Inmaculada Molina

Contribution of hyperammonemia and inflammatory factors to cognitive impairment in minimal hepatic encephalopathy

To assess the contribution of hyperammonemia and inflammation to induction of mild cognitive impairment (or MHE). We analyzed the presence of mild cognitive impairment (CI) by using the PHES battery of psychometric tests and measured the levels of ammonia and of the inflammatory cytokines IL-6 and IL-18 in blood of patients with different types of liver or dermatological diseases resulting in different grades of hyperammonemia and/or inflammation. The study included patients with 1) liver cirrhosis, showing hyperammonemia and inflammation; 2) non-alcoholic fatty liver disease (NAFLD) showing inflammation but not hyperammonemia; 3) non-alcoholic steatohepatitis (NASH) showing inflammation and very mild hyperammonemia; 4) psoriasis, showing inflammation but not hyperammonemia; 5) keloids, showing both inflammation and hyperammonemia and 6) controls without inflammation or hyperammonemia. The data reported show that in patients with liver diseases, cognitive impairment may appear before progression to cirrhosis if hyperammonemia and inflammation are high enough. Five out of 11 patients with NASH, without liver cirrhosis, showed cognitive impairment associated with hyperammonemia and inflammation. Patients with keloids showed cognitive impairment associated with hyperammonemia and inflammation, in the absence of liver disease. Hyperammonemia or inflammation alone did not induce CI but the combination of certain levels of hyperammonemia and inflammation is enough to induce CI, even without liver disease.

Cutaneous sarcoidosis developing after treatment with pegylated interferon and ribavirin: a new case and review of the literature

Sarcoidosis is a multisystem granulomatous disease that affects multiple organs in adults between 20 and 50 years old. Interferon alpha (IFN‐α) is an immunomodulator that has been used in a wide range of diseases, including hepatitis C virus infection, multiple sclerosis, and other types of neoplasias, including leukemia, lymphoma, Kaposi’s sarcoma, and melanoma. Standard IFN‐α‐induced sarcoidosis has been reported, but there are few reports of cutaneous sarcoidosis with pegylated IFN‐α therapy. We present a new case of cutaneous sarcoidosis after treatment with pegylated IFN, and a review of the literature.

Buschke-Lowenstein tumor

BACKGROUND Verrucous carcinoma of the skin and mucosa is an uncommon type of well-differentiated squamous cell carcinoma. When it is present in the genitoanal region the term used is Buschke-Lowenstein tumor. The human papillomavirus seems to be implicated in its aetiology. Treatment is controversial. Topical chemotherapy, radiotherapy, immunotherapy and radical surgery have been employed. MAIN OBSERVATIONS We report a rapidly progressing penile verrucous carcinoma which was treated sucessfuly with conservative surgery and CO2 laser. CONCLUSION Treatment with CO2 laser in combination with conservative surgery may be a therapeutic option in Buschke-Lowenstein tumor.

Eczema de contacto agudo a parafenilendiamina contenida en tatuajes transitorios con henna

Henna is a plant with coloring properties which is used as a dye for hair and skin, on occasion mixed with other substances. Paraphenylendiamine (PPD) is one of the additives used to accelerate drying, improve definition and darken its reddish color. There are several descriptions in literature of sensitization to the PPD contained in henna. We describe 3 new cases of allergic contact dermatitis to temporary tattoos, with skin tests positive for PPD in 2 of them. The lesions resolved in one of the patients, leaving persistent hypopigmentation. It is important for the population to be aware of this circumstance and the risk entailed by sensitization to PPD.

