survey was conducted from January to March 2001 in areas partly covered by the FHP in a peripheral area of the city of Sao Paulo and included common mental disorders screening in 2,337 individuals > 15 years of age. There was no significant difference in common mental disorders prevalence according to FHP. Common mental disorders prevalence was significantly higher among females (PR = 1.34), elderly (PR = 1.56), and individuals with lower income (PR = 2.64) or less schooling (PR = 2.83). Common mental disorders was associated with indicators of social disadvantage, implying the need to focus on specific health problems and risk groups to improve the impact of care.

Campanha voluntária em comunidades carentes para diagnóstico precoce da moléstia de Hansen: integração docente, discente e assistencial / Voluntary campaign in needy communities in order to acomplish early diagnosis of Hansen disease: integration into teaching staff, student and social service

Objetivo: Comparação do número de doentes de hanseníase verificado nas campanhas realizadas em comunidades carentes de São Paulo com os dados do Minitério da Saúde e da Organização Mundial da Saúde; e também , com os verificados nas campanhas realizadas em três cidades do Acre...

Objective: comparison between the number of patients with Hansen disease obtained in this analysis performed in the State of São Paulo and the number found by the Ministry of health and World Health and World Health Organization, as well as the data from three campaigns carried out in the State of Acre...