Loan Towersey

Dermoscopia da sarna crostosa associada à síndrome da imunodeficiência adquirida

The authors report here on the case of a female patient with Norwegian (crusted) scabies and acquired immunodeficiency syndrome whose compliance with antiretroviral therapy was poor. Definitive diagnosis was confirmed by direct microscopic examination, which revealed numerous Sarcoptes scabei. Dermoscopy showed pathognomonic scabetic burrows and brownish structures in the shape of a hand-glider with a millipede-like appearance. The latter constitutes a diagnostic feature in the pathology of Norwegian scabies that has not yet been described. The patient responded well to oral ivermectin and topical vaseline with sulphur at a proportion of 10%. There was a simultaneous improvement in dermoscopic parameters.

Dermatophilus congolensis human infection

Four cases of human dermatophilosis observed in Rio de Janeiro, Brazil, are reported. Data that suggest nail infection by Dermatophilus congolensis are presented. The clinical spectrum of the disease ranged from an asymptomatic infection to a pustular eruption. Our findings suggest that epidermal Langerhans cells play a role in the pathogenesis of the infection.

Outbreak of Tinea capitis by Trichophyton tonsurans and Microsporum canis in Niterói, RJ, Brazil

18 girls from an orphanage (Orfanato Santo Antônio) in Niterói presented tinea capitis due to Trichophyton tonsurans (15 cases-83.3%) and Microsporum canis (3 cases-26.7%). Comments are made about clinical, mycological and therapeutic aspects of this microepidemic.

Mycetoma by Nocardia asteroides: a 9 year follow-up.

An extensive and severe actinomycetoma by Nocardia asteroides, a rare etiologic agent of this infection in Brazil, observed during a 9 year follow-up is reported. Unsuitable social and financial conditions led to amputation as the only possible solution for this case, no signs of infection relapse having been observed in three years after his surgery.

Clinical Manifestation, Histopathology, and Imaging of Traumatic Injuries Caused by Brazilian Porcupine (Sphiggurus villosus) Quills

Injuries to humans caused by porcupines are rare. However, they may occur due to the proximity of urban areas and the animals habitat in areas such as the Floresta da Tijuca in Rio de Janeiro. Outdoor sports and leisure activities in areas close to forests or in the rain forest are also relevant for incidents of this kind and a better knowledge of the local forest fauna would prevent such undesirable accidents. Porcupine quills have microscopic barbs at their tips which facilitate skin penetration, but hampering their removal. Once the spines are lodged in tissue, the microscopic backward-facing deployable barbs at the tips cause trauma if anyone tries to remove them. Local haemorrhage and an inflammatory response to the contaminated foreign body occur. Depending on the time lapse in removing the spines either septic or sterile foreign body reactions may occur. There is also the risk of migration of the spines, where fatal cases have been reported in human and veterinary medicine. Herein we report two unusual cases of accidents involving humans and the South American porcupine. The Sphiggurus villosus spines removed from scalp skin were also documented through Scanning Electron Microscopy.

Micetoma por Actinomadura madurae: relato de dois casos

Sao relatados dois casos de micetoma por Actinomadura madurae, atendidos no Hospital Universitario Clementino Fraga Filho (UFRJ), em 1990, e no Hospital Universitario Antonio Pedro (UFF), em 1984. Caso 1: paciente masculino, pardo, de 27 anos, iniciou o quadro em 1988, apos traumatismo no pe esquerdo, com aumento de volume com nodulos apresentando fistulas drenando secrecao e graos branco-amarelados. A radiografia mostrou lesoes liticas nos ossos do tarso e 2o e 3o metatarsianos do pe esquerdo. O exame histopatologico evidenciou graos basofilicos recobertos por franja eosinofilica, arredondados, medindo ate 1mm. Ao exame micologico foi isolado em cultivo A. madurae. Diante do fracasso de outras tentativas, foi instituida terapeutica com tetraciclina oral por 6 meses; contudo, como nao houve resolucao do quadro clinico-radiologico, foi indicada a amputacao do membro. Caso 2: paciente masculino, branco, de 70 anos, iniciou quadro em 1974, apos traumatismo no pe direito, que evoluiu com aumento de volume e fistulas. Ao exame histopatologico, graos basofilicos com franjas eosinofilicas ao redor, tamanho grande, de 1 a 2mm de diâmetro, caracteristicas de A. madurae. Discreta melhora com tetraciclina e sulfamidicos. Sem controle posterior. O primeiro caso adquiriu a infeccao no Rio de Janeiro e o segundo caso a adquiriu em Pernambuco. Alem de aspectos clinicos, diagnosticos e terapeuticos, e comentada a ocorrencia dos micetomas nas Americas, destacando a frequencia dos actinomicetomas por A. madurae.

Acute paracoccidioidomycosis with duodenal and cutaneous involvement and obstructive jaundice

Paracoccidioidomycosis (PCM) is the most widespread endemic mycosis in LatinAmerica. If PCM is not diagnosed and treated early and adequately, the endemic fungal infection could result in serious sequelae. We report a case of PCM with duodenal and cutaneous involvement simulating cholangitis that was initially misdiagnosed as a lymphoproliferative disease. Clinicians should consider acute paracoccidioidomycosis in the differential diagnosis of jaundice and/or signs/symptoms of cholangitis developing in young patients from paracoccidioidomycosis endemic regions.