Ana Afonso

Alternariosis cutánea en receptor de trasplante hepático

Resumen Se presenta un enfermo trasplantado de higado, con alternariosis cutanea por Alternaria infectoria. Las lesiones cutaneas han regresado con la disminucion de las dosis diarias de imunosupresores y permanecen cicatriciales despues de un ano de seguimiento.

Phaeohyphomycosis Caused by Alternaria Infectoria Presenting as Multiple Vegetating Lesions in a Renal Transplant Patient

The genus Alternaria is one of the most common black moulds and appears to be increasing as a causative agent of subcutaneous phaeohyphomycosis, particularly among immunosuppressed patients. A 53-year-old patient who had received a kidney transplant presented with multiple verrucous lesions on the distal extremities. Positive histopathology and cultures, in addition to rDNA ITS region sequencing, identified the fungal isolate as Alternaria infectoria. Oral itraconazole was administered for 10 months. A follow-up at 15 months demonstrated no signs of infection. Clinical manifestations of cutaneous alternariosis vary significantly and only a few cases have been described in the literature. Although optimal treatment options remain controversial, this case of phaeohyphomycosis was successfully treated with itraconazole monotherapy.

Drug-induced Sweet’s syndrome by aceclofenac

Sweet’s syndrome (SS) or acute febrile neutrophilic dermatosis is a reactive process that presents in different clinical settings and ranges from classical (idiopathic), malignancy associated or drug induced. The authors describe a 51-year-old Caucasian woman referred to our department with a 3-day history of pseudovesicular reddish papules on her neck, upper trunk and limbs. Two days prior to the eruption, aceclofenac 100 mg every 8 h was initiated for lower back pain. She also complained of high fever (39°C), arthralgias and general malaise. Laboratory evaluation showed an elevation of erythrocyte sedimentation rate and C reactive protein. A biopsy specimen of skin lesions showed throughout the upper reticular dermis a dense infiltrate of mature neutrophils. Aceclofenac was discontinued and oral prednisolone (0.5 mg/kg) was started. Fever resolved within 48 h, whereas cutaneous lesions cleared within the first week. No relapse was noted after a 6-month follow-up period. Drug-induced SS by aceclofenac diagnosis was sustained by the presence of all the five diagnostic criteria for drug-induced SS presented by Walker and Cohen in 1996. Several hundred cases of SS have been reported in the literature. However, drug-induced SS represent overall less than 5% of all cases, mostly as isolated clinical cases. Reports of nonsteroidal anti-inflammatory drug-induced SS include diclofenac, celecoxib and rofecoxib. Our patient represents the first case of aceclofenac-induced SS and illustrates the need to enquire about recent drugs in a patient with suspicion of SS.

Leprosy and Kaposi sarcoma presenting as an immune reconstitution inflammatory syndrome in a patient with AIDS

The simultaneous presence of infectious organisms within cutaneous lesions of Kaposi sarcoma in persons with AIDS has been demonstrated. We describe a patient with concurrent leprosy and Kaposi sarcoma presenting as an immune reconstitution inflammatory syndrome in the setting of AIDS.

Rituximab in pemphigus foliaceous with autoantibodies against both Desmoglein 1 and Desmoglein 3

ejd.2011.1288 Auteur(s) : Rodrigo CARVALHO1 rodrigoaraujocarvalho@gmail.com, Paula MAIO1, Daniela CUNHA1, Isabel FREITAS1, Ana AFONSO2, Jorge CARDOSO1 1 Department of Dermatology and Venereology, Curry Cabral Hospital, Lisbon, Portugal 2 Department of Pathology, Curry Cabral Hospital, Lisbon, Portugal Reprints.: R. CARVALHO Pemphigus foliaceous (PF) is generally a benign autoimmune blistering disease, but in some patients lesions are severe with serious implications in life quality. We report a [...]

Intertriginous pattern of toxic erythema of chemotherapy

Chemotherapeutic agents may induce both local and systemic cutaneous toxicity, and evaluation of these reactions in oncologic patients constitutes a real challenge. The authors describe a 78-year-old Caucasian woman, with a past medical history relevant for right radical mastectomy with axillary dissection because of stage 2 breast invasive ductal carcinoma (T2N3M0), referred to our department because of an intertriginous eruption in her groin. Two weeks before the eruption, a chemotherapy regime with cyclophosphamide, methotrexate, and 5-fluorouracil was performed. Examination revealed erythematous and dusky violaceous papules coalescing into edematous patches in the inguinal intertriginous area, including the internal surface of her thighs, groin, genital area, and intergluteal cleft. Skin cultures for bacteria and fungus were negative. Clinical and histological data were consistent with an intertriginous pattern of toxic erythema of chemotherapy (TEC). Oral prednisolone therapy (0.5 mg/kg) was started, tapered over a 1-week period, and along with general measures that included topical zinc oxide suspension, cutaneous lesions cleared completely within the first days. Although patient reassurance, she refused any kind of new chemotherapy infusions. Due to their high metabolic rate, the skin, mucous membranes, and annexes are one of the most important target organs of the toxicity associated with systemic chemotherapy. Several patterns of cutaneous eruptions to chemotherapy have been reported in the literature. Trying to resolve this issue, recently recommended was a new clinically descriptive term, TEC, in order to emphasize the overlapping features of these entities. Early recognition of this entity is critical, not just from a prognostic standpoint, but also to avoid unnecessary, potentially harmful therapeutic interventions.

