RESUMO
Cutaneous larva migrans is a common infestation among travelers. Although the diagnosis may be suspected clinically, cases can show atypical presentations. We present the ultrasound features of 4 cases at 18 and 70 MHz. Small linear hyperechoic and hyper-refringent subepidermal and intrafollicular structures suggestive of fragments of larvae, hypoechoic dermal and hypodermal tunnels that match with dilatation of lymphatic ducts, and inflammatory dermal and hypodermal ultrasound signs can support the diagnosis. This work suggests that larvae can penetrate the cutaneous basement membrane through the ostia of the hair follicles and potentially disseminate through the dermal and hypodermal lymphatic network.
Assuntos
Larva Migrans/diagnóstico por imagem , Adulto , Feminino , Humanos , Ultrassonografia/métodosAssuntos
Acitretina/administração & dosagem , Anti-Inflamatórios/administração & dosagem , Clobetasol/administração & dosagem , Ceratolíticos/administração & dosagem , Doenças da Unha/diagnóstico , Doenças da Unha/tratamento farmacológico , Administração Tópica , Quimioterapia Combinada , Feminino , Humanos , Pessoa de Meia-Idade , Unhas/efeitos dos fármacos , Unhas/patologia , Resultado do TratamentoRESUMO
DRESS syndrome (drug reaction with eosinophilia and systemic symptoms) is an adverse life-threatening drug reaction characterized by a polymorphous rash associated with fever, lymphadenopathy and multiorgan involvement with eosinophilia. We present the case of an immunocompetent man with DRESS syndrome secondary to carbamazepine, that developed concomitantly meningoencephalitis caused by human herpes virus 6 (HHV-6), and a review of literature. The pathogenic role of HHV-6 in DRESS syndrome remains controversial. Given the diagnostic and possibly prognostic significance of HHV-6, the screening seems to be a good measure to use in the clinical management of these patients.
Assuntos
Anticonvulsivantes/efeitos adversos , Carbamazepina/efeitos adversos , Síndrome de Hipersensibilidade a Medicamentos/etiologia , Herpesvirus Humano 6/fisiologia , Imunocompetência , Meningoencefalite/virologia , Adulto , Antivirais/uso terapêutico , Síndrome de Hipersensibilidade a Medicamentos/diagnóstico , Humanos , Masculino , Meningoencefalite/tratamento farmacológico , Meningoencefalite/imunologia , Reação em Cadeia da Polimerase , Ativação ViralRESUMO
El síndrome DRESS (drug reaction with eosinophilia and systemic symptoms) constituye una reacción adversa a fármacos, potencialmente mortal, caracterizada por una erupción cutánea polimorfa asociada a fiebre, linfadeno-patías y compromiso multiorgánico con eosinofilia. Presentamos el caso clínico de un hombre inmunocompetente con un síndrome DRESS secundario a carbamazepina que cursó concomitantemente con una meningoencefalitis por virus herpes humano 6 (VHH-6). El rol patogénico del VHH-6 en el síndrome DRESS sigue siendo controversial; sin embargo, dada la importancia diagnóstica y eventualmente pronóstica de la infección por VHH-6, su tamizaje sería recomendable dentro del estudio de estos pacientes.
DRESS syndrome (drug reaction with eosinophilia and systemic symptoms) is an adverse life-threatening drug reaction characterized by a polymorphous rash associated with fever, lymphadenopathy and multiorgan involvement with eosinophilia. We present the case of an immunocompetent man with DRESS syndrome secondary to carbamazepine, that developed concomitantly meningoencephalitis caused by human herpes virus 6 (HHV-6), and a review of literature. The pathogenic role of HHV-6 in DRESS syndrome remains controversial. Given the diagnostic and possibly prognostic significance of HHV-6, the screening seems to be a good measure to use in the clinical management of these patients.
Assuntos
Humanos , Masculino , Adulto , Carbamazepina/efeitos adversos , Herpesvirus Humano 6/fisiologia , Síndrome de Hipersensibilidade a Medicamentos/etiologia , Imunocompetência , Meningoencefalite/virologia , Anticonvulsivantes/efeitos adversos , Antivirais/uso terapêutico , Ativação Viral , Reação em Cadeia da Polimerase , Síndrome de Hipersensibilidade a Medicamentos/tratamento farmacológico , Meningoencefalite/imunologia , Meningoencefalite/tratamento farmacológicoRESUMO
Erosive lichen planus is an uncommon variant of lichen planus. Chronic erosions of the soles, accompanied by intense and disabling pain, are some of its most characteristic manifestations. We present the case of a woman who developed oral and plantar erosive lichen planus associated with lichen planus pigmentosus and ungueal lichen planus that were diagnosed after several years. The patient failed to respond to multiple therapies requiring longstanding medication but remained refractory. Knowledge of the treatment options for erosive lichen planus is insufficient. Further research is required to clarify their effectiveness, ideally adopting an evidence-based methodology.
Assuntos
Dermatoses do Pé/tratamento farmacológico , Dermatoses do Pé/patologia , Líquen Plano/tratamento farmacológico , Líquen Plano/patologia , Corticosteroides/uso terapêutico , Idoso , Fármacos Dermatológicos/uso terapêutico , Feminino , Humanos , Falha de TratamentoRESUMO
Abstract Erosive lichen planus is an uncommon variant of lichen planus. Chronic erosions of the soles, accompanied by intense and disabling pain, are some of its most characteristic manifestations. We present the case of a woman who developed oral and plantar erosive lichen planus associated with lichen planus pigmentosus and ungueal lichen planus that were diagnosed after several years. The patient failed to respond to multiple therapies requiring longstanding medication but remained refractory. Knowledge of the treatment options for erosive lichen planus is insufficient. Further research is required to clarify their effectiveness, ideally adopting an evidence-based methodology.
Assuntos
Idoso , Feminino , Humanos , Dermatoses do Pé/tratamento farmacológico , Dermatoses do Pé/patologia , Líquen Plano/tratamento farmacológico , Líquen Plano/patologia , Corticosteroides/uso terapêutico , Fármacos Dermatológicos/uso terapêutico , Falha de TratamentoRESUMO
Chronic spontaneous urticaria is a disorder mediated by mast cells, characterized by the development of wheals, angioedema or both, lasting six weeks or more, with or without a known trigger agent. First and second line treatment are antihistamines, but some refractory cases require other alternatives, such as omalizumab. Searching in Epistemonikos database, which is maintained by screening 30 databases, we identified four systematic reviews including five pertinent randomized controlled trials overall. We combined the evidence using meta-analysis and generated a summary of findings following the GRADE approach. We concluded omalizumab reduces symptoms and improves quality of life in patients with chronic spontaneous urticaria.
La urticaria crónica espontánea es una enfermedad mediada por degranulación de mastocitos, caracterizada por la aparición de ronchas y/o angioedema por más de seis semanas, con o sin un gatillante conocido. El manejo de primera y segunda línea son los antihistamínicos, pero existen casos refractarios que requieren otras alternativas terapéuticas, dentro de las cuales destaca el omalizumab. Utilizando la base de datos Epistemonikos, la cual es mantenida mediante búsquedas en 30 bases de datos, identificamos cuatro revisiones sistemáticas que en conjunto incluyen cinco estudios aleatorizados. Realizamos un metanálisis y tablas de resumen de los resultados utilizando el método GRADE. Concluimos que el uso de omalizumab disminuye los síntomas y mejora la calidad de vida en pacientes con urticaria crónica espontánea.
