Case for diagnosis. Keloidal cord-like lesion on the leg

Abstract We report a 74-year-old male presented to an outpatient dermatology clinic in Manaus, Amazonas, with a one-year history of pruritic, keloidal lesions on his left lower extremity. Histopathology showed round structures in reticular dermis. Grocott methenamine silver stain revealed numerous round yeasts with thick double walls, occurring singly or in chains connected by tubular projections. The diagnosis was lobomycosis. Although the keloidal lesions presented by this patient are typical of lobomycosis, their linear distribution along the left lower limb is unusual.

De novo histoid leprosy in a Colombian patient with multiple skin nodules on the ears and extremities

Abstract Histoid leprosy is an uncommon form of lepromatous leprosy with distinct clinical, histopathological, immunological, and bacteriological features. This variant usually occurs in multibacillary patients who have irregular or inadequate treatment. Herein, we report a case of de novo histoid leprosy diagnosed in a patient from Cali, Colombia. In endemic areas, histoid leprosy should be in the differential diagnosis of any patient presenting with skin nodules. Early diagnosis and appropriate treatment are recommended for mitigating the impact of histoid leprosy cases, which are important reservoirs of Mycobacterium leprae.

Schamberg's disease: case report with therapeutic success by using colchicine

Abstract: Pigmented purpuric dermatoses (PPD) include a spectrum of diseases with different clinical aspects, but with similar histopathological features. Specific clinical findings allow the division of PPD in variants. Schamberg's disease is the most common. Treatment is sometimes ineffective and recurrences are common. There are reports of patients who responded well to the use of colchicine. We report the case of a 32-year-old woman, previously healthy, with a history of onset of asymptomatic lesions in legs. She presented purpuric skin eruptions and brownish stains diffusely distributed in the lower limbs. Biopsy was compatible with PPD. We decided for the introduction of colchicine, with good clinical response. The patient has been followed on outpatient basis for ten months without recurrence.

Necrolytic acral erythema: a rare skin disease associated with hepatitis C virus infection

Abstract: Necrolytic acral erythema is a rare skin disease associated with hepatitis C virus infection. We report a case of a 31-year-old woman with hepatitis C virus infection and decreased zinc serum level. Physical examination revealed scaly, lichenified plaques, well-demarcated with an erythematous peripheral rim located on the lower limbs. After blood transfusion and oral zinc supplementation the patient presented an improvement of lesions.

Granulomatosis with polyangiitis, a new nomenclature for Wegener's Granulomatosis - Case report

The granulomatosis with polyangiitis, initially known as Wegener's granulomatosis, is a small and medium vessels vasculitis. It's classic form presents a triad: necrotizing granuloma of respiratory tract, necrotizing cutaneous vasculitis and glomerulonephritis. This vasculitis has cytoplasmic antineutrophil antibodies as signal. This work illustrates a case, of multisystemic rare disease, in which the segment and treatment were considered satisfactory for symptoms remission.

Pre-tibial myxedema: treatment with intralesional corticosteroid

The pretibial myxedema is a manifestation of Graves' disease characterized by accumulation of glycosaminoglycans in the reticular dermis. The dermopathy is self-limiting but in some cases may cause cosmetic and functional damage. Conventional treatment is use of topical steroids under occlusive dressing, however the intralesional application has shown good results. We present a case of pretibial myxedema treated with single injection of intralesional corticosteroid.

Segmental Darier's disease: a presentation of difficult diagnosis

Darier's disease is a rare autosomal dominant genodermatosis. It has an estimated prevalence of 1 in 55,000 to 100,000 individuals, regardless of gender. It is characterized by multiple keratotic papules on the seborrheic areas of the trunk, scalp, forehead and flexures, and the clinical picture is worsened by heat, sun exposure, perspiration and mechanical trauma. Histopathology observed loss of epithelial adhesion and abnormal keratinization. About 10% of cases present in the localized form of the disease. We report a case of segmental Darier's Disease Type I and discuss the main characteristics of this condition.

Phototherapy as an effective treatment for Majocchi's disease - Case report

Pigmented purpuric dermatoses are chronic and relapsing disorders characterized by a symmetrical rash of petechial and pigmentary macules, mainly confined to the lower limbs. Purpura annularis telangiectodes of Majocchi is a less common variant of Pigmented purpuric dermatoses characterized by punctate telangiectatic macules progressing to annular, hyperpigmented patches with central clearing and infrequent atrophy. A 12 year-old girl presented with asymptomatic round to oval reddish brown macules, present symmetrically over her lower and upper limbs for 3 years. Few lesions were annular in shape. Biopsy from the lesion was compatible with Pigmented purpuric dermatoses. On the basis of clinical and histopathological findings, a diagnosis of Purpura annularis telangiectodes of Majocchi was made. The patient began phototherapy thrice a week and showed excellent response.

Verrucous lepromatous leprosy: a rare form of presentation - Report on two cases

Leprosy skin lesions are described as hypochromic or erythematous macules, pale erythematous or reddish-brown plaques, papules, nodules, and diffuse cutaneous infiltration, depending on the clinical form of the disease. They may be accompanied by hypo or anesthesia, alopecia, and hypo or anhidrosis. Verrucous lesions are now quite uncommon in leprosy. The literature is sparse, with only 25 reported cases of this association, especially in the lepromatous pole of the disease. This work is a report on two cases of lepromatous leprosy of long evolution, coursing with vegetant verrucous lesions.

Psoriasiform Keratosis - Case report

Psoriasiform Keratosis is a rare clinic entity. The etiopathogenesis remains unknown and the disease is characterized by a solitary, scaly or keratotic papule, or plaque mainly located on the extremities. Histopathological features closely resemble those of psoriasis. We report the case of a 70-year-old woman presenting a solitary and asymptomatic keratotic plaque, located on the back of the left leg, unresponsive to topical corticosteroids. We performed an excisional biopsy and histopathology was consistent with psoriasiform keratosis.

