Joel Schwartz

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.

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.

Micose fungóide hipopigmentar com 20 anos de evolução

Hypopigmented mycosis fungoides is a rare variant of the cutaneous T-cell lymphoma, in which hypopigmented lesions are seen without the classical lesions. Only three cases are found in the Latin-American literature. We report the case of a 29-year-old black male patient, who first presented with these lesions 20 years ago. The treatment is similar to the classical forms of the disease: psoralen plus ultraviolet A (PUVA) and topical nitrogen mustard are most often used.