Early malignant syphilis

Abstract Early malignant syphilis is a rare and severe variant of secondary syphilis. It is clinically characterized by lesions, which can suppurate and be accompanied by systemic symptoms such as high fever, asthenia, myalgia, and torpor state. We report a diabetic patient with characteristic features of the disease showing favorable evolution of the lesions after appropriate treatment.

Dermatomyositis: analysis of 109 patients surveyed at the Hospital das Clínicas (HCFMUSP), São Paulo, Brazil

BACKGROUND: Dermatomyositis affects striated muscles, skin and other organs. OBJECTIVE: To characterize the disease from January 1992 to December 2002, assessing its classification, cutaneous and systemic manifestations, and also laboratory results, therapeutic and prognostic findings compared to those in the literature. METHODS: Data were obtained from medical records of 109 patients who were classified into five groups: 23 juvenile dermatomyositis; 59 primary idiopathic dermatomyositis; 6 amyopathic dermatomyositis; 7 dermatomyositis associated with neoplasms and 14 dermatomyositis associated with other connective tissue diseases. RESULTS: Sixty patients were classified as "definite" diagnosis; 33 as "possible"; four as "probable" and 12 and as amyopathic. The average age at diagnosis was 36 years. Cutaneous manifestations occurred in all patients; the most frequent symptom was loss of proximal muscle strength; the most common pulmonary disorder was interstitial lung disease, and gastritis was the most prevalent digestive manifestation. Tumors were documented in 6.42% of cases. Lactate dehydrogenase was the muscle enzyme most frequently elevated in the majority of cases. Skin biopsies were performed in 68 patients; muscle biopsies in 53; and electroneuromyographies in 58 patients. The most commonly used treatment was corticotherapy and the mortality rate was 14.7%. CONCLUSION: in this sample, the disease appeared in younger individuals, was more frequent in women and the association with cancer was small. .

Segmental vitiligo after infliximab use for rheumatoid arthritis - A case report

The tumor necrosis factor alpha is a cytokine related to immune and inflammatory processes by acting on different parts of the body. It is secreted by several cell types including macrophages, lymphocytes, monocytes, neutrophils, dendritic cells, among others. Infliximab is a chimeric monoclonal antibody that specifically binds to soluble and transmembrane tumor necrosis factor alpha form blocking its action. In rheumatoid arthritis it is used because the cytokines that cause inflammation in this disease are regulated by tumor necrosis factor alpha and IL-1. We report the case of a 46-year-old patient with rheumatoid arthritis who developed segmental vitiligo after two months using infliximab. The event aims to alert to the existence of this adverse effect that can be induced with the use of this medication.

Avaliação da resposta imune anti-Mycobacterium tuberculosis em pacientes com psoríase moderada a grave submetidos à terapia com inibidor de fator de necrose tumoral, infliximabe / Evaluated of immune responses anti-Mycobacterium tuberculosis in patients with psoriasis moderade to severe undergoing treatment with TNF blocking agent, infliximab

O tratamento de pacientes apresentando doenças inflamatórias imunomediadas com drogas anti-TNF-alfa aumenta o risco da reativação da tuberculose. Isso sugere que tais drogas possam afetar a imunidade celular destes. No entanto, há dados conflitantes sobre se esse tratamento suprime as respostas para o teste tuberculínico (TT) e os ensaios de liberação de interferon-gama (IGRAs) e poucos dados em pacientes com psoríase. O presente estudo avaliou pacientes com psoríase moderada a grave enfocando os efeitos do tratamento com infliximabe em suas respostas imunológicas celulares. Foram avaliadas as respostas imunes celulares de doze pacientes antes e durante o tratamento com infliximabe. As células mononucleares do sangue periférico (PBMC) foram estimuladas com a fito-hemaglutinina (PHA), o superantígeno enterotoxina B (SEB), um lisado de citomegalovírus (CMV), e antígenos de Mycobacterium tuberculosis, e a ativação de linfócitos foi avaliada por ELISPOT para enumerar células secretoras de IFN-y, por ELISA para detecção da secreção de IFN-y, e através da incorporação de[3H] timidina para medir a proliferação. O tratamento com infliximabe não levou à redução de INF-y e da resposta linfoproliferativa nos pacientes. Pelo contrário, aumentou a liberação desta citocina em culturas de PBMC estimulados com PHA e SEB por 12 h. Este efeito foi mais notado no pico do efeito clínico do agente anti-TNF (7 semanas de tratamento) e menos proeminente no seu nadir (logo antes da infusão da próxima dose). Reatividade imunitária ao CMV também não foi significativamente afetada, notando-se leve aumento pelo agente anti-TNF. É de se notar que secreção de IFN-y e resposta proliferativa a Mtb dos dois pacientes TT positivos foram, também, visivelmente aumentadas na semana 7, declinando quando infliximabe atingiu o seu nadir. Os efeitos deletérios do bloqueio do TNF em pacientes com psoríase grave, submetidos ao tratamento com infliximabe parecem ser atenuados, pelo menos parcialmente...

