Rhino-orbito-cerebral mucormycosis caused by Rhizopus microsporus var. microsporus in a diabetic patient with COVID-19

Abstract COVID-19 disease caused by the SARS-CoV-2 coronavirus causes a wide range of clinical manifestations, ranging from mild to severe, with the main ones affecting the respiratory tract, such as pneumonia. In patients with greater severity, the high frequency of bacterial and fungal coinfection stands out, a situation related both to the patient's pre-existing comorbidities and due to the hospitalization itself. Cases of mucormycosis associated with COVID-19 were highlighted in the lay and scientific media, with the increase in mycosis cases being directly and indirectly attributed to the viral infection. This report describes a case of rhino-orbito-cerebral mucormycosis in a diabetic patient hospitalized for COVID-19, whose diagnosis was confirmed by identifying the agent Rhizopus microsporus var. microsporus through culture for fungi and PCR examination.

Presence of hyphae in chromoblastomycosis examinations: an enigma to be solved

Abstract The detection of muriform cells in direct mycological or anatomopathological examination is considered pathognomonic for chromoblastomycosis. The morphological aspect that these fungal structures acquire were called "Borelli spiders", when associated with hyphae. Reports of this association have been described for decades, initially related to more pathogenic agents of this mycosis. More recent studies have shown aspects related to the host's immunity that participate in this process, as well as an association with a worse disease prognosis. The present study discloses the findings of complementary examinations with the presence of "Borelli's spiders" in a patient diagnosed with chromoblastomycosis.

Pagetoid dyskeratosis in dermatopathology

Abstract Currently, pagetoid dyskeratosis is believed to involve an accelerated keratinization process, possibly induced by mechanical trauma. It represents, in almost its totality, incidental histological findings of specific cells, except when it occurs in the hands, where it usually occurs simultaneously with skin lesions and local dyschromia. These are large, rounded keratinocytes, with pale cytoplasm and a pyknotic nucleus surrounded by a clear halo, which can be easily mistaken by other skin diseases. Its etiology is not completely elucidated, and the correct identification of this entity can be of great importance in the differential diagnosis of skin disorders and the understanding of the keratinization process of the epidermis.

Identification of Leishmania species by high-resolution DNA dissociation in cases of American cutaneous leishmaniasis

Abstract Background American cutaneous leishmaniasis is an infectious dermatosis caused by protozoa of the genus Leishmania, which comprises a broad spectrum of clinical manifestations depending on the parasite species involved in the infections and the immunogenetic response of the host. The use of techniques for amplification of the parasites DNA based on polymerase chain reaction polymerase chain reaction and the recent application of combined techniques, such as high-resolution DNA dissociation, have been described as a viable alternative for the detection and identification of Leishmania spp. in biological samples. Objectives To identify the Leishmania species using the polymerase chain reaction high-resolution DNA dissociation technique in skin biopsies of hospital-treated patients, and compare with results obtained by other molecular identification techniques. Methods A retrospective study assessing patients with suspected American cutaneous leishmaniasis seen at a hospital in São Paulo/Brazil was conducted. The paraffin blocks of 22 patients were analyzed by polymerase chain reaction high-resolution DNA dissociation to confirm the diagnosis and identify the species. Results Of the 22 patients with suspected American cutaneous leishmaniasis, the parasite was identified in 14, comprising five cases (35.6%) of infection by L. amazonensis, four (28.5%) by L. braziliensis, two (14.4%) by L. amazonensis + L. infantum chagasi, two (14.4%) by L. guyanensis, and one (7.1%) by Leishmania infantum chagasi. In one of the samples, in which the presence of amastigotes was confirmed on histopathological examination, the polymerase chain reaction high-resolution DNA dissociation technique failed to detect the DNA of the parasite. Study limitations The retrospective nature of the study and small number of patients. Conclusions The method detected and identified Leishmania species in paraffin-embedded skin biopsies with a sensitivity of 96.4% and could be routinely used in the public health system.

