Gerzaín Rodríguez

The asteroid body of lobomycosis

Obomycosis is a dermal mycosis produced by Loboa loboi. It gives rise to dermal granulomas in which giant cells phagocytose an overwhelming number of fungi. Intracytoplasmatic asteroid bodies (AB) have been observed in some giant cells. Their nature is unknown and they have been confused with the sporotrichotic AB. We studied 84 skin biopsies from 53 patients with lobomycosis, 7 by electron microscopy (EM). Immunohistochemistry with a polyclonal anti-Sporothrix schenckii antibody was performed in five biopsies. We found AB in the giant cells in 22 of the 84 biopsies on HE staining. They appeared as single eosinophilic intracytoplasmic structures surrounded by a clear empty space. This clear space did not appear when the biopsy was fixed with OsO4, thus indicating that it is lipid in nature, and that the vacuole is an artefact produced by lipid extraction. Under the EM, the AB consist of bundles of dense, filamentous material, dense bodies and myelin structures resembling the image of AB in sarcoidosis. Some giant cells containing AB either phagocytosed only few fungi or did not contain any of them. The AB and the fungi did not react with the anti-sporotrichotic antibody, which stained the extracellular AB of sporotrichosis. These two asteroid structures are, therefore, different and unrelated phenomena.

Búsqueda Activa de Lepra y de Otras Enfermedades de la Piel en Escolares de Agua de Dios, Colombia

Objetivo Buscar lepra, otras enfermedades de la piel y la cicatriz BCG, en escolares de Agua de Dios, municipio con la mas alta prevalencia de lepra en Colombia: 23-39/10 000; educar y difundir los resultados en la comunidad. Metodos Se hizo examen clinico de los ninos por enfermeras, medicos internos y generales y por expertos en lepra. Cuando la clinica lo indicaba, se practicaron baciloscopias y biopsias de piel. En pocos casos se buscaron anticuerpos en sangre contra el glicolipido fenolico 1, del bacilo de Hansen. Resultados Se examinaron 86 % de los 2 844 escolares de las 17 instituciones del municipio; 833 tuvieron patologias cutaneas, de los cuales 16 % requirieron el examen por expertos. Se demostraron cuatro casos nuevos de lepra paucibacilar, dos indeterminados y dos polineuriticos primarios. Las entidades mas frecuentes fueron: pediculosis, pitiriasis alba, pitiriasis versicolor, nevus hipocromicos, picaduras de insectos y miliaria. Cuatro ninos tuvieron maltrato infantil y una nina de 11 anos, micosis fungoides hipocromiante. La vacunacion BCG se aplico en 387 ninos que no la habian recibido. Se trataron las condiciones encontradas. Se informo a la comunidad sobre las enfermedades detectadas, las funciones de la piel y sus cuidados generales, enfatizando la importancia del diagnostico temprano de la lepra. Conclusiones La incidencia de lepra encontrada (16/10 000), es la mas alta en Colombia, 123 veces mayor que la global del pais. Su busqueda activa demostro enfermedad paucibacilar, sin discapacidades y otras enfermedades cutaneas importantes. Es recomendable persistir con este examen clinico y con la investigacion de los factores predisponentes para adquirir la enfermedad.OBJECTIVE Actively searching for leprosy, other skin diseases and BCG vaccination scars amongst school children from Agua de Dios, the municipality having the highest prevalence of leprosy in Colombia. METHODS A clinical examination of the children was carried out by nurses, interns, general practitioners and experts on leprosy. Skin smear tests and skin biopsies were performed when the clinical findings suggested leprosy. Anti-phenolic glycolipid antibodies in blood were determined in special cases. RESULTS 86 % of the 2 844 school children were examined; 833 had skin diseases and 16 % of these required evaluation by specialists. Four new cases of paucibacillary leprosy, two indeterminate and two primary polyneuritic cases were found. Pediculosis capitis, pityriasis alba, tinea versicolor, hypopigmented nevus, insect bites and miliaria were frequently detected. BCG vaccination scars were absent in 387 children; following several logistical problems, they were vaccinated. Four children had signs of childhood abuse. An 11-year-old girl presented hypopigmented mycosis fungoides. All diseases and conditions found were treated. The community received information regarding the results, emphasising the importance of an early diagnosis of leprosy. CONCLUSIONS The incidence of leprosy found (16/10,000) was 123 times higher than the rest of the countrys incidence. It is advisable to continue clinical examinations in Agua de Dios and research into risk factors for acquiring leprosy.

