Cutaneous metastases in a patient with no previous diagnosis of cancer: diagnostic challenge

Abstract: On rare occasions, skin lesions are the first local of metastatic manifestation of internal malignancies. In case of no previous diagnosis of these tumors, the approach of suspicious skin lesions becomes a challenge, especially in differentiating cutaneous metastases and adnexal primary neoplasms. Currently, besides epidemiologic, dermoscopic and histopathologic aspects, the evaluation also integrates immunohistochemical exams and cell markers such as p40 and p63, highly specific for skin metastases. This article describes the case of cutaneous metastases as the sole obvious sign of breast cancer in a previously asymptomatic woman. The diagnosis was made by the finding of neoplastic cells in the dermis and immunohistochemistry compatible with ductal carcinoma.

Disseminated cryptococcosis with cutaneous involvement in an immunocompetent patient

Abstract Cryptococcosis is a fungal infection of opportunistic behavior that is unusual in immunocompetent patients. We report a rare case of disseminated cryptococcosis with cutaneous involvement in an immunocompetent individual. During hospitalization, Cryptococcus gattii was isolated from skin lesions, lung and spinal fluid. The diagnosis of disseminated cryptococcosis was confirmed and treatment was established. The patient showed improvement. Due to the probable clinical severity of the disease and the possibility that skin lesions may be the first manifestation of this illness, prompt diagnosis must be established and treatment provided.

Response of chromoblastomycosis to voriconazole

Abstract: Chromoblastomycosis is a chronic fungal infection of the epidermis, dermis and subcutaneous tissue, in which the most common etiologic agent in Brazil is Fonsecaea pedrosoi. In more advanced cases we found many difficulties in their treatment, and therefore, we report a case of extensive and severe chromoblastomycosis, with therapeutical failure of first choice treatments, but good response to voriconazole.

O Papel Transformador do Estudante de Medicina no Cenário da Endemia de Hanseníase no Brasil: Relato de Experiência / The Transformative Role of the Medical Student in relation to the Leprosy Endemic in Brazil: Case Report

RESUMO Durante o Internato em Saúde da Comunidade, os acadêmicos de Medicina vivenciaram uma experiência em que foi possível desenvolver habilidades e atitudes na resolução de um caso de diagnóstico tardio de hanseníase. Trata-se de um estudo descritivo de abordagem qualitativa, envolvendo uma Unidade Básica de Saúde da Família em Campo Grande (MS) e a Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul. O acompanhamento desta paciente permitiu reflexões e aprendizado quanto à necessidade de realizar exame físico e, com base em protocolos para diagnóstico e tratamento da hanseníase, assegurar o acompanhamento e seguimento de um caso que permaneceu por mais de dois anos sem tratamento apesar dos evidentes sinais clínicos da doença. Por outro lado, o analfabetismo, a ocupação e o espaço geográfico da paciente contribuíram para o agravamento do quadro. Este estudo de caso favoreceu uma visão ampliada da formação de profissionais, que praticaram a integração dos diferentes campos de conhecimento para garantir a assistência integral à paciente.

ABSTRACT Medical students during their Internship in Community Health hadan experience in which it was possible to develop skills and attitudes in solving a case of late diagnosis of leprosy. Thisis a descriptive qualitative study, involving a Basic Family Health Unit inCampo Grande (MS)and the Federal University of Mato Grosso do SulMedicine School. Following the patient’s case allowed for reflections and learning regarding the need to perform physical examination and, based on procedures for leprosy diagnosis and treatment, to ensure the adequate follow-up and monitoring of a case in which the patient was not treated for more than two years, despite the obvious symptoms of the disease. Moreover, the patient’s illiteracy, occupation and geography contributed to condition worsening. This case study favored an expanded view on the training of professionals, who practiced the integration of different fields of knowledge to ensure comprehensive patient care.

