[Isolation of Neisseria meningitidis in anorectal specimen in a men who have sex with men with uretritis and primary syphilis]. / Aislamiento de Neisseria meningitidis en muestra anorectal en hombre que tiene sexo con hombre con uretritis y sifilis primaria.

Neisseria meningitidis is a Gram-negative bacterium frequently associated with invasive diseases with high mortality. Although its natural reservoir is the human nasopharynx, in recent years there have been increasing reports of isolation of this agent in the anorectal mucosa, mainly in men who have sex with men (MSM). We present the case of an HIV-positive MSM who consulted for urethritis and primary syphilis, in which N. meningitidis was isolated in an anorectal specimen. He was treated empirically with ceftriaxone and azithromycin, and a post-treatment control culture was negative. Despite the increase in anogenital infections and colonization by N. meningitidis, its role is unknown as a genital pathogen and in the transmission of other infections and the need for specific therapeutic regimens.

Aislamiento de Neisseria meningitidis en muestra anorectal en hombre que tiene sexo con hombre con uretritis y sifilis primaria / Isolation of Neisseria meningitidis in anorectal specimen in a men who have sex with men with uretritis and primary syphilis

Resumen Neisseria meningitidis es una bacteria gramnegativa asociada frecuentemente a enfermedades invasoras de elevada mortalidad. Si bien su reservorio natural es la nasofaringe humana, en los últimos años han aumentado los aislamientos de este agente en la mucosa anorectal, principalmente en hombres que tienen sexo con hombres (HSH). Presentamos el caso de un HSH con infección por VIH, que consultó por un cuadro de uretritis y sifilis primaria, en el cual se aisló N. meningitidis en una muestra anorectal. Fue tratado en forma empírica con ceftriaxona y azitromicina, realizándose un cultivo de control post-tratamiento que fue negativo. A pesar del aumento de las infecciones y colonizaciones anogenitales por N. meningitidis, se desconoce su rol como patógeno genital, en la transmisión de otras infecciones y la necesidad de esquemas terapéuticos específicos.

Abstract Neisseria meningitidis is a Gram-negative bacterium frequently associated with invasive diseases with high mortality. Although its natural reservoir is the human nasopharynx, in recent years there have been increasing reports of isolation of this agent in the anorectal mucosa, mainly in men who have sex with men (MSM). We present the case of an HIV-positive MSM who consulted for urethritis and primary syphilis, in which N. meningitidis was isolated in an anorectal specimen. He was treated empirically with ceftriaxone and azithromycin, and a post-treatment control culture was negative. Despite the increase in anogenital infections and colonization by N. meningitidis, its role is unknown as a genital pathogen and in the transmission of other infections and the need for specific therapeutic regimens.

Pilomatrixoma buloso: una rara pero característica variante clínica / Bullous pilomatrixoma: a rare but characteristic clinical variant

El pilomatrixoma es un tumor anexial benigno, que muestra diferenciación hacia células matriciales y supramatriciales del folículo piloso. Es el segundo tumor benigno más frecuente en la población infantil luego del quiste epidérmico. Su presentación clínica habitual consiste en una lesión única, de consistencia firme y generalmente indolora.1 La variante anetodérmica o bulosa es poco frecuente, en general de rápido crecimiento y en ocasiones dolorosa.2 Se presenta a continuación un caso clínico de esta rara variante, por la importancia de conocer esta particular forma presentación.

A clinical case of bullous pilomatrixoma is present. Correspond to the second most frequent benign tumor in children, derived from the matrix cells of the hair follicle. It commonly presents as a single lesion, of firm consistency and mostly painless. The bullous variant corresponds to 2% of the presentations, the morphology is explained by the dilation of the lymphatic vessels and the consequent extravasation of lymph, as well as by the absence of elastic and collagen fibers. Treatment is the surgical excision of the lesion, and a biopsy specimen is necessary to establish a definitive diagnosis. Knowing this form of presentation allows us to pose it as a diagnostic option in clinical practice.

A Chair-based Abbreviated Repositioning Maneuver (ChARM) for fast treatment of posterior BPPV.

PURPOSE: To assess the effectiveness of a variation of the Epley maneuver, which we have titled "Chair-based Abbreviated Repositioning maneuver (ChARM)", in solving cases of benign positional paroxysmal vertigo (BPPV) of the posterior canal. ChARM addresses multiple issues of highly overloaded medical centers that delay its due and timely resolution. For example it does not necessitate an examination bed/table and requires only a backed chair, and less than 3 min to be performed. In combination with a recently published abbreviated diagnostic maneuver it can solve BPPV cases within few minutes of single medical visit. METHODS: Patients being diagnosed with posterior BPPV by means of an abbreviated diagnostic maneuver were recruited. Immediately after diagnosis, a single attempt of ChARM was conducted. The patient was followed for 48 h and at 1 month after these procedures to assess the persistence of symptomatology. RESULTS: 124 patients were treated with ChARM immediately after diagnosis during their very first medical visit. 92 patients (74.2%) solved their symptomatology completely after a single attempt of ChARM. The absence of symptoms persisted during the 30 days of follow-up. DISCUSSION: ChARM showed high success rates in solving posterior BPPV. The entire diagnostic-treatment procedure takes less than 5 min to perform and may allow direct treatment of patients, thereby avoiding unnecessary referrals or full vestibular testing. These abbreviated tools may be particularly useful in primary care settings or heavily overloaded otolaryngology or neurology departments.