Cutaneous lupus erythematosus: a review of etiopathogenic, clinical, diagnostic and therapeutic aspects

Abstract Cutaneous lupus erythematosus is an autoimmune disease of varied clinical expression, which may present as an exclusively cutaneous disease or be one of the multiple manifestations of systemic lupus erythematosus. Its classification includes acute, subacute, intermittent, chronic and bullous subtypes, which are usually identified based on clinical features and histopathological and laboratory findings. Other non-specific cutaneous manifestations may be associated with systemic lupus erythematosus and are usually related to disease activity. Environmental, genetic and immunological factors play a role in the pathogenesis of skin lesions in lupus erythematosus. Recently, considerable progress has been made in elucidating the mechanisms involved in their development, which allows for foreseeing future targets for more effective treatments. This review proposes to discuss the main etiopathogenic, clinical, diagnostic and therapeutic aspects of cutaneous lupus erythematosus, aiming to update internists and specialists from different areas.

Fatal sclerosing mesenteritis: a 7-year-old male autopsy case report

ABSTRACT Sclerosing Mesenteritis (SM) is a rare diagnosis, particularly in pediatric patients, and is typically non-fatal when appropriately treated. Although molecular and immunohistochemical alterations have been described, no pathognomonic signature has been identified for this entity. This report presents a case of a seven-year-old boy who suffered sudden cardiorespiratory arrest. Upon autopsy, he was found to have multicentric SM on the upper mesentery, which led to bowel wall thinning and abdominal bleeding with bacterial translocation. We performed comprehensive morphological, immunohistochemical, and molecular analyses. SM is an atypical disorder with diverse clinical manifestations, including a rare but potentially fatal course. Early diagnosis is critical, given its potential severity. To our knowledge, this is the first case report of pediatric mortality linked to SM. Our findings emphasize the importance of increased awareness and early detection of SM in pediatric patients.

Ultrasound analysis for pancreatic panniculitis: A case report / 中南大学学报(医学版)

Pancreatic panniculitis (PP) is a necrotizing inflammation of subcutaneous fat that is a rare complication of pancreatic disease appearing in 2% to 3% of all patients. It is more common in the elderly and often affects the extremities. It presents as skin inflammation with pain and erythema nodules. We report a case of acute pancreatitis associated with PP in an old female. She was admitted for vomiting and abdominal pain for 3 days and presented with a 2-week history of erythematous subcutaneous nodules on her legs. Laboratory and ultrasonic findings revealed acute pancreatitis. High frequency ultrasound showed hypoechoic foci in subcutaneous soft tissue layer and adipose layer. Histopathological examination confirmed the diagnosis of PP. Nodules disappeared with the resolution of acute pancreatic inflammation. PP may be the first manifestation of pancreatic disease. Imaging features of this pathology are seldom described and ultrasonic diagnosis experience is worth to be accumulated.

Pseudomonas aeruginosa as an uncommon agent of infectious panniculitis

Abstract Pseudomonas aeruginosa is a Gram-negative bacillus that frequently causes septicemia, abscesses and infections in skin wounds. Panniculitis caused by this microorganism is unusual and there are few well-documented cases, none of them in a patient with systemic lupus erythematosus. The present report describes an immunosuppressed patient with systemic lupus erythematosus who developed panniculitis caused by Pseudomonas aeruginosa, with a review of the literature on this rare presentation.

Paniculitis mesentérica / Mesenteric panniculitis

Introducción: La paniculitis mesentérica es una afección infrecuente. Aparece en la adultez tardía, con manifestaciones clínicas inespecíficas, puede cursar asintomática o caracterizarse por dolor, hinchazón y distensión abdominal, masa palpable a nivel del abdomen. Esto puede ser un hallazgo casual al realizar exploraciones radiológicas. Objetivo: Describir las características clínico-imagenológicas, así como terapéutica empleada en el tratamiento de un paciente con paniculitis mesentérica. Presentación de caso: Se presenta el caso de un paciente blanco, masculino de 59 años. Con antecedentes de hiperlipidemia, con cuadros doloroso abdominal inespecífico, de 6 meses de evolución. Se le realiza tomografía axial computarizada de abdomen simple y E/V donde se observó engrosamiento de la grasa mesentérica y múltiples imágenes nodulares a nivel del mesenterio compatible con paniculitis mesentérica. Desarrollo: La paniculitis mesentérica es una enfermedad de baja prevalencia, con mayor predominio en la sexta década de la vida, es habitualmente un hallazgo incidental en laparotomía exploratoria o tomografía computarizada de abdomen. Conclusiones: Deben conocerse las manifestaciones clínicas y hallazgos imagenológicos de la paniculitis mesentérica, así como las variantes terapéuticas en su tratamiento para evitar las intervenciones quirúrgicas innecesarias(AU)