Treatment of patients with immune-mediated inflammatory diseases with anti-TNF agents increases the risk of tuberculosis reactivation, suggesting that it may affect their cellular immune response. However, there are conflicting data on whether anti-TNF treatment suppresses the responses to tuberculin skin test (TST) and interferon-y release assays and no information regarding psoriasis patients on anti-TNF treatment. The present study evaluated patients with moderate to severe psoriasis focusing on the effects of treatment with infliximab on their cellular immune responses. Cellular immune responses of twelve patients were evaluated before and during infliximab treatment. Peripheral blood mononuclear cells (PBMC) were stimulated with phytohemaglutinin (PHA), the superantigen enterotoxin B (SEB), a cytomegalovirus lysate (CMV), and Mycobacterium tuberculosis antigens, and the lymphocyte activation was evaluated by ELISPOT for enumeration of IFN-y-secreting cells, ELISA for detection of secreted IFN-y, and by [3H]thymidine incorporation for proliferation measurement. Treatment with infliximab does not lead to reduction in the INF-y and lymphoproliferative responses of patients. It rather increased the overnight release of this cytokine in PBMC cultures stimulated with PHA and SEB. This effect was most noted at the peak of the clinical effect of the anti-TNF agent (week 7 of treatment) and less prominent at its nadir (just before infusion of the next dose). Immune reactivity to CMV was also either unaffected or slightly increased by the TNF blocking agent. Of note, the IFN-y and proliferative responses to Mtb from the two TST-responder patients were also remarkably increased at week 7, declining when infliximab reached its nadir. The deleterious consequences of TNF blockade in patients with severe psoriasis undergoing infliximab treatment may be in part attenuated by an enhancing effect on the cell mediated immunity of the patients, possibly due to the...

Ceratoacantoma solitário após luz intensa pulsada para tratamento de melanoses solares no dorso das mãos / Solitary keratoacantoma after intense pulsed light in the treatment of melanoses on the dorsum of hand

O ceratoacantoma é tumor cutâneo benigno, de rápido crescimento, composto por células escamosas e possui características clínicas e histopatológicas semelhantes ao CEC, podendo sofrer regressão espontânea sem qualquer tipo de tratamento. Acomete principalmente idosos e imunossuprimidos do sexo masculino e que possuem pele clara, em locais do corpo que sofreram exposição crônica à luz solar, como rosto, antebraços e dorso das mãos. O diagnóstico diferencial com o CEC é importante. O tratamento preconizado é a excisão cirúrgica, sendo as outras formas: crioterapia, eletrocoagulação e aplicação intralesional de agentes quimioterápicos.

The keratoacanthoma is a fast growing benign skin tumor that is composed of squamous cells and has clinical and histopathological features similar to those of the squamous cell carcinoma, and may undergo spontaneous regression without any treatment. It mainly affects elderly and immunosuppressed males who have fair skin, occuring in body sites that have been chronically exposed to sunlight, such as the face, forearms and backs of hands. The differential diagnosis with squamous cell carcinoma is particularly important. The recommended treatment is its surgical excision. Other treatment modalities, such as cryotherapy, electrocoagulation and intralesional injection of chemotherapeutic agents, are also available.

