A importância do uso precoce de hialuronidase no tratamento de oclusão arterial por preenchimento de ácido hialurônico / The importance of the early use of hyaluronidase in the treatment of arterial occlusion resulting from hyaluronic acid based cutaneous filling

A isquemia cutânea é um dos eventos adversos vasculares decorrentes da aplicação de ácido hialurônico, causada por embolia arterial. A aplicação precoce de hialuronidase representará o sucesso da degradação e reversão do quadro que pode ser grave e causar danos ao paciente. Relatam-se casos com suspeita de oclusão arterial no qual foi realizada degradação com hialuronidase em diferentes períodos. Tal análise permitiu observar que o tempo de degradação e a eficácia do procedimento relacionam-se com tempo de intervenção

Cutaneous ischemia, caused by arterial embolism, is one of the vascular adverse events resulting from the application of hyaluronic acid. Early application of hyaluronidase will lead to the successful degradation and reversal of the condition ­ which might be severe and cause harm to the patient. The authors report cases with suspected arterial occlusion in which degradation was performed with hyaluronidase at different timepoints. This analysis has evidenced that the degradation time and the procedure's effectiveness are correlated to the intervention timepoint.

Proteus syndrome

Abstract: Proteus syndrome is a rare syndrome characterized by disproportionate overgrowth of limbs, multiple hamartomas, and vascular malformations. The cerebriform connective tissue nevi, also called cerebriform plantar hyperplasia, are present in most patients, and is the main characteristic of the syndrome. If present, even alone, they can be considered as a pathognomonic sign. This article reports a classic case of Proteus syndrome in a 2-year-old male patient who began to show a discrete asymmetry of the right hemibody in relation to the left one after birth, which increased over the months. He also showed cerebriform plantar hyperplasia and Port-wine stains, among other alterations.

Disseminated cryptococcosis manifested as a single tumor in an immunocompetent patient, similar to the cutaneous primary forms

Abstract Cryptococcosis is a fungal infection caused by Cryptococcus neoformans that tends to affect immunocompromised individuals. The fungi are mostly acquired by inhalation, which leads to an initial pulmonary infection. Later, other organs - such as the central nervous system and the skin - can be affected by hematogenous spread. In addition, cutaneous contamination can occur by primary inoculation after injuries (primary cutaneous cryptococcosis), whose diagnosis is defined based on the absence of systemic involvement. The clinical presentation of cutaneous forms typically vary according to the infection mode. We report an unusual case of disseminated cryptococcosis in an immunocompetent patient with cutaneous lesions similar to those caused by primary inoculation. This clinical picture leads us to question the definition of primary cutaneous cryptococcosis established in the literature.