Panniculitis associated with amyopathic dermatomyositis

Abstract: Panniculitis is a rare clinical finding in dermatomyositis, with less than 30 cases reported and there is only one case associated with the amyopathic subtype described in the literature. The present report describes a 49-year-old female patient that one year after being diagnosed with amyopathic dermatomyositis, presented indurated, painful, erythematous to violaceous nodules located on the upper limbs, thighs and gluteal region. Skin biopsy revealed lobular panniculitis with a lymphocytic infiltrate. The patient was treated with prednisone and methotrexate, but remained unresponsive to treatment.

Enxertos de couro cabeludo para a correção de feridas cirúrgicas / Scalp grafts for correcting surgical wounds

Das diversas opções de reconstrução de feridas cirúrgicas, utilizam-se enxertos cutâneos quando o fechamento primário ou por segunda intenção é inviável ou devido a outros fatores que não recomendem o uso de retalhos. O reparo de ferida cirúrgica com enxerto de espessura parcial obtido do couro cabeludo com lâmina flexível é relatado em três casos de exérese convencional de dois casos de carcinoma basocelular na regão nasal e um caso de carcinoma espinocelular no dorso da mão. A técnica proporcionou bom resultado estético tanto na área receptora quanto na área doadora.

Among the diverse reconstruction alternatives used in surgical wounds, those employing cutaneous grafts are implemented when the closure ­ primary or by second intention ­ is unfeasible or, due to other factors, flaps are not recommend. The repair of surgical wounds using partial thickness graft obtained from the scalp with a flexible blade is described in 3 cases of conventional exeresis (2 basal cell carcinomas in the nasal region and 1 case of squamous cell carcinoma on the dorsum of the hand). The technique yielded good aesthetic outcomes, both in the receiver and donor areas.

Prevalência de doenças autoimunes em pacientes com síndrome de Down / Prevalence of autoimmune diseases in Down syndrome patients

Introdução: Diversas doenças podem acometer pacientes com síndrome de Down (SD), dentre elas as doenças autoimunes (DAI). Quando comparados à população geral, pacientes com SD apresentam maior risco para desenvolvimento de DAI. O objetivo do estudo foi avaliar a prevalência de DAI em pacientes com SD. Métodos: Estudo retrospectivo. Foram avaliados prontuários de 71 pacientes atendidos no ambulatório universitário de SD. Foram pesquisadas: tireoidite de Hashimoto (TH), doença de Graves (DG), doença Celíaca (DC), alopecia areata (AA), vitiligo, leucemia e diabetes mellitus tipo I (DMI). Diagnóstico de TH foi considerado quando T4 livre normal ou baixo, TSH elevado, presença de anticorpos antitireoideanos e ultrassonografia de tireoide compatível com TH. Diagnóstico de DG foi considerado quando T4 livre normal ou elevado, TSH suprimido e anticorpo antirreceptor de TSH positivo. A DC foi diagnosticada quando anticorpo antendomísio IgA positivo e biópsia intestinal compatível com DC. AA e vitiligo foram considerados quando presença de lesão de pele diagnosticada por dermatologista. Alterações no hemograma e biópsia de medula óssea foram considerados para diagnóstico de leucemia e hiperglicemia com anticorpo anti-GAD positivo foram considerados para DMI. Resultados: A prevalência de DAI foi 18,3%. TH foi encontrado em 6 pacientes; DG em 2 pacientes; DC em 4 pacientes; AA em 2 pacientes; vitiligo em 1 paciente e leucemia em 1 paciente. Nenhum paciente apresentou DMI. Conclusão: A prevalência de DAI neste estudo foi maior comparado à prevalência de DAI na população em geral. Recomenda-se rastreio regular destas doenças nos pacientes com SD.

Introduction: Several diseases can affect patients with Down syndrome (DS), among them autoimmune diseases (AID). As compared to the general population, patients with DS are at increased risk for development of AID. The aim of this study was to evaluate the prevalence of AID in patients with DS. Methods: A retrospective study. We analyzed the records of 71 patients treated in a university outpatient unit of DS. We surveyed for Hashimoto’s thyroiditis (HT), Graves’ disease (GD), celiac disease (CD), alopecia areata (AA), vitiligo, leukemia and diabetes mellitus type I (DMI). Diagnosis of HT was considered when free T4 was normal or low, TSH was high, presence of anti-thyroid antibodies, and thyroid ultrasound compatible with TH. GD was diagnosed when free T4 was normal or elevated, TSH was suppressed, and anti-TSH receptor was positive. CD was diagnosed when anti-endomysium IgA was positive and intestinal biopsy was compatible with CD. AA and vitiligo were considered in the presence of skin lesions diagnosed by a dermatologist. Changes in blood count and bone marrow biopsy were considered for diagnosis of leukemia, and hyperglycemia with positive anti-GAD were considered for DMI. Results: The prevalence of AID was 18.3%. HT was found in 6 patients, DG in 2, DC on 4, AA in 2, vitiligo in one, and leukemia in one patient. No patient had DMI. Conclusion: The prevalence of AID in this study was greater than in the general population. Regular screening of these diseases in patients with DS is recommended.