RESUMO
Abstract Patients with lepromatous or borderline leprosy may present two types of vasculonecrotic reactions: Lucio's phenomenon (LP) and necrotic erythema nodosum leprosum (nENL). These are serious conditions, which mostly lead to life-threatening infectious and thrombotic complications. The authors report the case of a patient with leprosy recurrence associated with an atypical type II reaction with LP characteristics on histopathology.
RESUMO
Patients with lepromatous or borderline leprosy may present two types of vasculonecrotic reactions: Lucio's phenomenon (LP) and necrotic erythema nodosum leprosum (nENL). These are serious conditions, which mostly lead to life-threatening infectious and thrombotic complications. The authors report the case of a patient with leprosy recurrence associated with an atypical type II reaction with LP characteristics on histopathology.
Assuntos
Eritema Nodoso , Hanseníase Dimorfa , Hanseníase Virchowiana , Hanseníase Multibacilar , Hanseníase , Eritema Nodoso/patologia , Humanos , Hanseníase/complicações , Hanseníase Virchowiana/complicações , Hanseníase Virchowiana/patologia , Hanseníase Multibacilar/complicações , NecroseRESUMO
Abstract Leprosy is a chronic infectious disease caused by Mycobacterium leprae and, depending on the host immune status, presents different clinical forms. This report describes the case of a 46-year-old man who had hypoesthetic lesions in the infrahyoid region for 30 days. The bacilloscopy was negative. The anatomopathological examination showed alterations corresponding to the tuberculoid pole (epithelioid histiocytes) and virchowian pole (foamy histiocytes), compatible with borderline-virchowian leprosy (Ridley and Jopling classification). Rapid tests for HIV I, II, and syphilis were positive, with a CD4 count of 223. The patient started treatment with multibacillary multidrug therapy, antiretroviral therapy, and benzathine penicillin, with marked clinical improvement in two months.
Assuntos
Humanos , Masculino , Hanseníase Dimorfa/tratamento farmacológico , Hanseníase/tratamento farmacológico , Quimioterapia Combinada , Hansenostáticos/uso terapêutico , Pessoa de Meia-Idade , Mycobacterium lepraeRESUMO
Leprosy is a chronic infectious disease caused by Mycobacterium leprae and, depending on the host immune status, presents different clinical forms. This report describes the case of a 46-year-old man who had hypoesthetic lesions in the infrahyoid region for 30 days. The bacilloscopy was negative. The anatomopathological examination showed alterations corresponding to the tuberculoid pole (epithelioid histiocytes) and virchowian pole (foamy histiocytes), compatible with borderline-virchowian leprosy (Ridley and Jopling classification). Rapid tests for HIV I, II, and syphilis were positive, with a CD4 count of 223. The patient started treatment with multibacillary multidrug therapy, antiretroviral therapy, and benzathine penicillin, with marked clinical improvement in two months.
Assuntos
Hanseníase Dimorfa , Hanseníase , Quimioterapia Combinada , Humanos , Hansenostáticos/uso terapêutico , Hanseníase/tratamento farmacológico , Hanseníase Dimorfa/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Mycobacterium lepraeRESUMO
Abstract Secondary osteoma cutis is a phenomenon that may occur in several conditions. When it occurs in a melanocytic nevus it is named osteonevus of Nanta, an event considered uncommon and characterized by the presence of bone formation adjacent or interposed with melanocytic cells. There are reports of its occurrence in various melanocytic lesions, being more frequently associated with intradermal nevus. We report a case of osteonevus of Nanta in combined nevus, possibly the first description of this association.
Assuntos
Humanos , Feminino , Adulto , Dermatoses do Couro Cabeludo/patologia , Dermatopatias Genéticas/patologia , Neoplasias Cutâneas/patologia , Doenças Ósseas Metabólicas/patologia , Ossificação Heterotópica/patologia , Nevo Intradérmico/patologia , Nevo Pigmentado/patologia , Dermatoses do Couro Cabeludo/cirurgia , Dermatopatias Genéticas/cirurgia , Neoplasias Cutâneas/cirurgia , Doenças Ósseas Metabólicas/cirurgia , Imuno-Histoquímica , Ossificação Heterotópica/cirurgia , Nevo Intradérmico/cirurgia , Melanócitos/patologia , Nevo Pigmentado/cirurgiaRESUMO
Secondary osteoma cutis is a phenomenon that may occur in several conditions. When it occurs in a melanocytic nevus it is named osteonevus of Nanta, an event considered uncommon and characterized by the presence of bone formation adjacent or interposed with melanocytic cells. There are reports of its occurrence in various melanocytic lesions, being more frequently associated with intradermal nevus. We report a case of osteonevus of Nanta in combined nevus, possibly the first description of this association.
