Clinical characteristics and outcomes of people living with HIV and ocular syphilis during the COVID-19 health emergency.

BACKGROUND: The global shift in healthcare during the COVID-19 pandemic led to challenges in the care of people living with HIV. METHODS: We conducted a retrospective study that aimed to delineate sociodemographic, clinical characteristics and outcomes, of people living with HIV diagnosed with ocular syphilis. RESULTS: Fifty-three people living with HIV were identified with ocular syphilis. Thirty-eight (71.6%) presented ocular symptoms. Twenty-three (43.3%) underwent lumbar puncture, 5 (9.4%) were positive for neurosyphilis. Forty-seven (88.6%) received treatment, 32 (68%) received standard treatment with aqueous crystalline penicillin G, and 15 (31.9%) were treated with alternative regimens due to the impossibility of hospitalization. Six (11.3%) individuals were lost to follow-up and/or did not receive treatment. Eighteen (56.2%) out of 32 individuals in the aqueous crystalline penicillin G group experienced serological response, 5 (15.6%) experienced treatment failure, and 9 (28.1%) were lost to follow-up. In the alternative therapy group, 12 out of 15 individuals (80%) experienced serological response. One (6.7%) experienced treatment failure, and 2 (13.3%) were lost to follow-up. CONCLUSIONS: During the COVID-19 health emergency in Mexico, alternative treatments for ocular syphilis demonstrated favorable clinical outcomes amid challenges in accessing hospitalization.

"Blueberry muffin": Manifestación atípica de una infección congénita frecuente / Blueberry muffin baby: an atypical manifestation of a common congenital infection

El síndrome "blueberry muffin" es una dermatosis maculopapular eritematoviolácea como resultado de una hematopoyesis extramedular. Se ha asociado con infecciones del espectro TORCH y causas no infecciosas. Presentamos el caso de un recién nacido pretérmino, quien desde el control prenatal presentó una ecografía con signos sugerentes de infección congénita por citomegalovirus (microcefalia, ventriculomegalia y calcificaciones intracerebrales). Al examen físico presentaba una dermatosis macular violácea compatible con síndrome "blueberry muffin". Se detectó carga viral de citomegalovirus en orina (81,200 copias/ml) e inició tratamiento con ganciclovir, con desenlace fatal. La infección congénita por CMV debe considerarse ante el síndrome "blueberry muffin"; el adecuado abordaje diagnóstico debe ser oportuno y debe incluir antecedentes maternos y perinatales, así como estudios serológicos para infecciones por TORCH con el fin del inicio precoz de tratamiento para evitar complicaciones y secuelas.

Blueberry muffin syndrome is characterized by an erythematousviolaceous maculopapular dermatosis due to extramedullary hematopoiesis. This entity has been associated with TORCH spectrum infections and noninfectious causes. We present the case of a preterm newborn, who since the prenatal control gave an ultrasound with data suggestive of congenital infection by cytomegalovirus (microcephaly, ventriculomegaly, intracerebral calcifications). On physical examination, he presented a violaceous macular dermatosis compatible with blueberry muffin syndrome. Cytomegalovirus viral load was detected in urine (81,200 copies/ml), with fatal outcome. Congenital cytomegalovirus infection should be considered in the presence of a blueberry muffin syndrome; an adequate diagnostic approach that includes maternal and perinatal history is essential, as well as serology studies for diseases of the TORCH spectrum in order to start early with treatment and avoid major comorbidities.