Introduction: Mesenteric panniculitis is a rare condition. It appears in late adulthood, with nonspecific clinical manifestations, it can be asymptomatic or characterized by pain, swelling and abdominal distension, a palpable mass in the abdomen. This can be a chance finding when performing radiological examinations. Objective: To describe the clinical-imaging characteristics, as well as the therapy used in the treatment of a patient with mesenteric panniculitis. Case report: We report the case of a 59-year-old white male patient, with history of hyperlipidemia, nonspecific abdominal pain and 6 months of evolution. A simple abdominal computed tomography and E / V were performed, showing thickening of the mesenteric fat and multiple nodular images at the level of the mesentery compatible with mesenteric panniculitis. Findings: Mesenteric panniculitis is a low prevalence disease, with greater prevalence in the sixth decade of life, which is usually found incidentally in exploratory laparotomy or abdominal computed tomography. Conclusions: The clinical manifestations and imaging findings of mesenteric panniculitis must be known, as well as the therapeutic variants in its treatment to avoid unnecessary surgical interventions(AU)

Comportamiento clínico-epidemiológico del eritema nudoso en el Hospital Provincial Docente Clínico Quirúrgico León Cuervo Rubio / Epidemiological clinical behavior of erythema nodosum at the Provincial Teaching Clinical Surgical Hospital Leon Cuervo Rubio

RESUMEN Introducción: el eritema nudoso es la variante clínico-patológica más frecuente de la paniculitis. Es una reacción cutánea inmunológica en respuesta a un amplio espectro de agentes etiológicos. Objetivo: caracterizar el comportamiento clínico-epidemiológico del eritema nudoso. Materiales y métodos: se realizó un estudio descriptivo, prospectivo y longitudinal en pacientes con diagnóstico de eritema nudoso, ingresados en el Hospital Provincial Docente Clínico Quirúrgico León Cuervo Rubio, de Pinar del Río, en el período de enero de 2017 a diciembre de 2018. El universo estuvo constituido por 34 pacientes con diagnóstico clínico de eritema nudoso, hospitalizados en los servicios de Medicina Interna y Dermatología. Para la recogida de la información se utilizaron la historia clínica, el examen físico y los exámenes de laboratorio. Se utilizaron métodos teóricos, empíricos y estadísticos; de los últimos se empleó la estadística descriptiva a través de frecuencias absolutas y porcentaje. Resultados: el mayor grupo de pacientes estuvo entre 30 y 39 años, y fue del sexo femenino. Las lesiones fueron más frecuentes en los meses de invierno. El tipo de eritema nudoso idiopático prevaleció. Predominó el tiempo de evolución de 1 a 3 meses. Como causa secundaria predominaron las infecciones, y los tratamientos más usado fueron los antiinflamatorios no esteroideos. Conclusiones: se trata de una importante enfermedad de salud, cuyo un diagnóstico etiológico temprano permite un tratamiento adecuado. Resulta difícil su identificación y manejo tanto en la atención primaria como en la secundaria (AU).

