João Roberto Antonio

Primary systemic amyloidosis associated with multiple myeloma

This case report is about a 48-year-old female patient with systemic amyloidosis and multiple myeloma simultaneously. Amyloid cutaneous infiltrative lesions like papules, nodules, or plaques with a serous-hemorrhagic aspect were found in the eyelids, neck and retroauricular region, among others. She had presented intermittent papular lesions on the upper eyelids one year before, which worsened following local trauma. A local skin biopsy showed amorphous and eosinophilic substance in the dermis. Congo red staining confirmed the amyloid deposits. Abnormal exams: proteinuria (570 mg/24h), Bence-Jones proteinuria and clonal plasma cells (70%) found in myelogram. Following the diagnosis of multiple myeloma based on amyloid skin lesions, the patient was referred to the Hematology service and died 5 months after the diagnosis.

Sífilis secundária com acometimento pulmonar

Syphilis is an infectious systemic disease caused by Treponema pallidum. A case of secondary syphilis in a 37- year-old man with respiratory complaints is reported. Clinical manifestations and imaging exams, including chest radiographs and CT, suggested neoplasm. Dermatological examination and skin biopsy, along with serologic testing, were performed and confirmed the diagnosis of syphilis. The patient was treated with weekly intramuscular injections of 24.000.00 IU of benzathine penicillin for two consecutive weeks. His symptoms and skin lesions disappeared, serological tests negativated and the regression of the radiological abnormalities was observed.

Correlation between dermoscopic and histopathological diagnoses of atypical nevi in a dermatology outpatient clinic of the Medical School of São José do Rio Preto, SP, Brazil

BACKGROUND The incidence of cutaneous melanoma is increasing worldwide. Since it is an aggressive neoplasm, it is difficult to treat in advanced stages; early diagnosis is important to heal the patient. Melanocytic nevi are benign pigmented skin lesions while atypical nevi are associated with the risk of developing melanoma because they have a different histological pattern than common nevi. Thus, the clinical diagnosis of pigmented lesions is of great importance to differentiate benign, atypical and malignant lesions. Dermoscopy appeared as an auxiliary test in vivo, playing an important role in the diagnosis of pigmented lesions, because it allows the visualization of structures located below the stratum corneum. It shows a new morphological dimension of these lesions to the dermatologist and allows greater diagnostic accuracy. However, histopathology is considered the gold standard for the diagnosis. OBJECTIVES To establish the sensitivity and specificity of dermoscopy in the diagnosis of pigmented lesions suspected of malignancy (atypical nevi), comparing both the dermatoscopic with the histopathological diagnosis, at the Dermatology Service of the outpatient clinic of Hospital de Base, São José do Rio Preto, SP. METHODS Analysis of melanocytic nevi by dermoscopy and subsequent biopsy on suspicion of atypia or if the patient so desires, for subsequent histopathological diagnosis. RESULTS Sensitivity: 93%. Specificity: 42%. CONCLUSIONS Dermoscopy is a highly sensitive method for the diagnosis of atypical melanocytic nevi. Despite the low specificity with many false positive diagnoses, the method is effective for scanning lesions with suspected features of malignancy.

Erythroplasia of Queyrat treated with topical 5-fluorouracil

We report a 33-year-old male patient diagnosed with erythroplasia of Queyrat. The patient had an erythematous and eroded lesion affecting more than 50% of the glans associated with bleeding and local pain. Despite previous indication of penectomy, he was successfully treated with topical 5-fluorouracil.

Effectiveness and safety of infliximab for 11 years in a patient with erythrodermic psoriasis and psoriatic arthritis

An Bras Dermatol. 2017;92(5):740-50. in size from 2 to 10cm, most often found on the upper trunk, cervical area, and proximal aspect of the limbs, besides other locations such as face and oral mucosa.1 Lesions are usually asymptomatic, but can be very painful and present with hypertrichosis and hyperhidrosis.2 It must be differentiated from other conditions, such as congenital hemangioma, infantile hemangioma, vascular malformations, pyogenic granuloma and, in adults, kaposiform hemangioendothelioma and Kaposi sarcoma. To differentiate between other tumors or to assess the area involved, imaging as ultrasound or magnetic resonance can be used..3 Histopathology of TA shows many lobules of tufts spread across the dermis with a “cannonball” appearance, crescent-shaped spaces around the vascular tufts and similar spaces in the tumor stroma.2,4,5 Immunohistochemistry can be strongly positive for Ulex uropaeus I lectin and EN4, besides CD31 and CD34, and rarely positive for smooth muscle actin and negative staining for GLUT1.3, 4 The main treatment option for tufted angioma is surgical excision. Other therapeutic modalities have been reported, such as cryotherapy, laser, topical or systemic corticosteroids and chemotherapy. Some authors believe the lesion should only be monitored due to the possibility of spontaneous regression of these cases.3, 5 q

Clouston Syndrome: 25-year follow-up of a patient

Clouston syndrome is a rare genodermatosis that affects skin and annexes. It is a form of ectodermal dysplasia characterized by generalized hypotrichosis, palmoplantar hyperkeratosis and nail dystrophy. This paper reports a 25-year follow-up of a patient with Clouston syndrome, from childhood to adulthood, monitoring diagnosis and clinical course of the disease.