Dermatosis purpúrica pigmentarias: a propósito de 5 casos en adolescentes / Pigmented purpuric dermatoses: five cases report in adolescente patients

Presentamos cinco pacientes adolescentes cuyo motivo de consulta fue la presencia de máculas hiperpigmentadas, parduscas, con lesiones puntiformes rojas que no desaparecían a la vitropresión, distribuidas simétricamente en los miembros inferiores. Los exámenes de laboratorio fueron normales, exceptuando el hallazgo de serología positiva para parvovirus B19 en uno de los pacientes, que presentaba además artralgias. El cuadro se observó también en un paciente con hipercalcemia idiopática y en otro con síndrome de McCune-Albright. La histopatología confirmó el diagnóstico de sospecha: púrpura de Schamberg. El tratamiento fue sintomático, con resolución completa de las lesiones en el transcurso de los meses sucesivos en dos de ellos. La púrpura de Schamberg es la dermatosis purpúrica pigmentaria más frecuente en los niños.

We report five adolescent patients whose reason for consulting was the presence of hyperpigmentedbrownish macules with red pointed injuries distributed symmetrically in lower limbs that didn´tdisappear at finger pressing. Laboratory test were normal except for the discovery of positiveimmunoglobulin M for parvovirus B19 in the patient who presented arthralgias. The symptomswere observed in a case with idiopathic hypercalcemia and in another one with Mc Cune Albrightsyndrome.The histopathology confirmed the diagnosis suspected: Schamberg´s disease. The treatmentwas symptomatic with complete resolution of the injuries in two of the cases in the course of thefollowing months. Schamberg’s purpura is the most frequent pigmented purpuric dermatoses in children.

Pioderma gangrenoso de rápida evolución / Pyoderma gangrenosum rapidly evolving

Se presenta caso de mujer adulta con múltiples lesiones ampollosas de 1 semana de evolución, acompañada de fiebre. Presentaba antecedentes de rectorragias ocasionales desde hace varios años. La colonoscopía detectó la presencia de Enfermedad inflamatoria intestinal, que se confirmó con la anatomía patológica. La biopsia de piel fue compatible con pioderma gangrenoso. La paciente mejoró con prednisona y aziatropina.

A case report of adult female with multiple bullous lesions of 1 week duration, accompanied by fever. She had a history of occasional rectal bleeding for several years. The colonoscopy detected the presence of inflammatory bowel disease, which was confirmed by pathology. Skin biopsy was consistent with pyoderma gangrenosum. The patient improved with prednisone and aziatropina.

Reações aos diferentes pigmentos de tatuagens: relato de dois casos / Reactions to the different pigments in tattoos: a report of two cases

A tatuagem é definida como deposição de pigmento intencional ou acidental na pele. Os pigmentos têm sido associados a diversas dermatoses, como a dermatite de contato alérgica, a dermatite liquenoide e as reações fotoinduzidas, granulomatosas, sarcoídeas e pseudolinfomatosas. Enfocam-se os diversos tipos de reações aos pigmentos e a importância de reconhecê-los clinicamente. São relatados dois casos: um de dermatite liquenoide sobre o pigmento vermelho e outro de pseudolinfoma sobre os pigmentos vermelho e lilás e de reação fotoinduzida sobre o amarelo. A remoção geralmente requer múltiplos tratamentos, e a maioria não retira as cores completamente.

Tattoos are defined as the intentional or accidental deposit of pigment into the skin. These pigments have been associated with various dermatoses such as allergic contact dermatitis, lichenoid dermatitis, photoinduced reactions, and granulomatous, sarcoid and pseudolymphomatous reactions. The objective of this report was to describe the various types of reactions to pigments and the importance of recognizing them clinically. Two cases are reported: one of lichenoid dermatitis resulting from a reaction to the red pigment of a tattoo and the other of a pseudolymphoma resulting from a reaction to red and lilac pigments and a photo-induced reaction to a yellow pigment. Removal generally requires multiple forms of treatment, most of which fail to remove the colors completely.

Caso para diagnóstico / Case for diagnosis

Nevo epidérmico verrucoso inflamatório linear (Nevil) é uma variante do nevo epidérmico verrucoso que acomete mais comumente o sexo feminino. Clinicamente, é caracterizado por fenômenos inflamatórios recorrentes, conferindo aspecto de dermatite eczematosa crônica ou psoriasiforme, frequentemente unilateral, com prurido intenso, de aparecimento desde o nascimento e de difícil tratamento.

Inflammatory linear verrucous epidermal nevus (Ilven) is a rare variant of epidermal verrucous nevus that commonly affects females. Clinically is characterized by the appearance, since birth, of recurrent inflammatory phenomena with chronic eczematous or psoriasiform aspects, usually unilateral, with severe pruritus, and refractory to therapy.

Mycetoma fungal infection: multiple organisms as colonizers or pathogens?

We describe a patient with mycetoma or Madura foot, in which histopathological stains of the bone and surface cultures suggested three different organisms including Nocardia species as the cause. Criteria for the diagnosis of the organisms, differentiation between colonizer and pathogen, and significance of mixed infections are discussed.

Descrevemos um paciente com micetoma ou maduromicose de pé, no que colorações histopatológicos de osso e de culturas superficiais sugeriram três organismos diferentes, incluindo espécies de Nocardia como causador. Os critérios de diagnóstico dos organismos, a diferenciação entre colonizador e patógeno, e a significância das infecções mistas são discutidos.