Gerson Vettorato

Neutrophilic dermatosis of the dorsal of the hands: Acral sweet syndrome?

A 47-year-old white man, with antecedents of alcoholism and diabetes mellitus, complained of pain and edema on his left knee. Seven days later vesicobullous lesions appeared over the erythematous base on the hands and right leg. Papular and purpuric lesions were also found on the dorsal of the patient’s hands. Aspiration of joint fluid on the left knee was performed. The complete blood count revealed the following results: hemoglobin 7.5 g/dl; hematocrit 22.4%; leukocytes 19,730/ mm 3 with 68% neutrophils; hepatitis B and C serology were negative; and three blood and two joint fluid cultures in aerobic and anaerobic media gave negative results. Neoplasia and autoimmune diseases were ruled out. Five days later, cutaneous lesions were localized predominantly on the dorsal of the hands (Figs 1 and 2). Dermatohistopathology revealed epidermis with acanthosis, intraepidermal and subcorneal microabscesses; areas of diffuse infiltrate of mature neutrophils in the dermis with leukocytoclastic vasculitis, and hemorrhage, mainly in the subepidermal area (Fig. 3). During 1 month the patient did not present any systemic manifestations, and the skin lesions underwent spontaneous regression.

A case of Exophiala spinifera infection in Southern Brazil: Molecular identification and antifungal susceptibility

We report a case of an 80-year-old Brazilian man, farmer, with lesions on the dorsum of the hand. A direct mycological examination, cultivation and microculture slide observation was performed. The sequencing of ITS1-5.8S rDNA-ITS2 region was carried out and the etiological agent confirmed as Exophiala spinifera. The in vitro susceptibility of this isolate to antifungal agents alone and in combination was evaluated. This is the third case of phaeohyphomycosis caused by Exophiala spinifera in Brazil.

Ecthyma‐like phaeohyphomycosis caused by Cladosporium cladosporioides

A case of cutaneous phaeohyphomycosis caused by Cladosporium cladosporioides in a 50‐year‐old housewife is described. The clinical presentation was an ecthyma‐like crusted lesion on the back of her left hand. Scanning electron microscopy of the culture showed the conidiophores and the limoniform or ellipsoidal conidia, with a slightly verrucous surface. The lesion was removed surgically, with no relapses after 6‐month follow up.

Feo-hifomicose causada por Veronaea bothryosa: relato de dois casos

Phaeohyphomycosis caused by Veronaea bothryosa is very rare. We report two cases. To our knowledge, these are the first and second cases to be reported on the American continent, and fourth and fifth cases in the world literature. We report one case in a kidney transplant recipient, and another case in an immunosuppressed non-transplant patient. Both patients presented with a lesion on the dorsal aspect of the foot, following trauma. One patient responded moderately well to treatment with itraconazole. The other responded well to a surgical excision.

Paracoccidioidomicose da região ocular: relato de dois casos e revisão da literatura

Paracoccidioidomycosis is an endemic disease in Brazil that commonly affects multiple organs, although ocular involvement is rare. The ocular form of this disease affects predominantly the eyelids and conjunctiva, highlighting the importance for dermatologists to consider this disease in the differential diagnosis for lesions within the orbital area. Even with localized forms of the disease, a complete systemic examination should be done bearing in mind that the exclusive ocular form of paracoccidioidomycosis can frequently hide a multi-systemic disease. We describe two cases of the ocular form of paracoccidioidomycosis with a revision of 55 cases described in the literature.

Freqüência de dermatoses infecciosas em 208 pacientes transplantados renais

BACKGROUND: Chronic immunosuppressive therapy predisposes renal transplant recipients to a heightened susceptibility to infectious dermatoses. OBJECTIVES: evaluate the frequency of infectious dermatoses in 208 renal transplant recipients over a 12-month period and verify the relation between the onset of dermatoses and the time elapsed since transplantation. METHOD: 208 renal transplant recipients, taken from a population of 720 transplant recipients, received a dermatological examination for a year. Dermatopathological examination, mycological examination, bacteriologic examination, and cultures were taken from suspected lesions. RESULTS: the prevalence of infectious dermatosis was 89.4% in this population. The more frequent fungal, viral and bacterial infections were respectively pitiyriasis versicolor (17.8%), warts (32.2%), and folliculitis (4.3%). CONCLUSION: infectious dermatoses are common in renal transplant recipients. Their occurrence is progressively higher as time passes after the transplantation, therefore making the frequent dermatological examination of these recipients very important.

Doença de Cowden ou síndrome dos hamartomas múltiplos

A case of Cowdens disease or Multiple Hamartoma Syndrome is reported. The disorder is inherited as an autosomal dominant trait, the classic dermatological features of which are multiple facial trichilemmomas (hamartomas of the follicular infundibula), oral fibroma and benign acral keratosis. Multiple organs are affected and it is associated with mama, thyroid and colon malignant neoplasms. We present a young woman with skin-colored flat-topped papules in the central facial area, papular gingival and palatal lesions, fissured tongue, palmoplantar keratoses and prior history of subtotal thyroidectomy.

Concordance between direct microscopy and fungical culture for the diagnostic of feet's onychomycosis

Prospective study compared the agreement between the direct microscopy and fungical culture from subungueal samples of the patients with clinical suspicion of feets onychomycosis. The agreement occurred in 56.1% of the exams with dermatophytes, in 52.4% by others fungi and in 90.4% of the negative cases, 0,54 according to the Kappa`s test. In 39.3% of the onychomycosis caused by dermatophytes and 31.8% by nondermatophytes, these were identificated only for direct microscopy. The direct microscopic showed more sensibility compared with the culture, being superior in 19.5% of the total sample and maintaining agreement with the culture in 71.5% of the sample.

Síndrome de Netherton com 20 anos de acompanhamento

Nethertons syndrome is a recessive autosomal skin disease, characterized by congenital erythroderma, hair anomalies such as trichorrhexis invaginata, and atopic manifestations. The case of a female patient with a 20-year follow-up is described, with an important improvement of hair alterations after use of oral acitretine.

Genetic diversity and antifungal susceptibility of Fusarium isolates in onychomycosis

Fusarium species have emerged as an important human pathogen in skin disease, onychomycosis, keratitis and invasive disease. Onychomycosis caused by Fusarium spp. The infection has been increasingly described in the immunocompetent and immunosuppressed hosts. Considering onychomycosis is a difficult to treat infection, and little is known about the genetic variability and susceptibility pattern of Fusarium spp., further studies are necessary to understand the pathogenesis and better to define the appropriate antifungal treatment for this infection. Accordingly, the objective of this study was to describe the in vitro susceptibility to different antifungal agents and the genetic diversity of 35 Fusarium isolated from patients with onychomycosis. Fusarium spp. were isolated predominantly from female Caucasians, and the most frequent anatomical location was the nail of the hallux. Results revealed that 25 (71.4%) of isolates belonged to the Fusarium solani species complex, followed by 10 (28.5%) isolates from the Fusarium oxysporum species complex. Noteworthy, the authors report the first case of Neocosmospora rubicola isolated from a patient with onychomycosis. Amphotericin B was the most effective antifungal agent against the majority of isolates (60%, MIC ≤4 μg/mL), followed by voriconazole (34.2%, MIC ≤4 μg/mL). In general, Fusarium species presented MIC values >64 μg/mL for fluconazole, itraconazole and terbinafine. Accurate pathogen identification, characterisation and susceptibility testing provide a better understanding of pathogenesis of Fusarium in onychomycosis.