Cicatricial pemphigoid of the Brunsting–Perry type

A 63-year-old woman presented with a 3-year history of confluent and painful erosions located on the occipital scalp. Examination revealed an extensive scarring erosion that involved the vertex and the occipital area of the scalp. The lesion measured 13 cm × 8 cm, had well-demarcated margins, and was covered in part by crusts (Fig. 1). The patient reported intense pain at the slightest touch. The rest of the physical examination revealed only an intense erythema in the oral cavity. There were no associated systemic symptoms, including ophthalmologic manifestations, and no previous history of trauma on the affected area. Laboratory tests, including hemogram, biochemical values, and proteinogram, were within normal limits. Antinuclear antibodies were also negative. The erythrocyte sedimentation rate was 39 mm/h (normal, < 20 mm/h). Microbiologic cultures from the exudate and a cutaneous biopsy for histologic and immunohistochemical analysis were also performed. Histologically, a large erosive cutaneous lesion with a superficial, perivascular, lymphoplasmacytic, dermal infiltrate immediately below the base of the erosion was present. Direct immunofluorescence showed continuous linear C3 dermo-epidermal deposition. Cultures were negative for bacteria, fungi, and mycobacteria. Anti-basement membrane zone antibodies and anti-interstitial substance antibodies were also negative. Cutaneous lesions progressively resolved after the use of clobetasol propionate cream (twice daily) for 3 weeks. Nevertheless, a scarring alopecia remained (Fig. 2).

Úlceras vulvares agudas de Lipschütz

Resumen —Dos ninas virgenes de 14 y 12 anos, previamente sanas, consultaron por ulceras dolorosas genitales agudas que aparecieron en el contexto de un proceso febril. Las exploraciones complementarias descartaron tanto una enfermedad venerea como el resto de causas habituales de ulceraciones genitales. En ambos casos, las lesiones se resolvieron en menos de 2 semanas tras la administracion de antibioticoterapia oral y topica, sin secuelas ni recidivas posteriores.

Lymphoepitelioma-like carcinoma of the skin: report of three cases

Primary cutaneous lymphoepithelioma‐like carcinoma (LELC) is an extremely rare cutaneous neoplasm with histopathological features similar to those seen in the undifferentiated subtype of nasopharyngeal carcinoma. Microscopically, the tumor is well circumscribed and is composed of irregular nests of malignant epithelial cells in a background of reactive lymphoid cells including mature plasma cells. Its histogenesis remains unknown although an adnexal or epidermic origin has been proposed, and despite its poorly differentiated histology, the LELC prognosis is relatively good. We describe three new cases of this entity that support an epidermic origin.

Lupus eritematoso cutáneo subagudo inducido por fármacos

Resumen —Una mujer de 46 anos, sin antecedentes de enfermedades autoinmunes, desarrollo una erupcion cutanea clinica e histologicamente indicativa de un lupus eritematoso cutaneo subagudo. El exantema coincidio con la administracion reciente de tetrazepam, aunque tambien tomaba de forma prolongada anticonceptivos orales. Los estudios de autoinmunidad mostraron una elevacion de anticuerpos antinucleares, antihistonas y anti-Ro. La retirada de la medicacion se acompano de una rapida mejoria clinica y de los parametros de laboratorio, sin que presentara otros brotes con posterioridad, lo que permitio el diagnostico de lupus eritematoso cutaneo subagudo inducido por farmacos.

Lupus miliar diseminado de la cara

Lupus miliaris faciei is a chronic inflammatory dermatosis that most often affects young adults. For years, it has successively been considered a form of tuberculosis, sarcoidosis and rosacea. Recently, some authors have proposed that it should be considered a distinct entity. It is an eruption of small, brownish-erythematous papules, primarily located on the face, especially in the periocular area. It is self-limited and generally leaves residual punctate scars. We present the case of a 25-year-old male affected by Lupus miliaris disseminatus faciei and discuss its main characteristics, as well as the different problems in its etiopathogenic classification.

Eritema anular centrífugo e hipotiroidismo

Resumen —Una mujer de 54 anos consulto por unas lesiones eritematosas con descamacion en el borde, localizadas en la cara externa de ambas piernas, indicativas de eritema anular centrifugo. Las exploraciones complementarias evidenciaron un hipotiroidismo subclinico que mejoro, al igual que las lesiones cutaneas, con levotiroxina. Posteriormente, un desajuste en el tratamiento propicio la reaparicion de un hipotiroidismo clinico en esta ocasion y dos nuevos brotes de eritema anular centrifugo.