Active search for leprosy and other skin diseases in school children from Agua de Dios, Colombia

Objetivo Buscar lepra, otras enfermedades de la piel y la cicatriz BCG, en escolares de Agua de Dios, municipio con la mas alta prevalencia de lepra en Colombia: 23-39/10 000; educar y difundir los resultados en la comunidad. Metodos Se hizo examen clinico de los ninos por enfermeras, medicos internos y generales y por expertos en lepra. Cuando la clinica lo indicaba, se practicaron baciloscopias y biopsias de piel. En pocos casos se buscaron anticuerpos en sangre contra el glicolipido fenolico 1, del bacilo de Hansen. Resultados Se examinaron 86 % de los 2 844 escolares de las 17 instituciones del municipio; 833 tuvieron patologias cutaneas, de los cuales 16 % requirieron el examen por expertos. Se demostraron cuatro casos nuevos de lepra paucibacilar, dos indeterminados y dos polineuriticos primarios. Las entidades mas frecuentes fueron: pediculosis, pitiriasis alba, pitiriasis versicolor, nevus hipocromicos, picaduras de insectos y miliaria. Cuatro ninos tuvieron maltrato infantil y una nina de 11 anos, micosis fungoides hipocromiante. La vacunacion BCG se aplico en 387 ninos que no la habian recibido. Se trataron las condiciones encontradas. Se informo a la comunidad sobre las enfermedades detectadas, las funciones de la piel y sus cuidados generales, enfatizando la importancia del diagnostico temprano de la lepra. Conclusiones La incidencia de lepra encontrada (16/10 000), es la mas alta en Colombia, 123 veces mayor que la global del pais. Su busqueda activa demostro enfermedad paucibacilar, sin discapacidades y otras enfermedades cutaneas importantes. Es recomendable persistir con este examen clinico y con la investigacion de los factores predisponentes para adquirir la enfermedad.OBJECTIVE Actively searching for leprosy, other skin diseases and BCG vaccination scars amongst school children from Agua de Dios, the municipality having the highest prevalence of leprosy in Colombia. METHODS A clinical examination of the children was carried out by nurses, interns, general practitioners and experts on leprosy. Skin smear tests and skin biopsies were performed when the clinical findings suggested leprosy. Anti-phenolic glycolipid antibodies in blood were determined in special cases. RESULTS 86 % of the 2 844 school children were examined; 833 had skin diseases and 16 % of these required evaluation by specialists. Four new cases of paucibacillary leprosy, two indeterminate and two primary polyneuritic cases were found. Pediculosis capitis, pityriasis alba, tinea versicolor, hypopigmented nevus, insect bites and miliaria were frequently detected. BCG vaccination scars were absent in 387 children; following several logistical problems, they were vaccinated. Four children had signs of childhood abuse. An 11-year-old girl presented hypopigmented mycosis fungoides. All diseases and conditions found were treated. The community received information regarding the results, emphasising the importance of an early diagnosis of leprosy. CONCLUSIONS The incidence of leprosy found (16/10,000) was 123 times higher than the rest of the countrys incidence. It is advisable to continue clinical examinations in Agua de Dios and research into risk factors for acquiring leprosy.

Perineural and intraneural cutaneous granulomas in granulomatous mycosis fungoides mimicking tuberculoid leprosy.

Histological similarities between granulomas and granulomatous mycosis fungoides (GMF) may lead to misdiagnoses of sarcoidosis or leprosy.