Assuntos
Doenças Ósseas Metabólicas/patologia , Nevo Intradérmico/patologia , Nevo Pigmentado/patologia , Ossificação Heterotópica/patologia , Dermatoses do Couro Cabeludo/patologia , Dermatopatias Genéticas/patologia , Neoplasias Cutâneas/patologia , Adulto , Doenças Ósseas Metabólicas/cirurgia , Feminino , Humanos , Imuno-Histoquímica , Melanócitos/patologia , Nevo Intradérmico/cirurgia , Nevo Pigmentado/cirurgia , Ossificação Heterotópica/cirurgia , Dermatoses do Couro Cabeludo/cirurgia , Dermatopatias Genéticas/cirurgia , Neoplasias Cutâneas/cirurgiaRESUMO
We report a rare case of subcutaneous phaeohyphomycosis caused by Cladophialophora bantiana in an immunocompetent patient in Amazonas, Brazil. This dematiaceous fungus has been mainly associated with life-threatening infections affecting the central nervous systems of immunosuppressed patients. We present the clinical, laboratory, and therapeutic aspects, and in vitro susceptibility test results for different antifungal drugs. A brief review of the cases reported in the literature over the past 20 years has also been discussed. According to the literature review, the present case is the first report of subcutaneous phaeohyphomycosis due to C. bantiana in an immunocompetent patient in Latin America.
Assuntos
Ascomicetos/isolamento & purificação , Feoifomicose/diagnóstico , Feoifomicose/microbiologia , Antifúngicos/classificação , Antifúngicos/uso terapêutico , Biópsia , Brasil , Dermatomicoses/tratamento farmacológico , Humanos , Hospedeiro Imunocomprometido , Masculino , Pessoa de Meia-Idade , Fungos Mitospóricos/isolamento & purificação , Feoifomicose/tratamento farmacológico , Feoifomicose/imunologiaRESUMO
Abstract We report a rare case of subcutaneous phaeohyphomycosis caused by Cladophialophora bantiana in an immunocompetent patient in Amazonas, Brazil. This dematiaceous fungus has been mainly associated with life-threatening infections affecting the central nervous systems of immunosuppressed patients. We present the clinical, laboratory, and therapeutic aspects, and in vitro susceptibility test results for different antifungal drugs. A brief review of the cases reported in the literature over the past 20 years has also been discussed. According to the literature review, the present case is the first report of subcutaneous phaeohyphomycosis due to C. bantiana in an immunocompetent patient in Latin America.
Assuntos
Humanos , Masculino , Ascomicetos/isolamento & purificação , Feoifomicose , Feoifomicose/diagnóstico , Biópsia , Brasil , Hospedeiro Imunocomprometido , Dermatomicoses/tratamento farmacológico , Fungos Mitospóricos/isolamento & purificação , Feoifomicose/imunologia , Feoifomicose/tratamento farmacológico , Pessoa de Meia-Idade , Antifúngicos/classificação , Antifúngicos/uso terapêuticoRESUMO
Crusted scabies is a less common variant of scabies that is highly contagious, difficult to treat and involves infestation by Sarcoptes scabiei var. hominis. The classical clinical presentation includes crusted, scaly and generally non-pruritic lesions usually located on the head, neck, palmar, plantar and periungual region. It was first described in Norway in 1848 in patients with leprosy who presented with crusted lesions. In this study, we report the case of a patient with crusted scabies with florid clinical manifestations and chronic liver disease due to hepatitis B and delta virus infection.
Assuntos
Doença Hepática Terminal/virologia , Vírus da Hepatite B , Vírus Delta da Hepatite , Escabiose/tratamento farmacológico , Escabiose/patologia , Antiparasitários/uso terapêutico , Doença Hepática Terminal/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Escabiose/imunologia , Resultado do TratamentoRESUMO
A few cases of pigmented squamous cell carcinoma affecting the skin and the ocular and oral mucosa of the elderly have been described in the literature. The disease manifests itself as papular and nodular erythematous or pigmented lesions. The main clinical differential diagnoses are pigmented basal cell carcinoma and melanoma. Histopathological examination is characterized by proliferation of atypical squamous cells with formation of horn pearls permeated by dendritic melanocytes. For this reason, a careful diagnosis is necessary to rule out other tumors that show melanin pigment. Surgical removal is the indicated treatment and the prognosis is similar to the classical squamous cell carcinoma. We report a case of pigmented squamous cell carcinoma with diagnosis confirmed by histological and immunohistochemical examinations.
