ABSTRACT
ABSTRACT The authors present a case of lupus miliaris disseminatus faciei , a rare skin disease of unknown etiology, which may cause unaesthetic scarring due to its difficult treatment. The histopathological examination of epithelioid granulomas with caseating necrosis, together with the clinical features, are important for diagnosis and early treatment with better results. Despite difficult and unsatisfactory treatment, there are ongoing studies on therapy to improve aesthetic and social impairment. This case report describes an initial misdiagnosis delaying appropriate treatment, and highlights the value of physical examination and clinical judgment for another pathological examination, whenever necessary, aiming at better treatment outcomes in daily practice.
RESUMO Os autores apresentam um caso de lupus miliaris disseminatus faciei , uma dermatose rara, de etiologia desconhecida, que pode deixar cicatrizes não estéticas, pela dificuldade de tratamento. O exame histopatológico de granulomas compostos por células epitelioides, com necrose caseosa, e as características clínicas, são importantes para o diagnóstico e tratamento precoce, com melhores resultados. Apesar do tratamento difícil e insatisfatório, há estudos em andamento sobre terapias para melhorar o comprometimento estético e social. Este relato de caso descreve um diagnóstico inicial errôneo, que atrasou o tratamento adequado, e destaca o valor do exame físico e raciocínio clínico para solicitar outro exame anatomopatológico, quando necessário, de forma a obter melhores desfechos com o tratamento, na prática diária.
Subject(s)
Humans , Female , Adult , Eyelid Diseases/pathology , Eyelid Diseases/drug therapy , Facial Dermatoses/pathology , Facial Dermatoses/drug therapy , Tetracycline/therapeutic use , Prednisone/therapeutic use , Isotretinoin/therapeutic use , Cicatrix , Tacrolimus/therapeutic use , Rosacea/pathology , Rosacea/drug therapy , Dapsone/therapeutic use , Granuloma/pathology , Granuloma/drug therapy , Lupus Vulgaris/pathology , Lupus Vulgaris/drug therapy , Minocycline/therapeutic useABSTRACT
La tuberculosis cutánea (TC) es una afección infrecuente dentro de la tuberculosis extrapulmonar, siendo su clínica variada e inespecífica. Se presenta el caso de TC: Mujer de 48 años sin antecedentes mórbidos que consultó por lesión cutánea en pabellón auricular y piel circundante, de dos años de evolución, pruriginosa, con aumento de tamaño progresivo y supuración serosa ocasional, al examen se constató placa eritematosa anaranjada, de consistencia blanda. Reacción en Cadena de Polimerasa de biopsia evidenció infección por Mycobacterium tuberculosis, logrando remisión de la lesión con tratamiento antituberculoso establecido en las normas sanitarias de Chile. La TC es una entidad de difícil diagnóstico, incluso contando con cultivos. A causa del aumento de casos de tuberculosis por el incremento de factores inmunosupresores, y a su potencial agresividad sistémica, se recomienda un alto nivel de sospecha.
Cutaneous tuberculosis (CT) is an infrequent condition of extrapulmonary tuberculosis, with a varied and non-specific clinical morphologies. A case of CT is presented: 48-yearold woman with no morbid history, who consulted for a skin lesion in the auricular pavilion and surrounding area, of two years of evolution, pruritic, with increasing progressive size and occasional serous secreation. On physical examination, orange erythematous plaque with soft consistency was found. Polymerase Chain Reaction from biopsy, showed infection by Mycobacterium tuberculosis, achieving remission of the lesion with antituberculosis treatment established in Chilean sanitary regulations. CT is an entity difficult to diagnose even with the use of culture. A high level of suspicion is recommended because of the increase of cases of tuberculosis due to immunosuppressive factors and their potential systemic aggressiveness.
Subject(s)
Humans , Female , Middle Aged , Tuberculosis, Cutaneous/diagnosis , Tuberculosis, Cutaneous/pathology , Biopsy , Polymerase Chain Reaction , Diagnosis, Differential , Ear AuricleABSTRACT
Lúpus eritematoso cutâneo crônico é doença autoimune, com apresentações polimorfas que podem, eventualmente, mimetizar outras condições clínicas, causando dificuldade diagnóstica. Quadro acneiforme, com comedões e lesões atróficas pontuadas (pitting scars) pode constituir apresentação atípica do lúpus eritematoso cutâneo discóide.
Chronic cutaneous lupus erythematosus is a polymorphous autoimmune disease which may mimic some other clinical conditions, causing diagnostic difficulties. Acneiform lesions, including comedones and pitting scars are occasionally atypical presentations of cutaneous discoid lupus erythematosus.
Subject(s)
Adult , Female , Humans , Facial Dermatoses/pathology , Lupus Erythematosus, Discoid/pathology , Anti-Bacterial Agents/therapeutic use , Chronic Disease , Facial Dermatoses/drug therapy , Hydroxychloroquine/therapeutic use , Lupus Erythematosus, Discoid/drug therapy , Tetracycline/therapeutic useABSTRACT
El lupus vulgar es una de las formas más frecuentes de tuberculosis cutánea. Se trata de una forma crónica y benigna que se presenta en pacientes previamente sensibilizados a Mycobacterium tuberculosis y su diagnóstico se basa principalmente en los hallazgos clínicos e histopatológicos. Se presenta el caso de un paciente de 48 años con antecedentes de infección por virus de inmunodeficiencia humana (VIH), que desarrolló lupus vulgar en el codo derecho, de un año de evolución...
Lupus vulgaris is one of the most common forms of cutaneous tuberculosis. It is a chronic and benign form that usually occurs in patients that had been previously sensitized to Mycobacterium tuberculosis and its diagnosis is based mainly in the clinical and histopathological findings. We present the case of a 48 year old male with HIV infection, who developed lupus vulgaris on his right elbow over a one year period...