NECROSE GORDA DO RECÉM-NASCIDO

A Necrose Gorda do Recem-nascido (NGRN) e uma paniculite rara, autolimitada, que surge em recemnascidos de termo, nas primeiras semanas de vida. A sua patogenese permanece desconhecida mas parece estar relacionada com situacoes de stress, que levam a hipoperfusao e cristalizacao do tecido adiposo, causando necrose e inflamacao granulomatosa. O caso clinico descrito representa uma NGRN apenas com envolvimento cutâneo. O provavel factor precipitante associado foi o parto por cesariana.

INFEÇÃO CUTÂNEA E PULMONAR POR MYCOBACTERIUM AFRICANUM

A tuberculose cutânea e uma doenca incomum, constituindo 1,5% de todas as formas de tuberculose. Na doenca pulmonar e cutânea, as infecoes causadas por Mycobacterium africanum e Mycobacterium tuberculosis podem ser clinicamente indistinguiveis. Um rapaz de 6 anos da Guine-Bissau foi hospitalizado devido a uma ulcera pre-auricular direita com evolucao de dois anos e linfadenopatia regional. O teste tuberculinico foi positivo e a radiografia de torax revelou um nodulo hipotransparente no lobo pulmonar direito, com caracteristicas solidas na TAC. As biopsias da ulcera e da linfadenopatia revelaram infiltrado linfocitico com reacao granulomatosa; o exame cultural e a PCR confirmaram infecao por Mycobacterium africanum. Foi realizado tratamento antibacilar durante 6 meses, com reducao significativa da lesao. Nos paises desenvolvidos e importante relembrar as varias formas de tuberculose cutânea, que se pode apresentar isoladamente ou em associacao com outras formas de infecao. Nos doentes provenientes de areas endemicas, um teste tuberculinico positivo deve levantar a suspeita desta entidade. PALAVRAS-CHAVE – Tuberculose cutânea; Tuberculose pulmonar; Mycobacterium africanum; Crianca.

Non Hodgkin T cell lymphoma: an atypical clinical presentation

Cytotoxic lymphomas comprise a spectrum of peripheral T-cell lymphomas that can have a initial or late cutaneous presentation. We describe a 46-year-old man from Cape Verde, with a dermatosis involving his face and trunk, consisting of monomorphic papules with a smooth surface and both motor and sensory polyneuropathy.The hypothesis of leprosy was supported by the clinical and initial hystopathological findings and the patient was referred to our hospital with suspected Hansens disease. In the new skin and lymph node biopsies a lymphocyte population was identified whose immunohystochemistry study allowed the diagnosis of T-cell lymphoma with expression of cytotoxic markers. The patient was started on chemotherapy with initial remission of the skin lesions but, subsequently, progression of systemic disease.

SARCOMAS CUTÂNEOS – DO DIAGNÓSTICO AO TRATAMENTO

The clinical diagnosis of cutaneous sarcomas is not an easy task, mainly due to their complex and hetero- geneous nature. Differential diagnosis may be difficult because there is substantial overlap of clinical features between a sarcoma that develop in superficial tissues (skin and subcutaneous tissue) and benign neoplasm and inflammatory dermatoses. Although not frequent, some types of cutaneous sarcomas have great importance, as they can be associa- ted with recurrence, aggressive local growth or metastasis, and can present high morbi-mortality rates. The authors report five clinical-pathological cases of cutaneous sarcomas – Kaposi’s sarcoma, dermatofibrosarcoma protuberans, atypical fibroxanthoma, leiomyosarcoma and angiosarcoma. A review of the relevant literature about cutaneous sarcomas with particular interest to dermatologists is presented, and we highlight some important clinical, laboratorial, histological and therapeutic findings. KEYWORDS – Skin neoplasms; Sarcoma; Sarcoma, Kaposi; Dermatofibrosarcoma; Histiocytoma, benign fibrous; Leio- myosarcoma; Hemangiosarcomal liposarcoma; Nerve sheath neoplasms.