Unhas meio a meio e síndrome das unhas amarelas em pacientes hemiplégicos com insuficiência renal / Half-and-half nails and yellow nail syndrome in hemiplegic patient with renal failure

Insuficiência renal crônica tem sido associada com várias alterações ungueais, devidas à condição renal ou ao tratamento. Unhas meio-a-meio constituem o achado mais comum. A síndrome das unhas amarelas se caracteriza por unhas amarelas, edema linfático e distúrbios respiratórios. Além disso, alterações ungueais podem desenvolver com o envelhecimento, incluindo-se modificações na velocidade de crescimento, cor, contorno, superfície, e espessura. Unhas meio-a-meio e unhas amarelas são descritas em um homem de 85 anos, com seqüela de hemiplegia direita e insuficiência renal. As unhas meio-a-meio foram observadas exclusivamente na mão paralisada. É possível que fatores patogênicos da síndrome tiveram influência de distúrbios vasculares locais no leito ungueal, secundários à hemiplegia. Assim, os dedos da mão direita poderiam ser poupados das alterações de unhas amarelas, desenvolvendo características de unhas meio-a-meio. Embora ambas condições ocorram em idosos e em renais crônicos, a coexistência de síndrome das unhas amarelas e unhas meio-a-meio é muitíssimo rara.

Chronic renal failure has been associated with several nail changes due to renal condition or to the treatment. Half-and-half nails constitute the most common finding. The yellow nail syndrome is characterized by yellow nails, lymph edema and respiratory disturbances. Moreover, nail disorders may develop with ageing, including changes in the growth rate, color, contour, surface, and thickness. Half-and-half nails and yellow nails are described in 85-year-old male with brachial sequel of right hemiplegia and renal failure. The half-and-half nails were exclusively observed in the paralyzed hand. It is possible that pathogenic factors of the syndrome were under the influence of local disturbances in nail-bed vessels secondary to hemiplegia. Thus, the right fingers could be spared of yellow nail changes and developed the half-and-half nail features. Although both conditions may occur in elderly and chronic renal patients as well, yellow nail syndrome coexistent with half-and-half nails is exceedingly rare.

Hantavirus pulmonary syndrome coexistent with dengue.

Dengue is an arthropod-borne disease caused by viruses of Flaviviridae family. It poses a major public health burden in tropical and sub-tropical regions. Clinical features of dengue vary from a mild flu-like disease and rash, to a potentially lethal haemorrhagic fever or shock syndrome. Hantavirus pulmonary syndrome is a rodent-born disease emerging in the American continent and is caused by viruses of the Bunyaviridae family. Potential reservoirs of these agents were described in Brazilian Central Plateau. Dengue infection is transmitted by mosquitoes, while hantaviruses are acquired by contact or inhalation of aerosolised excreta of infected rodents. Dengue and hantavirus infections have also been considered as emerging public health problems in some Indian areas; moreover, other infections mixed with dengue have been documented. The case of a Brazilian patient with hantavirus pulmonary syndrome and serologic evidence of dengue infection is described.