Assuntos
Carcinoma de Células Escamosas/patologia , Neoplasias Cutâneas/patologia , Idoso , Carcinoma de Células Escamosas/diagnóstico , Diagnóstico Diferencial , Humanos , Imuno-Histoquímica , Masculino , Melanócitos/patologia , Pigmentação , Neoplasias Cutâneas/diagnóstico , Lobo TemporalRESUMO
We present a case of a penile lesion with a clinical appearance similar to Mondor penile disease (thrombosis of the dorsal vein of the penis) or penile sclerosing lymphangitis. Laboratory evaluation, however, showed a solid lesion, with no vascular component to Doppler ultrasonography and no treponema to immunohistochemistry. Histological and serological tests were compatible with secondary syphilis. The authors reinforce the need for the inclusion of syphilis in the differential diagnosis of penile cord injuries.
Assuntos
Doenças do Pênis/diagnóstico , Sífilis/diagnóstico , Adulto , Diagnóstico Diferencial , Humanos , Masculino , Doenças do Pênis/patologia , Sífilis/patologia , Ultrassonografia DopplerRESUMO
Abstract: Crusted scabies is a less common variant of scabies that is highly contagious, difficult to treat and involves infestation by Sarcoptes scabiei var. hominis. The classical clinical presentation includes crusted, scaly and generally non-pruritic lesions usually located on the head, neck, palmar, plantar and periungual region. It was first described in Norway in 1848 in patients with leprosy who presented with crusted lesions. In this study, we report the case of a patient with crusted scabies with florid clinical manifestations and chronic liver disease due to hepatitis B and delta virus infection.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Escabiose/patologia , Escabiose/tratamento farmacológico , Vírus Delta da Hepatite , Vírus da Hepatite B , Doença Hepática Terminal/virologia , Escabiose/imunologia , Resultado do Tratamento , Doença Hepática Terminal/complicações , Antiparasitários/uso terapêuticoRESUMO
Abstract: We present a case of a penile lesion with a clinical appearance similar to Mondor penile disease (thrombosis of the dorsal vein of the penis) or penile sclerosing lymphangitis. Laboratory evaluation, however, showed a solid lesion, with no vascular component to Doppler ultrasonography and no treponema to immunohistochemistry. Histological and serological tests were compatible with secondary syphilis. The authors reinforce the need for the inclusion of syphilis in the differential diagnosis of penile cord injuries.
Assuntos
Humanos , Masculino , Adulto , Doenças do Pênis/diagnóstico , Sífilis/diagnóstico , Doenças do Pênis/patologia , Sífilis/patologia , Ultrassonografia Doppler , Diagnóstico DiferencialRESUMO
Abstract: A few cases of pigmented squamous cell carcinoma affecting the skin and the ocular and oral mucosa of the elderly have been described in the literature. The disease manifests itself as papular and nodular erythematous or pigmented lesions. The main clinical differential diagnoses are pigmented basal cell carcinoma and melanoma. Histopathological examination is characterized by proliferation of atypical squamous cells with formation of horn pearls permeated by dendritic melanocytes. For this reason, a careful diagnosis is necessary to rule out other tumors that show melanin pigment. Surgical removal is the indicated treatment and the prognosis is similar to the classical squamous cell carcinoma. We report a case of pigmented squamous cell carcinoma with diagnosis confirmed by histological and immunohistochemical examinations.
Assuntos
Humanos , Idoso , Neoplasias Cutâneas/patologia , Carcinoma de Células Escamosas/patologia , Neoplasias Cutâneas/diagnóstico , Lobo Temporal , Pigmentação , Imuno-Histoquímica , Carcinoma de Células Escamosas/diagnóstico , Diagnóstico Diferencial , Melanócitos/patologiaRESUMO
Psoriasis is a chronic inflammatory disease of multifactorial etiology influenced by genetic, immunological, and environmental factors. We report the case of a patient with psoriasis for more than 25 years who developed hyperuricemia and chronic tophaceous gout with unusual appearance. In psoriasis, hyperuricemia may occur by increased epidermal cell turnover, which accelerates purine metabolism and has uric acid as the product of its catabolism. The association of psoriasis with hyperuricemia can trigger the onset of gouty arthritis, and pose a greater risk of developing other inflammatory comorbidities. Therefore, it is important to periodically investigate uric acid levels in order to treat changes triggered by hyperuricemia.
Assuntos
Gota/etiologia , Hiperuricemia/etiologia , Psoríase/complicações , Doença Crônica , Gota/patologia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Abstract: Psoriasis is a chronic inflammatory disease of multifactorial etiology influenced by genetic, immunological, and environmental factors. We report the case of a patient with psoriasis for more than 25 years who developed hyperuricemia and chronic tophaceous gout with unusual appearance. In psoriasis, hyperuricemia may occur by increased epidermal cell turnover, which accelerates purine metabolism and has uric acid as the product of its catabolism. The association of psoriasis with hyperuricemia can trigger the onset of gouty arthritis, and pose a greater risk of developing other inflammatory comorbidities. Therefore, it is important to periodically investigate uric acid levels in order to treat changes triggered by hyperuricemia.