Pseudomycetoma of the scalp caused by Microsporum canis

Abstract Pseudomycetoma is an extremely rare deep mycosis, caused by dermatophytic fungi that penetrate the tissue from infected follicles of tinea capitis. Both clinically and histopathology are similar to eumycetoma, being distinguished through the isolation of the fungus, which in the case of pseudomycetoma can be Microsporum spp. or Trichophyton spp. genre. We present a 24-year-old man with an exuberant tumor in the occipital region with fistula, whose histopathological examination evidenced grains composed of hyaline hyphae and the culture for fungi isolated the agent Microsporum canis. Combined treatment of surgical excision followed by oral griseofulvin for two years was performed, with resolution of the condition.

Aspects of Langerhans cells and TNF-α in the cutaneous immunity of anogenital warts

Abstract Background: Anogenital warts are the leading sexually transmitted infection in patients seeking care at specialized clinics. They may display a vast array of forms, according to the interaction of the virus with the host's immunity. Cellular immunity is the epithelium's main form of defense against the virus, involving an active participation of the Langerhans cells and pro-inflammatory cytokines such as TNF-α. Objective: To assess the epithelial immune response of anogenital warts in males, according to the number of lesions presented. Methods: This is a prospective, cross-sectional study carried out at the dermatology outpatient clinic in a tertiary hospital. We included male patients over 18 years of age without comorbidities who had anogenital condylomata and no previous treatments.In order to evaluate the local epithelial immunity, the lesions were quantified, then removed and employed in CD1a immunohistochemistry assays for assessing the morphometry and morphology of Langerhans cells; TNF-α; reaction was used for determining cytokine positivity in the epithelium. Results: 48 patients were included in the study. There was no statistically significant difference as to the number of Langerhans cells, in their morphology, or the presence of TNF-α. However, patients presenting with more Langerhans cells in the lesions had cells with a star-like and dendritic morphology, whereas in those with a lower cell count had cells with a rounded morphology and no dendrites (p < 0.001). Study limitations: Small number of patients analyzed. Conclusion: There was no difference in epithelial immunity between patients having few or many anogenital condyloma lesions as measured by the morphology and morphometry of Langerhans cells and TNF-α; positivity. Such an assessment employing immunity markers differing from the usual ones is expected to yield useful results.

In vivo and ex vivo dermoscopy of lesions from implantation of human papillomavirus in tattoos: report of two cases

Abstract The number of individuals with tattoos has been increasing worldwide, alongside with reports of complications varying from reactions to the injected pigments to infections caused by agents inoculated in the pigmentation process. The diagnosis of such unwanted events can be obtained through complementary non-invasive methods, preserving the maximum of the tattoo design. The authors present two cases of patients with warts on tattooing, and correlate their clinical aspects to in vivo and ex vivo dermoscopy, and to the findings in the histopathological examination, aiming to determine patterns that aid the diagnosis of these lesions without performing biopsy.

Paracoccidioidomycosis in a child: exuberant presentation due to the inadvertent use of systemic corticosteroids

Abstract: Paracoccidioidomycosis is a fungal infection that occurs in immunocompetent patients and are classified into two forms: the acute-subacute form, predominantly in young patients, and the chronic adult form that may present classic ulcerated lesions to rare sarcoid ones. We present the case of a boy whose infection began with sarcoid lesions but, after being mistakenly diagnosed with cutaneous sarcoidosis and treated (for three years) with prednisone, developed painful ulcerations throughout the body. After the correct diagnosis, with evidence of the fungus in histopathological and mycological examinations, the patient was properly treated with itraconazole for eight months and evolved with total remission of the disease.