Histoid leprosy with giant lesions of fingers and toes

This work was conducted at the Facultad de Medicina, Universidad de La Sabana, and at the Facultad de Medicina, Universidad Surcolombiana. Histoid leprosy, a clinical and histological variant of multibacillary leprosy, may offer a challenging diagnosis even for experts. An 83-year-old woman presented with papular, nodular and tumor-like lesions of 3 years of evolution, affecting fingers, toes, hands, thighs and knees, and wide superficial ulcers in her lower calves. Cutaneous lymphoma was suspected. A biopsy of a nodule of the knee showed a diffuse dermal infiltrate with microvacuolated histiocytes, moderate numbers of lymphocytes and plasma cells. Cutaneous lymphoma was suggested. Immunohistochemistry (IHC) showed prominent CD68-positive macrophages, as well as CD3, CD8 and CD20 positive cells. Additional sections suggested cutaneous leishmaniasis. New biopsies were sent with the clinical diagnoses of cutaneous lymphoma, Kaposi´s sarcoma or lepromatous leprosy, as the patient had madarosis. These biopsies showed atrophic epidermis, a thin Grenz zone and diffuse inflammation with fusiform cells and pale vacuolated macrophages. ZiehlNeelsen stain showed abundant solid phagocytized bacilli with no globii formation. Abundant bacilli were demonstrated in the first biopsy. Histoid leprosy was diagnosed. The patient received the WHO multidrug therapy with excellent results. We concluded that Ziehl Neelsen staining should be used in the presence of a diffuse dermal infiltrate with fusiform and vacuolated histiocytes, which suggests a tumor, and an IHC particularly rich in CD68-positive macrophages; this will reveal abundant bacilli if the lesion is leprosy. A good clinical pathological correlation is essential to establish a proper diagnosis and management of the patient.

Leprosy and the testis

INTRODUCTION Damage of testicles is frequent in lepromatous leprosy and worsened by the presence of erythema nodosum leprosum. Objective. A patient is presented who developed lepromatous leprosy and erythema nodosum leprosum with major testicular compromise. MATERIAL AND METHODS The 28-year-old male patient had lepromatous leprosy since age 22. During a polychemotherapy treatment for the lepromatous leprosy, he presented chronic erythema nodosum leprosum that affected both testicles; he did not respond to the conventional treatment. A left orchidectomy was performed to treat the persistent pain. RESULTS The extracted testis evidenced the following: tubular atrophy, extensive fibrosis, cumulus of foamy macrophages without rods, focal Leydig cell hyperplasia, linfocitary and granulomatous arteritis and endarteritis of small and medium size vessels. These changes were also observed in the epididymis. Two years after the polychemoterapy and the orchidectomy, the patient exhibited azoospermy, normal total testosterone, slightly diminished free testosterone and elevated levels of luteinizing hormone and follicle-stimulating hormone. No loss of libido or sexual activity was reported. General concepts of erythema nodosum leprosum were reviewed, as well as the pathologic changes produced by leprosy in the testis. CONCLUSION Lepromatous leprosy may lead to hypogonadism. This condition is recommended for inclusion in leprosy diagnostic programs in order to detect and treat the consequences of the possible hypogonadism.

Leishmaniasis cutánea y embarazo

We studied a 19-year-old woman, with a 4-month pregnancy who presented with four cutaneous leg ulcers of three months of evolution diagnosed by biopsy as cutaneous leishmaniasis. Direct smear and the leishmanin skin test were negative. Since all the usual medications for cutaneous leishmaniasis are contraindicated in pregnancy, she did not receive any treatment but cured spontaneously of her lesions during pregnancy. It is believed that cutaneous leishmaniasis does not carry danger for pregnant women and that there is no maternal-fetal transmission in humans, though it occurs in experimental animals. The patient gave birth without complications and both she and her son remained normal after two years of follow-up.

Glucógeno hepático en dengue severo: análisis histopatológico

Background: Dengue virus affects various organs, but the liver is the main target of damage and where the most severe damage can occur. There are few studies on the histological changes in the liver during dengue infection. Aims: To analyze the histopathological post-mortem alterations in livers from patients with severe dengue.