Mario Fernando Ribeiro de Miranda

Development of leprosy in a patient with ankylosing spondylitis during the infliximab treatment: reactivation of a latent infection?

The use of tumor necrosis factor α as a treatment for chronic inflammatory conditions has been shown to be associated with an increased risk of developing infections, especially Mycobacterium tuberculosis, atypical mycobacteria, and other microorganisms. We report the case of a 58-year-old man with ankylosing spondylitis, receiving infliximab treatment, who presented with multiple plaques on the face, chest, and extremities, a thickened, tender ulnar nerve, and severe neuritis of the feet. The results of a biopsy of these lesions revealed histopathological features of lepromatous Hansen disease. The use of anti-tumor necrosis factor biologic agent on this patient may have resulted in either a new infection or reactivation of a latent infection of Mycobacterium leprae.

Transepidermal elimination of parasites in Jorge Lobo's disease

BACKGROUND Few studies have focussed on the transepidermal elimination of parasites in Jorge Lobos disease (lobomycosis). OBJECTIVE To identify the morphological features of the transepidermal elimination of parasites in lobomycosis. METHODS Sections were obtained from paraffin-embedded biopsy specimens of patients with lobomycosis and stained with hematoxylin-eosin for microscopic examination. Only the presence of parasites in epidermal structures was considered to constitute transepidermal elimination. RESULTS Forty biopsies from 37 patients were included in the study (31 males and 6 females). The mean age of patients was 51.03 years (range 29-80 years). Biopsies performed over a period of 37 years (1967-2003) were used, from which 511 sections were obtained (a mean of 12.77 sections per case; range 2-39 sections per case). Transepidermal elimination of parasites was found in 110/511 (21.52%) and was absent in 401/511 sections (78.48%) (p<0.0001). Features consistent with the phenomenon were found in 15/37 patients (40.5%) and were absent in 22/37 (59.5%) (p>0.05). Parasites in the epidermis were detected within hyperplastic infundibula, either connected in chains or as isolated units, associated or not with inflammatory cells. CONCLUSION Features consistent with transepidermal elimination of parasites were found in a statistically nonsignificant number of patients in the sample (p>0.05), suggesting that in Jorge Lobos disease, this phenomenon invariably occurs through the infundibular epithelium. Future studies are required to evaluate the significance of this finding in the epidemiology of mycosis.

Tumor triquilemal proliferante: relato de caso

Tumor triquilemal proliferante e uma neoplasia incomum que surge do istmo folicular, cuja caracteristica histologica e a presenca de ceratinizacao triquilemal. Apresenta-se usualmente como nodulo solitario no couro cabeludo de mulheres idosas. Descreve-se um caso de tumor triquilemal proliferante que se apresenta como lesao tumoral nodular na regiao glutea de uma jovem de 16 anos de idade

Dermatofibroma in a black tattoo: report of a case*

Tattooing has been associated with a variety of complications including inflammatory and granulomatous reactions, transmission of infections, and neoplasms. We report a case of a 24-year-old male who presented with a 2-month history of an erythematous nodule involving a newly made tattoo on the right leg. An excisional biopsy was performed and the histopathological evaluation was consistent with dermatofibroma. Only three cases of dermatofibroma associated with tatooing were reported in litetature. We report an additional case and review the literature regarding cutaneous reactions to tattoos.

Líquen escleroso e atrófico acral: relato de caso

O liquen escleroso e atrofico e uma doenca cronica da pele e mucosas, que, usualmente, afeta a area genital de mulheres. Poucos casos de liquen escleroso e atrofico, confinados nos pes e/ou maos, tem sido relatados. Relatamos um caso de liquen escleroso e atrofico envolvendo as extremidades e,posteriormente, a area perigenital

Leucodermia sifilítica: expressão rara do secundarismo diagnosticada por exame histopatológico

Biopsies are occasionally necessary to confirm the diagnosis of secondary-stage syphilis, currently achieved by clinico-serological correlation. However, histopathologic examination may offer clues that can lead to the diagnosis of the disease in previously unsuspected or unusual cases. We report the case of a 35-year-old male patient with vitiligo-like lesions for two years, whose diagnosis of syphilis was suggested only after histopathologic examination. Some microscopic aspects observed are discussed and compared to data from the literature.

Comparison between histopathologic features of leprosy in reaction lesions in HIV coinfected and non-coinfected patients*

BACKGROUND Leprosy and HIV are diseases that have a major impact on public health in Brazil. Patients coinfected with both diseases, appear to be at higher risk to develop leprosy reactions. OBJECTIVE The aim of this study is to describe the histopathological aspects of cutaneous lesions during reactional states in a group of patients with HIV-leprosy coinfection, compared to patients with leprosy, without coinfection. METHODS Two groups were established: group 1 comprised of 40 patients coinfected with HIV-leprosy; group 2, comprised of 107 patients with leprosy only. Patients presenting reactional states of leprosy had their lesions biopsied and comparatively evaluated. RESULTS Reversal reaction was the most frequent feature in both groups, with dermis edema as the most common histopathological finding. Giant cells were seen in all group 1 histopathological examinations. Dermis edema was the most common finding in patients with erythema nodosum leprosum. CONCLUSION Few histopathological differences were found in both groups, with reversal reaction as the most significant one, although this fact should be analyzed considering the predominant BT clinical form in the coinfected group and BB form in the group without HIV. Larger prospective studies in patients with HIV-leprosy coinfection are needed to confirm and broaden these results.

Granuloma anular elastolítico gigantocelular: relato de caso

Annular elastolytic giant cell granuloma is a rare granulomatous skin disease characterized histologically by phagocytosis of elastic fibers by multinucleated giant cells and clinically by annular patches with elevated borders and atrophic centers found mainly on sun-exposed skin. The pathogenesis of the disease is controversial. We report the case of a 44-year-old woman with classical clinical and histological findings of the disease whose condition improved when hydroxychloroquine was administered over a four-week period

Epidermólise bolhosa distrófica pruriginosa: relato de caso

A epidermolise bolhosa distrofica pruriginosa e doenca genetica rara cujo padrao de heranca ainda nao esta bem estabelecido na literatura. O defeito genetico, que envolve a codificacao do colageno tipo VII, esta localizado no braco curto do cromossomo 3, ocorrendo mutacao no gene COL7A1. Apresenta-se o caso de um paciente do sexo masculino que referia prurido nas pernas ha cerca de 15 anos, cujo diagnostico foi firmado com base nos exames dermatologico e imuno-histopatologico. Devido a raridade dessa condicao patologica, realiza-se breve revisao do tema.

Tufted angioma in ear auricle: importance of the differential diagnosis

Tufted angioma is an acquired vascular proliferation with specific histological characteristics. The most common clinical features are erythematous macules. It occurs predominantly in children and young adults, especially in the chest and neck. We report the case of a male patient, 12 years old, with an increased right ear auricle associated with erythematous macules and increased local temperature, referred with a diagnosis of lepromatous leprosy; however, this diagnosis was questioned. Histopathology was consistent with tufted angioma.