Tratamento da poroqueratose actínica superficial disseminada com laser 1340-nm Nd: YAP / Treatment of disseminated superficial actinic porokeratosis with 1,340nm Nd:YAP laser

Este estudo demonstrou o resultado clínico e histológico do tratamento com laser fracionado não ablativo de paciente com poroqueratose actínica superficial disseminada. A paciente recebeu sete sessões de laser 1340-nm Nd:YAP, com intervalos de quatro a cinco semanas. Biópsias e fotos foram realizadas antes e após o tratamento, o qual foi bem tolerado e trouxe melhora do eritema e da textura das lesões. O seguimento foi de um ano. O exame anatomopatológico após o tratamento revelou pouca modificação da lamela cornoide.

This study demonstrated the clinical and histologic result of the treatment of one disseminated superficial actinic porokeratosis patient with non-ablative fractional laser. The patient was treated with seven sessions of 1340-nm Nd:YAP laser, with 4 or 5 week-intervals. Biopsies and photographs were performed before and after treatment, which was well tolerated and lead to improvement in the erythema and texture of the lesions. There was a 1-year follow-up. Histopathologic examination after treatment revealed little changes in the cornoid lamella.

Vertical plane ex vivo dermoscopy: a novel dermoscopic technique. A preliminary study

Abstract: Dermoscopic examination allows visualization of horizontal images on the skin, showing well-defined patterns. The authors propose ex vivo dermoscopic visualization using a vertical view of skin sections. The new image clearly distinguishes the stratum corneum, epidermis, and dermis as well as the anatomical location of the pigment. Will this new approach be useful in dermoscopic diagnosis? Further studies are needed.

Cutaneous atypical mycobacteriosis with sporotrichoid clinical presentation caused by automotive accident

Abstract: Atypical mycobacterial infections are caused by mycobacteria other than those from the M. tuberculosis complex and M. leprae. Its incidence has increased progressively, with considerable increase of scientific publications on the subject. Only 10% of the cases present with cutaneous infections, most of them related to surgical interventions and aesthetic procedures. We present a case of mycobacteriosis due to automotive accident that presented a diagnostic challenge due to its clinical presentation with lesions of sporotrichoid progression in the lymphatic system.

Donovanosis in a child victim of sexual abuse: response to doxycycline treatment

Abstract: Donovanosis is a chronic infectious disease caused by the Gram-negative bacteria Klebsiella granulomatis, which mainly affects the skin and mucous membranes of the genital, perigenital, and inguinal regions. Also known as venereal granuloma or granuloma inguinale, it is endemic in tropical and subtropical regions of the globe and often associated with sexual transmission. We report the case of an 11-year-old female victim of chronic sexual abuse, who was diagnosed with donovanosis and presented a good therapeutic response to doxycycline.

Subcutaneous fat necrosis of the newborn: clinical and histopathological correlation

Abstract: Subcutaneous fat necrosis of the newborn is a rare benign panniculitis found in term and post-term neonates. Diagnosis is based on clinical characteristics and specific alterations in the adipocytes, detected by anatomical pathology. Subcutaneous fat necrosis of the newborn can occur in uncomplicated pregnancy and childbirth. However, perinatal complications such as asphyxia, hypothermia, seizures, preeclampsia, meconium aspiration, and even whole-body cooling used in newborns with perinatal hypoxia/anoxia may be associated with this entity.

Pigmented Bowen's disease associated with high-risk HPV simulating melanoma of the hand

Abstract: Bowen's disease is an in situ squamous cell carcinoma of the skin with only 2% of pigmented cases reported. It is clinically characterized by papules and plaques of blackened surface that may be caused either by sun damage - usually in photoexposed areas in elderly individuals - or by human papillomavirus infection - usually in the anogenital region of young adults. Dermoscopic aspects of Bowen's disease are discussed for over a decade, but with no definitive criteria that would lead to a definitive diagnosis. We present a case of Bowen's disease affecting the finger of a 57-year-old Asian patient. The lesion clinically and dermoscopically simulated a melanoma. Histopathological findings suggested the diagnosis of pigmented Bowen's disease. Pigmented Bowen's disease should be considered a differential diagnosis of melanoma, since its clinical and dermoscopic criteria are unspecific. Histopathological examination remains the gold standard for the diagnosis of the disease.