ABSTRACT Introduction: erythema nodosum is the most common clinical-pathological variant of panniculitis. It is an immunological skin reaction in response to a wide spectrum of etiologic agents. Objective: to characterize the clinical-epidemiological behavior of erythema nodosum. Materials and methods: a descriptive, prospective and longitudinal study was carried out in patients with diagnosis of erythema nodosum, admitted to the Provincial Teaching Clinical Surgical Hospital León Cuervo Rubio, of Pinar del Río, in the period January 2017 to December 2018. The universe was formed by 34 patients with clinical diagnosis of erythema nodosum, hospitalized in the services of Internal Medicine and Dermatology. Medical records, physical examination and laboratory tests were used for the collection of information. Theoretical, empirical and statistical methods were used; descriptive statistics was used through absolute frequencies and percentage. Results: the largest group of patients was between 30 and 39 years, and they were female. Injuries were more frequent in the winter months. The type of idiopathic erythema nodosum prevailed. The time of evolution prevailed from 1 to 3 months. Infections predominated as a secondary cause, and the most commonly used treatments were non-steroidal anti-inflammatory drugs. Conclusions: it is an important health condition, whose early etiological diagnosis allows the proper treatment. Its identification and management in both primary and secondary care is difficult (AU).

A case report and literature review of cutaneous intravascular large B-cell lymphoma presenting clinically as panniculitis: a difficult diagnosis, but a good prognosis,

Abstract Intravascular large B-cell lymphoma is a rare, non-mass-forming, extranodal large B-cell lymphoma subtype characterized by the presence of tumor cells in the lumens of vessels. It is divided into two major types: classical and Asian. Patients presenting only with skin involvement are mostly female, at a younger age than classical intravascular large B-cell lymphoma patients, and have a better prognosis. Since the diagnosis of cases with isolated skin involvement is difficult, keeping this entity in mind, performing a careful microscopic examination, and applying new, effective treatment regimens will make it possible to achieve better clinical outcomes in these cases.

Analysis of clues to pathological diagnosis of panniculitis / 中华皮肤科杂志

Panniculitis is a group of skin diseases involving subcutaneous adipose tissues, including primary and secondary panniculitis associated with tumors and inflammations. According to patterns of inflammation and types of fat necrosis, and combined with the learning experience at Ackerman Academy of Dermatopathology, the authors summarize pathological changes in various types of primary panniculitis, and propose some diagnostic clues, hoping to provide some ideas for the pathological diagnosis of panniculitis.

Subcutaneous panniculitis-like T-cell lymphoma secondary to familial hemophagocytic syndrome: report of one case and review of literature / 白血病·淋巴瘤

Objective:To investigate the clinical characteristics and gene mutations of subcutaneous panniculitis-like T-cell lymphoma (SPTCL) secondary to familial hemophagocytic syndrome (FHL).Methods:The clinical features, disease evolution, gene mutation and genetic characteristics of 1 SPTCL patient secondary to FHL in Henan Children's Hospital in June 2012 were analyzed retrospectively, and the related literatures were reviewed.Results:The UNC13D of FHL patient was homozygous mutation accompanied by STXBP2 heterozygous mutation, while that of his parents and elder brother was heterozygous mutation. After regular chemotherapy with HLH-2004 regimen, the disease relapsed 4 years later, and secondary SPTCL developed after 1 year of remission with the second chemotherapy. After giving SMILE regimen chemotherapy, allogeneic hematopoietic stem cell transplantation was performed, and now the patient had disease-free survival.Conclusions:The detection of related genes in children with hemophagocytic syndrome should be improved in time to confirm the diagnosis of primary disease. FHL can follow SPTCL, and chemotherapy combined with allogeneic hematopoietic stem cell transplantation can be the only method to cure this disease.

Subcutaneous panniculitis-like T-cell lymphoma with hemophagocytic syndrome: A case report

INTRODUCTION@#Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a rare disease, accounting for less than 1 % of non-Hodgkin's lymphomas that is characterized by infiltration of T-cells in the subcutaneous adipose tissue.@*CASE PRESENTATION@#A 21-year-old Filipino female presented with intermittent fever which eventually was associated with multiple eruption of cutaneous lesions. The serum antinuclear antibody (ANA) titer and pattern revealed negative results. Further clinical investigation prompted a skin lesion punch biopsy revealing atypical lymphoid infiltrates with lobular panniculitis consistent with SPTCL. lmmunohistochemical studies stained strongly posItIve for CD3, CDS, granzyme B and negative for CD20, CD4, and CD56. The case was also compounded with the existence of hemophagocytic syndrome having fulfilled five of the eight criteria . She was given prednisone (1 mg/kg/day) with gradual resolution of cutaneous lesions leaving marked hyperpigmentation and lipoatrophy.@*DISCUSSION@#SPTCL presents with a myriad of systemic symptoms but will always present with skin lesions. The biopsy for histopathological interpretation is commonly performed as a first diagnostic step followed by immunohistochemical staining. Clinical presentation, histo-pathological findings, and 1mmunohistochemical results together clinched the diagnosis of SPTCL.@*CONCLUSION@#Patients with history of intermittent fever associated with cutaneous lesions and systemic clinical findings, SPTCL should be a differential diagnosis. However, lupus erythematosus panniculitis (LEP) must be ruled out first as its closest mimicker. This case report along with other large case series provides further evidence that monotherapy with oral prednisone can be an initial choice of therapy.

