Ana Isabel Gouveia

Bullous hemorrhagic dermatosis induced by enoxaparin

Abstract The bullous hemorrhagic dermatosis induced by enoxaparin is a rare adverse reaction, which may be under-reported given its favorable evolution. We report a 71-year-old man who developed hemorrhagic bullae at sites distant from subcutaneous enoxaparin injections. It is important that clinicians be aware of the different adverse reactions of these widely used drugs.

Porokeratosis and malignant melanoma: A causal or incidental association?

Indian Dermatology Online Journal November-December 2015 Volume 6 Issue 6 451 10. Smoller BR, Bortz J. Immunophenotypic analysis suggests that granuloma faciale is a gamma‐interferon‐mediated process. J Cutan Pathol 1993;20:442‐6. 11. Teixeira DA, Estrozi B, Ianhez M. Granuloma faciale: A rare disease from a dermoscopy perspective. An Bras Dermatol 2013;88(Suppl 1):97‐100. 12. Gupta L, Naik H, Kumar NM, Kar HK. Granuloma faciale with extrafacial involvement and response to tacrolimus. J Cutan Aesthet Surg 2012;5:150‐2. 13. Ludwig E, Allam JP, Bieber T, Novak N. New treatment modalities for granuloma faciale. Br J Dermatol 2003;149:634‐7.

Nasal ala reconstruction: Surgical conundrum

Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Herpes simplex virus and cytomegalovirus co-infection presenting as exuberant genital ulcer in a woman infected with human immunodeficiency virus

In patients infected with human immunodeficiency virus (HIV), genital herpes can result in severe and atypical clinical presentations, and can become resistant to aciclovir treatment. Rarely, these manifestations may represent concurrent herpes simplex virus (HSV) with other agents. We report a 41‐year‐old black woman with HIV who presented with extensive and painful ulceration of the genitalia. Histological examination of a biopsy sample was suggestive of herpetic infection, and intravenous aciclovir was started, but produced only partial improvement. PCR was performed on the biopsy sample, and both HSV and cytomegalovirus (CMV) DNA was detected. Oral valganciclovir was started with therapeutic success. CMV infection is common in patients infected with HIV, but its presence in mucocutaneous lesions is rarely reported. This case exemplifies the difficulties of diagnosis of genital ulcers in patients infected with HIV. The presence of exuberant and persistent HSV genital ulcers in patients with HIV should also raise suspicions of the presence of co‐infection with other organisms such as CMV.

Infiltrados Linfocitários Cutâneos Simuladores de Linfoma

Os pseudolinfomas cutâneos englobam um grupo heterogeneo de entidades clinico-patologicas que tem em comum o facto de simularem clinica ou histologicamente linfomas cutâneos primarios. O seu diagnostico e dificil pois nao existem criterios precisos que diferenciem os infiltrados linfocitarios reactivos dos infiltrados linfocitarios neoplasicos. Os pseudolinfomas podem ser classificados de acordo com a predominância de linfocitos do tipo B versus T, ou agrupados segundo o tipo de linfoma cutâneo que mimetizam. O objectivo deste trabalho e discutir as pistas diagnosticas (histologicas e/ou clinicas) mais importantes na separacao entre as varias entidades simuladoras de linfoma e os linfomas cutâneos que estas mimetizam.

Púrpura de Henoch-Schönlein (Vasculite por IgA) no Adulto

Henoch-Schonlein purpura is a small vessel vasculitis mediated by the deposition of IgA immune complexes. It is characterized by palpable purpura, arthralgia / arthritis, abdominal and renal involvement. Its etiology remains unknown, but various stimuli have been proposed to trigger this pathology, namely infectious agents, drugs and tumor antigens. There is also a possible association with malignancy and auto-immune diseases. Henoch-Schonlein purpura occurs mostly in children and is rare in adults. In the pediatric population the disease is generally self-limited, whereas in adults it is associated with a worse prognosis and a greater number of complications. This article reviews the main aspects of adult Henoch-Schonlein purpura, highlighting its particularities and specificities.

ÉSTERES DE ÁCIDO FUMÁRICO - UMA OPÇÃO TERAPÊUTICA NA PSORÍASE EM PLACAS

Os esteres de acido fumarico estao licenciados para o tratamento sistemico da psoriase, na Alemanha, desde 1994. Estes derivados do fumarato constituem uma terapeutica eficaz, segura e economica quando comparada com outras terapeuticas sistemicas utilizadas no tratamento da psoriase moderada a grave. Considera-se que este farmaco tem um grande potencial, nao so para o tratamento da psoriase em placas, como tambem para outras doencas dermatologicas menos frequentes. Este artigo tem como objetivo efetuar uma revisao sobre mecanismos de accao, indicacoes e contra-indicacoes para esta terapeutica.

INFECÇÃO CUTÂNEA POR SCEDOSPORIUM APIOSPERMUM NUM DOENTE IMUNOCOMPROMETIDO TRATADO EFICAZMENTE COM VORICONAZOL

During the last decades, the incidence of opportunistic fungal infections has been increasing, namely in the context of immunosuppression. The Scedosporium apiospermum is a ubiquitous filamentous fungus in soil, decaying vegetation, sewers and polluted waters. Can cause infections in immunocompetent patients after trauma and severe and potentially fatal infections in immunocompromised patients. The authors describe a case of an infection by S. apiospermum on the dorsum of the left foot of a patient under prolonged systemic corticosteroid therapy combined with methotrexate due to the diagnosis of giant cell arteritis. Treatment of these infections can be a challenge due to the inherent resistance to many of the available systemic antifungal agents, including amphotericin B. In the case described, therapy with voriconazole was performed, with complete resolution of the lesions.

ELASTÓLISE DA DERME PAPILAR SEMELHANTE A PSEUDOXANTOMA ELÁSTICO - UMA ENTIDADE SUBDIAGNOSTICADA

A elastolise da derme papilar semelhante a pseudoxantoma elastico (EDP-PXE) e uma entidade clinico- -patologica adquirida, de etiologia desconhecida, caracterizada por ausencia parcial ou total de fibras elasticas na derme superficial. Reportamos o caso clinico de uma doente caucasiana de 62 anos, fototipo III, com uma dermatose localizada nas regioes posterior e laterais do pescoco caracterizada por multiplas papulas amareladas, monomorficas, arredondadas, com 2-3mm de diâmetro, assintomaticas, presentes desde ha cerca de 2 anos. O exame histopatologico, com a coloracao de orceina, revelou ausencia quase total de fibras elasticas na derme superficial, compativel com o diagnostico de EDP-PXE. Consideramos que esta entidade, exclusivamente cutânea, esta sub-diagnosticada por se tratar de uma patologia assintomatica, cujo diagnostico histopatologico esta dificultado, na ausencia de corretas hipoteses de diagnostico.

SÍFILIS NA GRAVIDEZ

Syphilis is a systemic infectious disease with particular importance in pregnant women due to placental transmission to the fetus. Untreated syphilis during pregnancy can lead to serious consequences and long-term sequelae. Congenital syphilis remains a serious public health problem in many developing countries where prenatal screening and treatment programs are not effective. The number of cases of congenital syphilis is still high in Portugal compared with other European countries, which means that this infection is also common in adults. The consequences of this infection in pregnancy can be prevented by early universal prenatal screening and treatment, therefore efforts should be made towards improving care and access to prenatal care.