Synchronous conjunctival melanoma and lentigo maligna melanoma

Abstract: Lentigo maligna has an extensive and neoplastic character. It typically progresses slowly and may eventually develop into an invasive melanoma, which is called lentigo maligna melanoma. Ocular melanoma is the second most common type of melanoma. The uvea is the most common site of origin of ocular melanomas, while conjunctival melanoma accounts for about 1-5% of cases. In this article, we describe a rare case of synchronic conjunctival melanoma and lentigo maligna on the face.

Tratamento cirúrgico e seguimento a longo prazo das micoses subcutâneas causadas por fungos demáceos: cromoblastomicose, feoifomicose e eumicetoma / Surgical treatment and long-term follow-up of subcutaneous mycoses caused by dematiaceous fungi: chromoblastomycosis, phaeohyphomycosis and eumicetoma

Introdução: As micoses subcutâneas provocadas por fungos demáceos (MSCFD)são classificadas conforme sua apresentação no tecido: cromoblastomicose com presença de corpúsculos fumagoides, feoifomicose com hifas septadas demáceas e eumicetoma com grãos compostos por hifas septadas demáceas. Diversos tratamentos são propostos, entre eles a exérese cirúrgica. O tratamento cirúrgico é mais indicado nos casos em que há infecção localizada e passível de exérese, com bons resultados terapêuticos e baixa taxa de recidiva. Objetivo: Apresentar a experiência de um serviço dermatológico no tratamento cirúrgico dos casos de MSCFD, discutindo as abordagens cirúrgicas e seus resultados. Métodos: Estudo retrospectivo com análise descritiva dos casos atendidos no período de abril de 2014 a dezembro de 2016 em clínica dermatológica da cidade de São Paulo. Foram incluídos todos os casos com diagnóstico de MSCFD que foram submetidos à terapêutica cirúrgica com exérese total da lesão. Resultados: Foram totalizados sete casos: dois de eumicetoma, um de cromoblastomicose e quatro de feoifomicose. De todos os casos apenas um não foi abordado em regime de centro cirúrgico ambulatorial. Todos evoluíram sem sequelas e sem recidivas no seguimento clínico. Conclusões: A remoção da lesão cutânea é um boa opção terapêutica nos casos de MSCFD em que o procedimento cirúrgico for viável.

Introduction: Subcutaneous mycoses caused by dematiaceous fungi are classified according to their characteristics in the tissue: chromoblastomycosis (with the presence of fumagoid corpuscles), phaeohyphomycosis (with dematiaceous septate hyphae) and eumicetoma (with grains composed of septate hyphae). Several treatments are proposed, among them, surgical excision. Surgical treatment is more indicated in cases where there is localized infection and where excision is possible, yielding good therapeutic outcomes and low recurrence rates. Objective: To describe the experience of a dermatological service in the surgical treatment of subcutaneous mycosis cases caused by dematiaceous fungi, discussing the surgical approach and its results. Methods: A retrospective study was carried out with the descriptive analysis of cases treated from April 2014 to December 2016, at a dermatological clinic in the Brazilian Southeast city of São Paulo. All cases diagnosed with subcutaneous mycoses caused by dematiaceous fungi were included and surgically treated with total exeresis of the lesion. Results: A total of 7 cases were analyzed ­ 2 eumicetomas, 1 chromoblastomycosis and 4 phaeohyphomycoses. Only one on the cases was not treated at an ambulatory surgical center. All cases progressed without sequelae or recurrences during the clinical follow-up. Conclusions: When surgical treatment is possible, the exeresis of the lesion is a good therapeutic option in cases of subcutaneous mycoses caused by dematiaceous fungi.