Tratamiento exitoso de lipodermatoesclerosis aguda con doxiciclina: reporte de diez casos / Successful treatment of acute lipodermatosclerosis with doxycycline: report of ten cases

Resumen La doxiciclina, una tetraciclina semisintética de segunda generación, ampliamente usada para el tratamiento de patologías dermatológicas por sus propiedades antimicrobianas, ha demostrado en varios estudios experimentales sus acciones como un potente fármaco antiinflamatorio, aprobado por estas características por la FDA como una terapia complementaria en la periodontitis del adulto, así como en el tratamiento de la forma papulopustulosa de la rosácea. Se describen además en la literatura otras indicaciones para procesos inflamatorios, tales como, calcinosis cutis, vasculitis livedoide, patologías ampollares, entre otras. Se presenta una serie de 10 pacientes con lipodermatoesclerosis que presentaron una respuesta eficaz a su patología al recibir tratamiento con doxiciclina durante 3 meses, destacando de esta forma su eficacia terapéutica, accesibilidad y baja asociación a efectos adversos.

Abstract Doxycycline, a second generation semi-synthetic tetracycline, widely used for the treatment of dermatological diseases for its antimicrobial effects, has shown in many clinical studies its actions as a powerful anti-inflammatory drug. Approved by the FDA as a complementary therapy in adult periodontitis, and of the papulopustular form of rosacea. In addition, other indications for inflammatory processes are described in the literature, such as calcinosis cutis, livedoid vasculitis, blistering pathologies, among others. We present a series of 10 patients with lipodermatosclerosis who presented an effective response to their pathology when receiving treatment with doxycycline for 3 months. Its therapeutic efficacy, accessibility and low association with adverse effects are highlighted.

Paniculitis mesentérica como causa de masa abdominal palpable / Mesenteric panniculitis as a cause of palpable abdominal mass

RESUMEN Introducción: la paniculitis mesentérica es un trastorno poco frecuente caracterizado por inflamación crónica del tejido adiposo del mesenterio intestinal, su etiología es desconocida. Objetivo: describir la presentación clínica y radiológica de un paciente con paniculitis mesentérica atendido en el Hospital Militar Dr. Carlos J. Finlay de La Habana, Cuba. Caso clínico: paciente masculino de 62 años de edad, con antecedentes de salud aparente, ex fumador que hace seis meses, notó la presencia de una masa abdominal localizada en el cuadrante inferior izquierdo del abdomen. Se diagnostica paniculitis mesentérica. Conclusiones: a pesar de ser una entidad poco frecuente, la paniculitis mesentérica, debe ser considerada en el diagnóstico diferencial de los pacientes con masa abdominal palpable, empleando los medios imagenológicos para su estudio.

ABSTRACT Introduction: mesenteric panniculitis is a rare disorder characterized by chronic inflammation of the adipose tissue of the intestinal mesentery, its etiology is unknown. Objective: to describe the clinical and radiological management of a patient with mesenteric panniculitis treated at Dr. Carlos J. Finlay Military Hospital in Havana, Cuba. Clinical case: a 62-year-old, male patient with apparent health history, ex-smoker. Six months ago, the patient noticed the presence of an abdominal mass located in the lower left quadrant of the abdomen. Mesenteric panniculitis is diagnosed. Conclusions: in spite of being a rare entity, mesenteric panniculitis should be considered in the differential diagnosis of patients with palpable abdominal mass, where the imaging studies are valuable for its diagnosis.