Granulomatosis with polyangiitis, a new nomenclature for Wegener's Granulomatosis - Case report

The granulomatosis with polyangiitis, initially known as Wegener's granulomatosis, is a small and medium vessels vasculitis. It's classic form presents a triad: necrotizing granuloma of respiratory tract, necrotizing cutaneous vasculitis and glomerulonephritis. This vasculitis has cytoplasmic antineutrophil antibodies as signal. This work illustrates a case, of multisystemic rare disease, in which the segment and treatment were considered satisfactory for symptoms remission.

Brazilian Spotted Fever: the importance of dermatological signs for early diagnosis

Brazilian spotted fever is an acute febrile infectious disease caused by Rickettsia rickettsii, transmitted by tick bite. As this disease is rare and has high mortality rates in Brazil, the clinical aspects and epidemiological data may help the diagnosis. We report a case of Brazilian spotted fever in a 19-year-old patient who presented maculopapular exanthema in the palmar region and upper limbs, lymphadenopathy, fever, chills, headache, conjunctival hyperemia, nausea, vomiting, dyspnea, myalgia, developing neurological signs and abdominal pain. He was treated with doxycycline with clinical improvement. We emphasize the importance of the recognition of this disease by dermatologists as cutaneous manifestations are the key findings to establish early diagnosis and prevent complications.

Do you know this syndrome? / Voce conhece esta sindrome?

The hyperimmunoglobulin E syndrome, or Job's syndrome is a rare primary immunodeficiency characterized by recurrent skin abscesses, recurrent respiratory tract infections, and high levels of IgE, eosinophilia, bone and dental changes. We report the case of a fourteen-year-old male patient presenting this disease, with both typical and also some relatively sporadic manifestations. We performed a literature review on the syndrome and its associated clinical findings.

A síndrome de hiperimunoglobulinemia E, ou síndrome de Job é uma imunodeficiência primária rara, caracterizada por abcessos cutâneos recorrentes, infecções de repetição do trato respiratório, títulos elevados de IgE, eosinofilia, alterações ósseas e dentárias. Relata-se o caso de um paciente do sexo masculino, 14 anos, portador da doença, com manifestações desde típicas a algumas relativamente esporádicas, fazendo-se uma revisão da síndrome e dos achados clínicos associados.

Study of dermatoses in kidney transplant patients / Estudo das dermatoses em pacientes transplantados renais

BACKGROUND: The increasing in the number of kidney transplant recipients has favored, more frequently than before, the emergence of dermatoses and warranted their study through subsequent publications. OBJECTIVES: to evaluate the frequency of dermatoses in kidney transplant recipients. METHODS: kidney transplant recipients with suspected dermatoses between March 1st 2009 and June 30th 2010. RESULTS: 53 patients (28 males and 25 females), aged between 22 and 69 (mean age = 45 years) were evaluated. Most of them came from the cities of Ceilândia, Samambaia and São Sebastião/DF, and had already been transplanted for 5 to 10 years before (37.7%); 62.3% were recipients of living donors and 83% were prednisone-treated. The most prevalent dermatoses were of fungal (45.3%) and viral (39.6%) etiologies. Among the non-melanoma malignant neoplasms, the basal cell carcinoma prevailed (six cases), in spite of the low incidence. Concerning fungal dermatoses, 12 cases of onychomycosis, five of pityriasis versicolor and four of pityrosporum folliculitis were reported. For diagnosis, in most cases (64.2%), laboratory examinations (mycological and histopathological) were performed. CONCLUSION: cutaneous manifestations in kidney transplant recipients are generally secondary to immunosuppression. The infectious dermatoses, especially those of fungal origin, are frequently found in kidney transplant recipients and their occurrence increases progressively according to the time elapsed from the transplantation, which makes follow-up important. .