Lucio's phenomenon: another case reported in Brazil / Fenômeno de Lúcio: mais um caso relatado no Brazil

Lucio's phenomenon is defined as a variant of type 2 leprosy reaction. It is a rare event, occurring in the evolution of leprosy of Lucio and other forms of lepromatous leprosy. It has an exacerbated proliferation of Hansen bacilli in its pathophysiology, which invade blood vessel walls and injure endothelial cells, causing endothelial proliferation and decreasing the vascular lumen. This fact, associated with inflammatory reactions and changes in the coagulation system causes vascular thrombosis, ischemia, infarction and tissue necrosis, leading to the histopathological characteristic of the phenomenon. We report a case of lepromatous leprosy with irregular treatment that developed Lucio's phenomenon. Treatment with multidrug therapy, antibiotics, steroids and thalidomide achieved a favorable outcome.

Define-se o fenômeno de Lúcio como uma variante da reação hansênica do tipo 2. Evento raro, que ocorre na evolução da hanseníase de Lúcio e de outras formas de hanseníase virchowiana. Tem na sua fisiopatologia uma proliferação exacerbada dos bacilos de Hansen, que invadem a parede dos vasos sanguíneos e agridem as células endoteliais, causando proliferação endotelial e diminuição do lúmen vascular, fato este, que associado a reações inflamatórias e a alterações no sistema da coagulação, causa trombose vascular, isquemia, infarto e necrose tecidual, gerando as alterações histopatológicas características do fenômeno. Relatamos um caso de hanseníase virchowiana, com tratamento irregular, que desenvolveu o fenômeno de Lúcio. Recebeu tratamento com poliquimioterapia, antibióticos, corticosteróide e talidomida, evoluindo com desfecho clínico favorável.

Dermatomiosite / Dermatomyositis

Dermatomiosite é doença idiopática inflamatória crônica que afeta a musculatura estriada, a pele e outros órgãos. Apresenta critérios diagnósticos definidos por Bohan & Peter, podendo os pacientes ser classificados em cinco grupos: dermatomiosite juvenil, dermatomiosite primária idiopática, dermatomiosites amiopáticas, dermatomiosite associada a neoplasias e dermatomiosite associada a outras doenças do tecido conectivo. O sexo feminino é mais afetado, e a idade média do diagnóstico é 40 anos. Manifestações cutâneas são observadas em todos os pacientes. Das alterações sistêmicas, a manifestação muscular mais freqüente é a perda de força proximal, e a manifestação pulmonar mais comum é a pneumopatia intersticial. Podem ser observadas neoplasias durante o seguimento da doença, sendo mais freqüentes nos pacientes acima de 60 anos. A desidrogenase lática é a enzima muscular alterada na maioria dos casos. Para diagnóstico da dermatomiosite, pode ser realizado exame anatomopatológico de biópsia cutânea e biópsia muscular, além de eletroneuromiografia. Os corticóides são a terapia mais utilizada. As causas de óbito mais freqüentes são a neoplasia maligna, a septicemia e a infecção pulmonar.

Dermatomyositis is a chronic idiopathic inflammatory disorder that affects striated skeletal muscles, the skin, and other organs. Diagnostic criteria were established by Bohan & Peter and patients may be classified into five groups: juvenile dermatomyositis, primary dermatomyositis, amyopatic dermatomyositis, dermatomyositis associated with malignancies and dermatomyositis associated with other connective tissue disorders. Females are more affected and the mean age of diagnosis is 40 years. Skin manifestations are observed in all patients. Loss of proximal strength is the most common systemic alteration and lung involvement is most often manifested as interstitial pneumopathy. Neoplasms may be detected during the course of the disease specially in patients over 60. Lactic dehydrogenase serum levels are altered in the majority of cases and diagnosis can be established or the basis of skin and muscle biopsies and electroneuromiography. Corticosteroids are the first line drugs. The most common causes of death are malignant neoplasms, sepsis and pulmonary infection.