Case for diagnosis. Infiltrated areas on the trunk

Abstract Leprosy is an infectious disease with chronic evolution, caused by Mycobacterium leprae, an acid-fast bacillus that mainly affects the skin and peripheral nervous tissue. Many of the clinical manifestations of leprosy can mimic connective tissue diseases. The authors present the case of a 49-year-old woman who had been treated for four years for systemic lupus erythematosus in a rheumatological service. Skin biopsy of a plaque on the inguinal region was compatible with borderline lepromatous leprosy associated with a type 1 lepra reaction. The patient is undergoing treatment with multibacillary multidrug therapy, showing clinical improvement.

Neonatal hypercalcemia associated with extensive subcutaneous fat necrosis: a case report

Subcutaneous fat necrosis (SCFN) of the newborn is rare self-limited fat tissue inflammation that usually occurs in term or post-term newborns exposed to perinatal stress factors, such as perinatal asphyxia, meconium aspiration, neonatal sepsis, and therapeutic hypothermia. SCFN usually appears in the first few weeks of life and has a benign course with spontaneous resolution. Monitoring for complications, in particular the potentially life-threatening hypercalcemia, is crucial. In this report, we describe a male infant with extensive SCFN and neonatal hypercalcemia that went through a prolonged course.

Pancreatic panniculitis: case report

Pancreatic panniculitis is a rare condition, affecting 2 to 3% of patients with pancreatic diseases, such as acute pancreatitis or pancreatic carcinoma. The clinical manifestations of panniculitis are painful erythematous nodules, predominantly affecting the lower limbs. From an anatomopathological point of view, the subcutaneous nodules are made of fat necrosis and vacuolated macrophages. The treatment consists in resolving the underlying diseases. We present the case of a 56-year-old female, admitted on the Emergency Department, who presented with acute abdominal pain and subcutaneous erythematous nodules. The combination of laboratory data, clinical and anatomopathological results confirmed the pancreatic panniculitis, in an underlying acute pancreatitis. The treatment focused on the resolution of the pancreatic disease.

Necrosis grasa del recién nacido / Fat necrosis of the newborn

Resumen: Introducción: Las paniculitis constituyen un grupo de enfermedades que afectan al tejido graso subcutáneo y se manifiestan clínicamente como nódulos. Su patogenia no es del todo clara, por lo general es asintomático. El diagnóstico confirmatorio es histológico. Objetivo: describir las características clínicas e histopatológicas de un caso de necrosis grasa, una forma especifica de paniculitis en el recién nacido (RN). Caso Clínico: RN femenino de 40 semanas, parto cesárea de urgencia por taqui cardia fetal más meconio, APGAR 7-8-9. Requirió oxigeno y presión positiva por 5 min. Al quinto día de vida presentó aumento de volumen en tronco posterior, de coloración eritematosa - violácea, remitente a la palpación, no doloroso. Ecotomografría de piel y partes blandas informó aumento de la ecogenecidad del tejido celular subcutáneo y pérdida de definición de las celdillas adiposas de aproximadamente 42.3 x 9.7 x 20.1 mm, sin presencia de vascularización. Biopsia de piel: epidermis con acantosis irregular y ortoqueratosis en cestas; dermis papilar con infiltrado inflamatorio y dermis reticular y tejido adiposo con presencia de infiltrado linfohistocitiario con tendencia a la formación de nódulos, sin compromiso vascular, leves depósitos de colesterol; compatible con necrosis grasa del recién nacido (NGRN). Paciente tuvo regresión completa de la lesión a los tres meses de vida. Conclusiones: se describe un caso compatible clínica e histológicamente con NGRN; sin complica ciones durante su observación. Por lo general esta patología tiene buen pronóstico, con resolución espontánea, como en nuestro caso.

