Ana Clara Torre

Emerging systemic fungal infections

Systemic mycoses are a heterogeneous group of infections caused by different species of fungi that mainly affect individuals with primary or secondary alterations of immunity. In recent years, there has been an increase in the incidence of infections related to migration, AIDS, and other causes of immunosuppression, such as solid organ and bone marrow transplantation; oncological, hematological, and autoimmune diseases; and the use of new drugs. In this paper, we outline the microbiological and epidemiological characteristics of 3 fungi: Aspergillus spp, Fusarium spp, and Penicillium spp. We describe the clinical manifestations of disease with emphasis on those that should alert the dermatologist to make an early diagnosis. We detail the various tools for early diagnosis, prevention, and the epidemiology of different antifungals available for treatment and their mechanism of action and therapeutic efficacy.

Disseminated strongyloidiasis in immunocompromised patients – report of three cases

Background  Strongyloides stercoralis is an intestinal nematode of humans. The characteristic cutaneous manifestation of strongyloidiasis is larva currens. Patients with suppressed immunity can develop a severe disseminated strongyloidiasis involving wide spread of the larvae to extraintestinal organs, outside the usual migration pattern. Patients with cell‐mediated immunodeficiency and on corticosteroid therapy appear to be at highest risk for the development of this highly fatal entity.

Pyoderma gangrenosum: clinical characteristics, associated diseases, and responses to treatment in a retrospective cohort study of 31 patients

The aim of this study was to describe the clinical characteristics of patients with pyoderma gangrenosum (PG) and to evaluate the association between these characteristics, the treatment followed, and the patient responses, relapses, and mortality rates.

Dermoscopy aids the diagnosis of crusted scabies in an erythrodermic patient

the Department of Dermatology, Hospital Italiano de Buenos ires, and Skin Cancer Unit, Arcispedale Santa Maria Nuova tituto di Ricovero e Cura a Carattere Scientifico (IRCCS), ggio Emilia. ing sources: None. licts of interest: None declared. int requests: Luis Agust in Bollea Garlatti, MD, Department of ermatology, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Per on 4190, C1199ABD, Ciudad Aut onoma de Buenos Aires, Argentina. E-mail: agubollea@gmail.com. J Am Acad Dermatol 2015;73:e93-5. 0190-9622/

Secondary syphilis with pulmonary involvement.

36.00 a 2015 by the American Academy of Dermatology, Inc. http://dx.doi.org/10.1016/j.jaad.2015.04.061

Lingual ulceration associated with retinoic acid syndrome during treatment of acute promyelocytic leukemia

tension when compared to controls. Importantly, a recent Danish nationwide study showed that a diagnosis of skin cancer was associated with less myocardial infarction, hip fracture and allcause mortality. A lower blood pressure due to sunlight exposure as suggested by our results could contribute to reduced risk of myocardial infarction and improved life expectancy in patients with skin cancer. Our study had limitations, e.g. we used skin cancer as a surrogate for sunlight exposure. However, a recent study showed that a high baseline VD3 status was a significant predictor of skin cancer but not of other cancers, compatible with VD3 being a surrogate for sustained high UVr exposure. While we attempted to adjust for socio-economic factors and smoking, residual unmeasured confounding factors (e.g., obesity) cannot be ruled out. We submit that our results and other emerging evidence on potentially favourable cardiovascular effects of sunlight should be carefully considered in future health policies, balancing the risks and benefits of sunlight exposure.

Bullous pyoderma gangrenosum as a predictor of hematological malignancies

All‐trans retinoic acid (ATRA) is routinely associated with chemotherapy for the treatment of acute promyelocytic leukemia (APL). Several reports of scrotal ulceration induced by this agent have been made in the recent years.

Invasive Trichosporosis due to primary cutaneous infection.

Pyoderma gangrenosum may precede, coexist or follow diverse systemic diseases. The bullous variety is usually associated with hematologic disorders. From 31 patients with pyoderma gangrenosum diagnosed in our hospital during 10 years, only 2 presented with the bullous type. One patient had previous diagnosis of chronic myeloid leukemia. Both had fast-progressive, painful lesions, and both showed an excellent response to systemic corticosteroids. In less than 3 months the lesions recurred simultaneously with the progression of chronic myeloid leukemia in one patient and with the initial diagnosis of acute myeloid leukemia in the other one. They died in less than four weeks. These findings emphasize the importance of its timely diagnosis. Cutaneous lesions could be the first predictor of an underlying disease.Pyoderma gangrenosum may precede, coexist or follow diverse systemic diseases. The bullous variety is usually associated with hematologic disorders. From 31 patients with pyoderma gangrenosum diagnosed in our hospital during 10 years, only 2 presented with the bullous type. One patient had previous diagnosis of chronic myeloid leukemia. Both had fast-progressive, painful lesions, and both showed an excellent response to systemic corticosteroids. In less than 3 months the lesions recurred simultaneously with the progression of chronic myeloid leukemia in one patient and with the initial diagnosis of acute myeloid leukemia in the other one. They died in less than four weeks. These findings emphasize the importance of its timely diagnosis. Cutaneous lesions could be the first predictor of an underlying disease.

Reactivation of Chagas-Mazza disease during treatment with infliximab

1 Kirtschig G, Becker K, G€ unthert A et al. Evidence-based(S3) Guideline on (anogenital) Lichen sclerosus. J Eur Acad Dermatol Venereol 2015; 29: e1–e43. 2 Bunker CB, Shim TN. Male genital lichen sclerosus. Indian J Dermatol 2015; 60: 111–117. 3 Meuli M, Briner J, Hanimann B, Sacher P. Lichen sclerosus et atrophicus causing phimosis in boys: a prospective study with 5-year follow-up after complete circumcision. J Urol 1994; 152: 987–989. 4 Bunker CBB. Letter to the Editor to “EDF Lichen Sclerosus Guideline”. J Eur Adac Dermatol. [Accepted article for publication].

Características clínicas y evolutivas de una población con herpes zoster diseminado: un estudio de cohorte retrospectiva

Dear Editor, Chagas-Mazza disease is a zoonosis caused by Trypanosoma cruzi, a species of parasitic euglenoid protozoan. It affects 21 countries in the Americas, where 7 to 10 million people are infected, 8 out of 100,000 individuals/year, and it has a mortality rate of 12,000 individuals/year. The main routes of transmission are exposure to vectors (Triatoma infestans), transfusion (second in frequency), placental and oral transmission. Given increasing migration and organ and blood product donations, this disease has become global, affecting Europe and North America. 1 Chagas disease presents three well -defined clinical phases. The acute phase develops after an incubation phase that lasts from 4 to 10 days. The acute stage can be asymptomatic or present with fever, macular or inflammatory lesions in the inoculation site (chagoma), edema, palpebral unilateral induration (Romaña’s sign) or myocarditis. Of all infected people, only 1 to 2 % is diagnosed during this phase. The indeterminate chronic phase is characterized by the absence of symptoms and by standard laboratory test findings. Thirty percent of patients can remain in this phase during their entire life, while the remaining 70% evolve into the chronic or symptomatic phase, with heart or esophagus involvement. Reactivation may occur in immunosuppressed patients, especially in those patients that present an alteration of cell mediated immunity. It can be asymptomatic or manifest with neurologic, cardiac or cutaneous changes.2 PCR technique amplifies in vivo fragments of the parasite’s DNA. In immunosuppressed patients, PCR test is useful for the diagnosis and control of the disease, given the fact that ELISA serology can be negative in some patients. It also allows to make early diag-