Yellow nail syndrome and adnexal tumour: Causal or casual association.

The yellow nail syndrome is an uncommon condition characterised by dystrophic nails, pulmonary disturbances and lymph oedema. In Brazil as well as in India, this syndrome has been scarcely described, at least in part due to diagnosis pitfalls related with darker skin pigmentation. A case of adnexal malignancy developing several decades after initial signs of yellow nail syndrome is reported in a 61-year-old Brazilian female admitted for evaluation of peripheral oedema. She reported recurrent sinusitis and bronchitis, and three antecedent pneumonias. Physical examination showed yellow thickened nails and lower limb oedema, and a painless huge adnexal mass. Diverse tumours have been described associated with yellow nail syndrome; however, associations can also occur by chance. The present report attempts to raise the awareness about casual co-existence of malignancy and the syndrome.

Drug-associated livedoid vasculopathy

Livedoid vasculopathy is reported in a 38-year-old white female, who first presented with spontaneous skin lesions in the left ankle, at 17 years old. For the last fifteen years she used low-dose oral contraceptive (gestodene and ethinylestradiol) and persisted asymptomatic for a long period. Nevertheless, painful red papules and dark spots reappeared in the same area and progressed to an intensely tender and irregular shallow ulcer, during summer. Skin biopsy samples showed dermal vessels with subintimal fibrinoid necrosis and intraluminal thrombosis, without clear inflammation. Cutaneous lesions have improved faster after topical betamethasone was added to treatment. Data from the present case suggests a drug-associated livedoid vasculopathy.

Relata-se caso de vasculopatia livedóide em uma mulher branca de 38 anos, que inicialmente apresentou lesões cutâneas espontâneas no tornozelo esquerdo aos 17 anos de idade. Durante os últimos quinze anos, fez uso de contraceptivos orais (gestodene e etinilestradiol). Permaneceu assintomática por longo período; entretanto, no último verão, pápulas avermelhadas dolorosas e manchas escuras reapareceram na mesma área e formaram uma úlcera rasa irregular intensamente dolorosa. O exame das amostras da biópsia de pele mostrou vasos dérmicos com necrose fibrinóide e trombose intraluminar, sem reação inflamatória. As lesões cutâneas apresentaram cicatrização mais rápida após acréscimo de betametasona tópica ao esquema terapêutico. Os dados do presente caso sugerem vasculopatia livedóide associada ao uso de droga.