Abstract: Introduction: Panniculitis is a group of diseases that affect subcutaneous fat tissue and clinically manifest as nodules. Its pathogenesis is not entirely clear, and it is usually asymptomatic. The confirma tory diagnosis is histological. Objective: To describe the clinical and histopathological characteristics of a case of fat necrosis, a specific form of panniculitis in the newborn (NB). Clinical Case: 40-week female NB, born by emergency cesarean section due to fetal tachycardia with meconium, Apgar score 7-8-9. She required oxygen and positive pressure for five minutes. On the fifth day of life, she presen ted an increased volume in the posterior trunk region, with an erythematous - purplish discoloration, which is soft and non-tender to palpation. Skin and soft tissues ultrasound showed increased echo genicity of the subcutaneous cellular tissue and loss of definition of the adipocytes of 42.3 x 9.7 x 20.1 mm approximately, without vascularization. Skin biopsy showed epidermis with irregular acanthosis and basket-weave orthokeratosis; papillary dermis with inflammatory infiltrate, and reticular dermis and adipose tissue with presence of lymphohistiocytic infiltrate with a tendency to form nodules, without vascular involvement, and small cholesterol deposits, compatible with subcutaneous fat ne crosis (SBFN) of the newborn. The patient at three months of age had complete regression of the lesion. Conclusions: a clinically and histologically compatible case with SBFN is described, that did not present complications during observation. In general, this pathology has a good prognosis, with spontaneous resolution as in our case.

Enfoque general del paciente con eritema nudoso / General approach of the patient with erythema nodosum

Resumen El eritema nudoso es una reacción de hipersensibilidad cutánea consistente en nódulos eritematosos, sensibles a la palpación, que se encuentran generalmente sobre la región pretibial, aunque también pueden compro- meter muslos, extremidades superiores, glúteos y rostro. La fiebre y las artralgias pueden ser manifestaciones concomitantes. Las lesiones tipo placa pueden aparecer de forma aislada o ser confluentes, evolucionando luego a nódulos dolorosos en el transcurso de varios días. Usualmente, tiene un curso agudo, aunque se han descrito presentaciones crónicas, recurrentes, poco frecuentes. La mayoría de las veces el examen microscópico de las lesiones muestra paniculitis septal sin vasculitis, siendo en ocasiones mixta (lobulillar y septal). Clásicamente, se ha considerado el heraldo de una condición sistémica subyacente (infecciosa o autoinmune) o un fenómeno reactivo tras la exposición a un tóxico o un fármaco. De allí la importancia de conocer su abordaje diagnóstico por parte del médico de atención primaria.

Abstract Erythema nodosum is a reaction of cutaneous hypersensitivity consisting of erythematous nodules, sensitive to palpation, which are usually found on the pretibial region, but which can also involve thighs, upper limbs, buttocks and face. Fever and arthralgia can be concomitant manifestations. The lesions appear in the form of isolated plaques or become confluent, then evolve into painful nodules over several days. Usually, it has an acute course, although chronic, recurrent, rare presentations have been described. Microscopic examination of the lesions shows septal panniculitis without vasculitis. Classically, is considered the herald of an underlying systemic condition (infectious or autoimmune) or a reactive skin phenomenon after exposure to a toxic or drug has been considered; hence the importance of knowing its diagnostic approach by the primary care physician.

Eritema nodoso asociado al uso de anillo vaginal anticonceptivo / Erythema nodosum associated with the use of contraceptive vaginal ring

El eritema nodoso (EN) es la forma de paniculitis más común. Este trastorno representa una reacción de hipersensibilidad frente a diferentes antígenos, así como múltiples enfermedades sistémicas y fármacos, aunque en la mayoría de casos se desconoce la causa. Nuevos fármacos se añaden a la lista de involucrados en la etiopatogenia del eritema nodoso conforme van pasando los años, siendo uno de ellos los anticonceptivos hormonales orales combinados. El objetivo de este trabajo es proponer una relación entre los estrógenos de cualquier método anticonceptivo como puede ser el anillo vaginal combinado y la aparición del eritema nodoso.

Erythema nodosum (EN) is the most common form of panniculitis. This disorder represents a hypersensitivity reaction in front of different antigens, as well as multiple systemic diseases and drugs, although in most cases the cause is unknown. New drugs are added to the list of those involved in the etiopathogenesis of erythema nodosum as the years go by, one of them being combined oral hormonal contraceptives. The objective of this study is to propose a relationship between estrogens from any contraceptive method such as the combined vaginal ring and the appearance of erythema nodosum.

