Maria de Lourdes Ribeiro de Carvalho

Leishmaniose tegumentar americana

American cutaneous leishmaniasis is endemic in widespread areas of Latin America. The causative agents include L. (V.) braziliensis, L. (L.) mexicana, L. (V.) panamensis, and related species. The spectrum of disease includes single, localized, cutaneous ulcers, diffuse cutaneous leishmaniasis, and mucosal disease.The main reservoirs for L. (V.) braziliensis and other Leishmania (Vianna) spp. are small forest rodents. The vectors are ground-dwelling or arboreal Lutzomyia sandflies, which are abundant in the forest. Disease is most common in persons working at the edge of the forest and among rural settlers. The incubation period of cutaneous leishmaniasis varies from two weeks to several months. A wide variety of skin manifestations ranging from small, dry, crusted lesions to large, deep, mutilating ulcers may be seen. Ulcerative lesions are usually shallow and circular with well-defined, raised borders and a bed of granulation tissue. In L. (V.) braziliensis infection, regional lymphadenopathy often precedes the development of cutaneous lesions by one to 12 weeks. A definite diagnosis depends on the identification of amastigotes in tissue or promastigotes in culture. Antileishmanial antibodies are present in the serum of some patients with cutaneous leishmaniasis as detected by ELISA, immunofluorescent assays, direct agglutination tests or other assays, but the titers are usually low. The leishmanin skin test result usually becomes positive during the course of the disease. For treatment two pentavalent antimony-containing drugs are used: stibogluconate sodium, and meglumine antimoniate (Glucantime). Amphotericin B deoxycholate is an alternative for persons who fail to respond to pentavalent antimony. Immunoprophylaxis and immunotherapy are promising new approaches to prevention and treatment.

Leishmaniose tegumentar americana: apresentação pouco comum

We report the case of a patient with American cutaneous leishmaniasis and prominent lesions on the face. Diagnostic criteria included clinical and epidemiological data, Montenegros skin test, identification of Leishmania by means of polymerase chain reaction and clinical response to treatment. Our report is important to call attention to an unusual presentation of American cutaneous leishmaniasis.

Acne induzida por amineptina

Relata-se um caso grave de lesoes acne-simile associada a amineptina (Survector®), proeminentes na face e dorso, acometendo outros sitios nao afetados pela acne vulgar, como perineo, bracos e pernas. As lesoes apareceram apos a auto-administracao cronica de altas doses do medicamento. Lesoes ceratoacantoma-simile tambem estavam presentes, tendo as lesoes menores resposta satisfatoria ao tratamento com imiquimod topico. O relato e significativo pela raridade da doenca.