FUNDAMENTOS: o crescente aumento do número dos transplantados renais tem favorecido o aparecimento mais frequente das dermatoses e permitido o estudo em sucessivos trabalhos. OBJETIVOS: avaliar a frequência das dermatoses em pacientes transplantados renais. MÉTODOS: captação de pacientes transplantados renais durante o período de 1° de março de 2009 a 30 de junho de 2010 com suspeita de dermatoses. RESULTADOS : foram avaliados 53 pacientes (28 homens e 25 mulheres), entre 22 e 69 anos (com uma média de 45 anos), a maioria procedente de Ceilândia, Samambaia e São Sebastião/DF, entre 5 e 10 anos de transplante renal (37,7%), sendo 62,3% receptor de doador vivo e 83% em uso de prednisona. As dermatoses mais prevalentes foram as de etiologia fúngica (45,3%) e viral (39,6%). Das neoplasias malignas não-melanoma, apesar da baixa incidência, predominou o carcinoma basocelular (seis casos). Com relação s dermatoses de origem fúngica, ocorreram 12 casos de onicomicoses, cinco casos de pitiríase versicolor e quatro casos de foliculite pitirospórica. Para realização do diagnóstico, na maioria dos casos (64,2%), foi utilizado os exames laboratoriais ( micológicos e histopatológicos). CONCLUSÃO: as manifestações cutâneas em pacientes transplantados renais são geralmente secundárias imunossupressão. As dermatoses infecciosas, principalmente as de etiologia fúngica, são frequentes em pacientes transplantados renais, e sua ocorrência aumenta progressivamente, conforme o tempo transcorrido, a partir do transplante, sendo importante o acompanhamento. .

Caso para diagnóstico / Case for diagnosis

Esteatocistoma múltiplo é um raro transtorno genético autossômico dominante que se caracteriza por múltiplos cistos dérmicos de tamanho variável e assintomáticos. Descreve-se o caso de um paciente do sexo masculino, de 23 anos, com quadro clínico e evolutivo típicos dessa desordem.

Steatocystoma multiplex is a rare genetic disorder, autosomal dominant, that is characterized by multiple asymptomatic dermal cysts which vary in size. It is described here the case of a 23 year-old male patient with a typical clinical and evolutional progression of this disease.

Diferenças sexuais no lúpus eritematoso sistêmico em um paciente com diagnóstico inicial de síndrome daimunodefi ciência adquirida: relato de caso / Sex differences in systemic lupus erythematosus in a patient initially diagnosed with acquired immunodefi ciency syndrome: case report

O Lúpus Eritematoso Sistêmico é o protótipo das doenças autoimunes,sendo muito mais frequente em pacientes do sexo feminino, onde antesda puberdade ocorre numa proporção de mulheres/homens 3:1, durantea idade reprodutiva, em taxas que variam de 10:1 a 15:1, e apósmenopausa de 8:1 casos. Porém no sexo masculino, as manifestaçõesclínicas são mais graves e com maior índice de mortalidade. Relata-seum caso de Lúpus Eritematoso Sistêmico em um paciente do sexo masculino, ex-presidiário, que inicialmente teve seu diagnóstico confundido com Síndrome da Imunodefi ciência Adquirida, pelos achados defebre de origem indeterminada, candidíase esofágica, dispnéia aos esforços e aumento da desidrogenase lática, e que durante sua internaçãomanifestou-se com vasculite sistêmica e psicose.

Systemic Lupus Erythematosus (SLE) is the prototype for autoimmunediseases being so much more frequent on female patients in which beforereaching puberty the proportional occurrence of cases female/maleis based on 3:1, during reproductive fertile age, manifests in diversifi edrates, from 10:1 to 15:1 and after climacteric cycle, 8:1 cases. Neverthelesson male patients, clinical events seem to be more severe and reachhigher level of mortality. It’s known a case report concerning SystemicLupus Erythematosus on a male patient, former convict, where previousdiagnosis was abashed with SIDA due to the esophageal candidiasisfi ndings, fever of unknown origin and increase of lactic dehydrogenasewhich was unfolded during hospital period as systemic vasculitis andpsychosis.