Ricardo Barbosa Lima

Cutaneous protothecosis - case report

Cutaneous protothecosis is a rare infection caused by achlorophyllic algae of the genus Prototheca. The lesions usually occur on exposed areas, related with trauma, in immunocompromised patients. The most common clinical presentation is a vesicobullous and ulcerative lesion with pustules and scabs, simulating bacterial, fungal or herpetic infections or eczema. The diagnosis is determined by agent identification through histopathology, culture and the carbohydrates assimilation test. The finding of morula-like spherules is characteristic of Prototheca sp. Its rarity and non-specific clinical aspect may difficult the disease diagnosis. We report a case of a diabetic patient, in chronic use of systemic corticosteroids, that developed a skin lesion after trauma to the right leg.

Cholesterol crystal embolization caused by anticoagulant therapy

CaseA 72-year-old white man, with a history of type II diabetesmellitus,hypertension,chronicrenalinsufficiency,andatrialfibrillation, had been receiving warfarin, 5 mg daily, for1 year when he developed macroscopic hematuria. He wasadmitted to our hospital with an International NormalizedRatio(INR)of14,causedbyincorrectuseofthemedication.Onthethirddayofadmission,hehadnofurther evidence ofhematuria and the prothrombin time was normal aftervitamin K administration. On the fourth day, however, hesuddenlydevelopedblue-coloredtoesandacutedeteriorationof renal function. Physical examination revealed discretelivedo reticularis on both feet, tender, blue-colored second,third,fourth,andfifthrightandlefttoes,withgoodperipheralpulses (Fig. 1). Laboratory examinations revealed an elevationof serum urea nitrogen at 239 mg/dL (3 days before, 192 mg/dL; normal, 10–50 mg/dL) and creatinine at 6.05 mg/dL(3 days before, 4.66 mg/dL; normal, 0.7–1.3 mg/dL). Thewhite blood cell count was 10.5 · 10

Reação reversa atípica em paciente com hanseníase dimorfa co-infectado pelo HIV

HIV infection does not modify the natural course of leprosy. However, HIV co-infection seems to be associated with an increased rate of reactional states and more severe cases of neuritis. The authors describe a case of borderline tuberculoid leprosy in a HIV-positive patient who developed a marked reversal reaction. Atypical and rare skin manifestations, such as verrucous lesions and ulcers, appeared after highly active antiretroviral therapy, which resulted in increased CD4+ T-lymphocyte count and drop in viral load. The restoration of the cellular immunity in HIV-seropositive patients can trigger reversal reactions that are one of the manifestations of the immune reconstitution inflammatory syndrome. Only recently the syndrome has been associated with leprosy.

Clinical and surgical therapeutic approach in Erithema Elevatum Diutinum - case report

Erythema elevatum diutinum is a rare chronic cutaneous vasculitis which usually affects adults. It is characterized by symmetrical and persistent papules, plaques, and nodules. These lesions are usually located on the extensor surfaces of the extremities. We report a case of erythema elevatum diutinum in which the association of dapsone and surgical excision promoted complete remission of skin lesions, providing a new approach to the treatments described in the literature.

Scleroderma en coup de sabre treated with polymethylmethacrylate - Case report.

The scleroderma en coup de sabre is a variant of localized scleroderma that occurs preferentially in children. The disease progresses with a proliferative and inflammatory phase and later atrophy and residual deformity, which are treated with surgical techniques such as injectable fillers, transplanted or autologous fat grafting and resection of the lesion. Among the most widely used fillers is hyaluronic acid. However, there are limitations that motivate the search for alternatives, such as polymethylmethacrylate, a permanent filler that is biocompatible, non-toxic, non-mutagenic and immunologically inert. In order to illustrate its application, a case of scleroderma en coup de sabre in a 17-year-old patient, who was treated with polymethylmethacrylate with excellent aesthetic results, is reported.

Refractory pemphigus vulgaris treated with rituximab and mycophenolate mofetil

The main treatment for pemphigus vulgaris are systemic corticosteroids and immunosuppressive agents, but due to adverse reactions and therapeutic failure, new drugs such as rituximab and mycophenolate mofetil have been used. In this case report are described two cases of severe pemphigus vulgaris refractory to various treatments, with resolution after use of rituximab and mycophenolate mofetil, associated with corticosteroids. A higher-than-usual dose of rituximab was employed, without the occurrence of serious adverse reactions. Mycophenolate mofetil was added as adjunctive therapy due to lack of response to azathioprine.

Gastric syphilis - Case report

Gastric syphilis is an uncommon extracutaneous manifestation of syphilis, occurring in less than 1% of patients, presenting nonspecific clinical manifestations. In general, it occurs on secondary stage. The critical point is the recognition of the syphilitic gastric involvement, without which there may be incorrect diagnosis of malignancy of the digestive tract. In this report, a case of secondary syphilis with gastric involvement that had complete remission with benzathine penicillin will be described.

Solitary eccrine syringofibroadenoma - Case Report

Eccrine syringofibroadenoma is a rare benign adnexal neoplasm derived from cells of the acrosyringium of eccrine sweat glands. ESFA usually manifests as a solitary nodule on the extremities of elderly patients, but it may also present as papules, nodules or plaques. Its clinical appearance is nonspecific and malignant neoplasms should beconsidered in the differential diagnosis. However, histopathological findings are typical. The main treatment is surgical excision. In order to illustrate a typical presentation of the tumor, we report a case of solitary eccrine syringofibroadenoma, including the surgical treatment used and its result.

Disseminated lichen sclerosus in a child: a case report *

1 This report describes the case of a female child with an exuberant clinical pre- sentation of LS with genital and disseminated extra- genital lesions.

Giant squamous cell carcinoma in HIV-positive patient

Master – Dermatologist of IPEC/FIOCRUZ PhD/Professor – Discipline of Pathological Anatomy, Universidade Federal do Estado do Rio de Janeiro (UNIRIO) Specialist/Professor – Discipline of Dermatology, Universidade Federal do Estado do Rio de Janeiro (UNIRIO) Specialist/Professor Discipline of Dermatology, Universidade Federal do Estado do Rio de Janeiro (UNIRIO) Specialist / Professor Discipline of Dermatology, Universidade Federal do Estado do Rio de Janeiro (UNIRIO)