Síndrome de arlequim idiopática: sucesso terapêutico com toxina botulínica / Idiopathic harlequin syndrome: successful therapy with botulium toxin

A síndrome de arlequim é uma rara desordem autonômica que se caracteriza por anidrose e falta de rubor unilateral da face, podendo acometer as regiões cervical e torácica. De forma paradoxal, há rubor e sudorese compensatórios no lado contralateral à alteração. É idiopática na maioria dos casos, mas pode ser congênita, secundária a lesões estruturais e à iatrogenia pós-cirúrgica. O tratamento é direcionado ao fator causal. Descreve-se caso de paciente com diagnóstico de síndrome de arlequim idiopática, sendo realizada aplicação de toxina botulínica na hemiface acometida pelos sintomas compensatórios com boa resposta terapêutica

Harlequin syndrome is a rare autonomic disorder characterized by anhidrosis and lack of unilateral flushing of the face, which may affect the cervical and thoracic regions. Paradoxically, there is compensatory flushing and sweating on the contralateral side to the alteration. It is idiopathic in most cases, but it can be congenital or secondary to structural or post-surgical iatrogenic lesions. Treatment is directed at the causative factor. We describe the case of a patient with a diagnosis of idiopathic Harlequin Syndrome with botulinum toxin application in the hemiface affected by compensatory symptoms with good therapeutic response.

Relationship between bacilloscopy and operational classification of Hansen's disease in patients with reactions

Abstract: Leprosy can be classified according to its operational form as paucibacillary or multibacillary. Bacilloscopy integrates its diagnostic armamentarium. Patients with the disease may present leprosy reactions. This study describes the association of bacilloscopy results and the type of operational classification of leprosy in patients with leprosy reactions. Medical records were analyzed at a reference center between 2010 and 2015. Reactions occurred in almost half of the patients, making their identification important. The bacilloscopic and operational characterization indicates a greater occurrence of leprosy reactions in patients with positive bacilloscopy and also in multibacillary.

Leprosy and American cutaneous leishmaniasis coinfection

Abstract: Brazil is a country with a high prevalence of infectious diseases such as leprosy and leishmaniasis. However, coinfection of these diseases is still poorly understood. We report a case of a patient who presented with lepromatous leprosy and cutaneous-mucosal leishmaniasis at the same period. After clinical, laboratory, and histopathological diagnosis, the treatment was introduced and the patient showed important clinical improvement. He was followed in our outpatient clinic. Both pathologies play an important role in the immune system. Depending on the immune response profile of the host, diseases may present themselves in different ways. In this case, the patient showed a divergent immune response for each disease. We hypothesized that this response is specific for each pathogen.

Imuno-histoquímica aplicada à cirurgia micrográfica de Mohs: estudo-piloto / Immunohistochemistry and Mohs micrografic surgery: a pilot study

Introdução: Na prática cirúrgica dermatológica, a cirurgia micrográfica de Mohs é de grande valia para a exérese de neoplasias cutâneas. No entanto, em determinados tipos de neoplasia, a imuno-histoquímica pode aumentar a acurácia diagnóstica. Objetivo: Relatar o uso da cirurgia micrográfica de Mohs associada à imuno-histoquímica e avaliar sua eficácia em relação aos métodos tradicionais. Método: Realizadas cirurgia micrográfica de Mohs em cinco casos de neoplasias cutâneas diversas e avaliação tecidual com hematoxilina-eosina e imuno-histoquímica, no intraoperatório. Resultados: Maior prevalência de pacientes do sexo feminino, idosos, com maior frequência de neoplasias do tipo carcinoma basocelular recidivado, na face. Em todos os casos foi possível realizar a imuno-histoquímica na peça congelada e, na maioria dos casos, foi realizado fechamento primário no primeiro estágio da cirurgia de Mohs, sem complicações pós-operatórias. Conclusão: A combinação das duas técnicas pode aumentar a sensibilidade, assegurando margens livres, permitindo menor número de recidivas e preservação de maior quantidade de tecido livre de neoplasia.

Introduction: In the dermatologic surgery practice, Mohs micrographic surgery is of great value in the excision of cutaneous neoplasias. Nevertheless, in certain types of neoplasia, immunohistochemistry can increase diagnostic accuracy. Objective: To describe the use of Mohs micrographic surgery associated to immunohistochemistry and evaluate their effectiveness regarding traditional methods. Method: Mohs micrographic surgery was performed in 5 cases of diverse cutaneous neoplasias. Tissue evaluation with hematoxylin-eosin and immunohistochemistry were carried out intraoperatively. Results: There was greater prevalence of elderly female patients with higher frequency of recurred basal cell carcinomas in the face. In all cases it was possible to perform immunohistochemistry in the frozen specimen. In most cases, primary closure was carried out in the first stage of the Mohs surgery, without postoperative complications. Conclusion: The combination of the two techniques can increase the procedure's sensitivity, guaranteeing the presence of free margins, leading to fewer recurrences and allowing the preservation of a greater amount of neoplasia-free tissue.