Detection of mercury and other undetermined materials in skin biopsies of endemic pemphigus foliaceus.

A novel variant of endemic pemphigus foliaceus (EPF) was described among individuals in an area surrounding El Bagre, Colombia, South America. The population in this rural mining community is exposed to high environmental levels of mercury, used for gold extraction, as well as other minerals, metalloids, and trace elements (e.g., quartz, rutile, granite, magnetite, and almenite) and ultraviolet radiation. Fifty control subjects and fifty EPF patients in the endemic area were examined for the presence of mercury in skin biopsies and hair, using autometallographic and mass spectroscopic analyses, respectively. Simultaneously, serum levels of IgE were measured, and cutaneous tests for hypersensitivity reactions were performed. Using autometallography, mercuric sulfides/selenides were detected in 14 of 51 skin biopsies distributed similarly in the control and patient groups. However, significantly higher serum IgE levels and mercury concentrations in hair, urine, and nails were found in patients compared with controls. Microscopic analysis revealed mercuric sulfides/selenides concentrated within and around the sweat gland epithelium, as well as in dendritic cells. Five skin biopsies from EPF patients and five from controls that tested positive for the presence of mercuric sulfides/selenides by autometallography were randomly selected for electron microscopic analysis. This analysis revealed a mixed electron-dense and electron-light material closely associated with desmosomes in patients. However, there were intracellular vesicles containing an amalgam of electron-dense and electron-light materials only in the EPF patients. Thus, EPF-affected individuals are exposed to high levels of environmental mercuric sulfides/selenides and other elements. This is the first study reporting mercuric sulfides/selenides in skin biopsies from people living in a focus of EPF, and these compounds may play a role in the pathogenesis of autoimmunity.

Enfermedad de Lyme: Un caso comprobado en Colombia / Lyme disease: A proven case in Colombia

La enfermedad de Lyme es un desorden inflamatorio multisistémico, producido por una espiroqueta, Borrelia Burgdorferi (B.b) la cual es transmitida el hombre por la picadura de una garrapata. Fue descrita inicialmente por Steere y colaboradores en 1975 – 1977 en un grupo de niños con artritis epidémica en Lyme, Connecticut. El agente infeccioso responsable fue identificado cuando Burgdorfer aisló y cultivo la espiroqueta Borrelia burgdorferi en 1982; desde entonces, múltiples casos han sido reportados en Estados Unidos y muchos países de Europa, África y Australia en Latinoamérica, algunos casos aislados han sido reportados de Brasil. Nosotros describimos el primer caso de enfermedad de Lyme diagnosticado en Colombia, el cual se presentó con el marcador cutáneo de esta enfermedad, el eritema migratorio crónico y una prueba serológica especifica positiva.