Paniculitis secundaria a terapia target en paciente con melanoma, lo que el dermatólogo debe saber: reporte de un caso / Panniculitis in association with target therapy in melanoma patient, what the dermatologist should know: a case report

Las terapias target constituyen hoy en día una alternativa terapéutica cada vez más utilizada para el manejo de pacientes con melanoma metastásico. Sin embargo, se han descrito múltiples efectos farmacológicos adversos asociados a su uso, siendo los cutáneos los de mayor prevalencia. Se presenta el caso de un hombre de 55 años con diagnóstico de melanoma cutáneo metastásico etapa IV, BRAFV600E mutado, en tratamiento con dabrafenib/trametinib que consultó por desarrollo de lesiones nodulares eritematosas sensibles en extremidades superiores e inferiores, asociadas a sensación febril durante el curso del tratamiento. Se descartó alguna infección sobreagregada. Se realizó una biopsia de las lesiones cutáneas, con confirmación diagnóstica histopatológica de una paniculitis mixta de predominio septal, granulomatosa y con vasculitis leucocitoclástica. La paniculitis asociada a esta terapia ha sido descrita en la literatura y se ha considerado un efecto farmacológico inmunomediado adverso, relacionándose a un mejor pronóstico para el melanoma metastásico en tratamiento. Por lo tanto, así como en el caso presentado, se evita la suspensión del fármaco y se asocia terapia sintomática en caso de mayores molestias del paciente. Es de alta relevancia para el dermatólogo conocer e interpretar adecuadamente este efecto adverso farmacológico, y así indicar el manejo más adecuado para el paciente.

Target therapies are currently a therapeutic option increasingly used for the management of patients with metastatic melanoma. However, there are multiple adverse pharmacological effects associated with their use that have been described. Cutaneous adverse reactions are the most frequent. We report the case of a 55-year-old man with a diagnosis of stage IV BRAFV600E-mutated metastatic cutaneous melanoma undergoing treatment with dabrafenib/trametinib, who consulted due to the development of erythematous nodular lesions in the upper and lower limbs associated with febrile sensation during the course of treatment. Infection was ruled out and a biopsy of the skin lesions was done, which provided the histopathological confirmation of a predominantly septal, granulomatous with leukocytoclastic vasculitis, mixed panniculitis. Panniculitis associated with this therapy has been described in the literature and has been considered an immune-mediated pharmacological adverse effect. It is considered to be related to a better prognosis in the treatment of metastatic melanoma. Consequently, as shown in this case report, target therapy should not be discontinued and symptomatic medication should be given to alleviate patient discomfort. The dermatologist should know and properly interpret this adverse effect and prescribe the most appropriate management for the patient.

Vulvitis migratoria causada por gnatostomiasis importada / Migratory vulvitis caused by imported gnathostomiasis

Resumen La gnatostomiasis es una parasitosis emergente en países no endémicos. Este nematodo zoonótico requiere de agua dulce para su ciclo de vida, donde sus larvas se enquistan principalmente en peces. La migración subcutánea de las larvas produce habitualmente una paniculitis eosinofílica de rápido avance. Se describe un caso clínico de un paciente con una lesión migratoria, sin mejoría clínica con terapia antibacteriana. La búsqueda de factores de riesgo, sumado a la evolución y a los hallazgos de laboratorio hizo sospechar el diagnóstico. La gnatostomiasis debe ser sospechado en pacientes con lesiones de piel migratorias, que han consumido pescado crudo durante viajes a países endémicos en Sudamérica o Asia.

Gnathostomiasis is an emerging disease in non-endemic countries. This zoonotic nematode requires aquatic freshwater environments to complete its life cycle where larvae get encrusted in fishes. Typically, the infection manifests as migratory subcutaneous lesion caused by the larvae trak, which produces an eosinophilic panniculitis. Here we describe a patient who presented a migratory lesion with no response to antimicrobial therapy, a careful travel and food history together with specific laboratory tests led to the correct diagnosis. Gnathostomiasis should be suspected in patients with migratory skin lesions who have consumed raw freshwater fish during travel to endemic countries in South America or Asia.