ABSTRACT
Las lesiones cutáneas son causa frecuente de consulta en viajeros siendo las picaduras de insectos unas de las más prevalentes. Damos a conocer un caso de paciente que presenta una lesión dolorosa en cuero cabelludo, tras viaje a la selva boliviana, refractario a tratamiento antibiótico empírico y con estudio complementario inconcluyente. Finalmente, se realizó estudio macroscópico de la costra, que determinó que se trataba de una larva de Dermatobia Hominis. Este caso demuestra la importancia de tomar en cuenta estos agentes no presentes en Chile y que son causantes de patologías dermatológicas del viajero.
Cutaneous lesions are frequent cause of consultation in travelers, being insect bites one of the most prevalent. We present a case of a patient with a painful lesion on the scalp, after a trip to the Bolivian jungle, refractory to empirical antibiotic treatment and with an inconclusive complementary study. Finally, macroscopic study of the crust was carried out, which determined that it was a larva of Dermatobia Hominis. This case demonstrates the importance of taking into account these agents not present in Chile and that are the cause of dermatological pathologies of the traveler.
Subject(s)
Humans , Animals , Male , Adult , Skin Diseases, Parasitic/diagnosis , Diptera , Myiasis/diagnosis , Scalp , Skin Diseases, Parasitic/parasitology , Skin Diseases, Parasitic/pathology , Travel , Biopsy , Chile , Larva , Myiasis/parasitology , Myiasis/pathologyABSTRACT
La pitiriasis liquenoide crónica (PLC) es una enfermedad benigna, que se caracteriza por tener un curso gradual, con aparición de múltiples pápulas con escamas adherentes de predominio en tronco y extremidades proximales. Con el objetivo de describir la presentación clínica, discutir el diagnóstico, diagnósticos diferenciales, tratamiento y revisar la literatura se presenta el caso de un hombre de 88 años que presentó múltiples lesiones papuloescamosas en extremidades inferiores. Se realizó biopsia cutánea que confirmó el diagnóstico de PLC. El paciente recibió tratamiento con emulsión hidratante, clobetasol tópico y claritromicina con resolución completa de las lesiones. La pitiriasis liquenoide crónica es un trastorno inflamatorio poco frecuente, de etiología desconocida que ocurre más comúnmente en adultos jóvenes y niños. Si bien la clínica es sugerente, se requiere biopsia cutánea para su confirmación diagnóstica. Es un trastorno benigno, a menudo asintomático y autolimitado, por lo que se debe valorar su tratamiento paciente a paciente. Principalmente se utilizan corticoides tópicos y antibióticos orales (tetraciclinas y eritromicina). Se ha vinculado en escasas publicaciones con el desarrollo de linfoma cutáneo y como síndromes paraneoplásicos, por lo que se sugiere realizar seguimiento.
Chronic lichenoid pityriasis (PLC) is a benign disorder, characterized by a gradual course with the appearance of multiple squamous papules with adherent scales predominating in the trunk and proximal extremities. With the objective to describe its clinical presentation, diagnosis, differential diagnosis, treatment and review literature, we present an 88-yearold male with multiple lesions in the lower extremities of one year of evolution, with papules and adherent scales. A skin biopsy was performed that confirmed the diagnosis of PLC. The patient received treatment with moisturizing emulsion, clobetasol topical and clarithromycin with complete resolution of the lesions. Chronic lichenoid pityriasis is a rare inflammatory disease of unknown etiology that occurs most commonly in young adults and children. Although the clinic is suggestive, a skin biopsy is required for diagnostic confirmation. It is a benign disorder, often asymptomatic and self-limiting, so its patientto- patient treatment should be assessed. Topical corticosteroids and oral antibiotics (tetracyclines and erythromycin) are used. It has been linked in few publications with the development of cutaneous lymphoma and as paraneoplastic syndromes, so it is suggested to follow up.
Subject(s)
Humans , Male , Aged, 80 and over , Pityriasis Lichenoides/diagnosis , Pityriasis Lichenoides/pathology , Biopsy , Clobetasol/administration & dosage , Chronic Disease , Treatment Outcome , Pityriasis Lichenoides/drug therapy , Clarithromycin/administration & dosage , Anti-Inflammatory Agents/administration & dosage , Anti-Bacterial Agents/administration & dosageABSTRACT
Background: Erythema Nodosum (EN) is an acute nodular erythematous cutaneous eruption. It is presumed to be a hypersensitivity reaction and it may be idiopathic, or occur in association with diverse diseases and medications. Aim: To identify the main etiologies of EN among patients admitted to a medicine service of a clinical hospital. Material and Methods: Analysis of medical records of patients discharged with the diagnosis of EN during a ten years period. Patients were considered to have secondary EN when an underlying condition was found, and to have idiopathic EN when no such condition was found. Results: One hundred twenty nine patients were identified, but 91, aged 38 ± 14 years (86% females) had available clinical information. The etiology was idiopathic in 32% and secondary in 68% of patients. The leading etiologies were post-Streptococcal in 32%, followed by sarcoidosis in 11%, primary tuberculosis in 7%, Mycoplasma infection in 3%, Bartonella infection in 3%, Behçet’s syndrome in 2%, inflammatory bowel disease in 2%, drugs in 1% and other etiologies in 8%. Secondary cases of EN had higher levels of C Reactive Protein and leucocytes than idiopathic cases. Conclusions: The distribution of causes in our study population were similar to those reported in the literature (With smaller proportion of idiopathic), as was the man/woman (1/6) ratio, and the preponderance of cases in winter and spring. Infectious diseases were the leading causes of EN in this group of patients, and a reasonable initial approach in the hospital should include a diligent medical history and physical examination, complete blood count, ESR, titles ASO, PPD tuberculin skin test, chest X-ray or CT scan and, where deemed appropriate, specific autoimmune and infectious serology.