Síndrome purpúrico de distribución atípica por parvovirus B19 en una adolescente / Atypical involvement of purpuric syndrome caused by parvovirus B19: case report in a 12-year-old female

Resumen El parvovirus B19 es causante de una variedad de enfermedades exantemáticas durante la infancia y adolescencia, como el eritema infeccioso y el síndrome papular purpúrico en guante y calcetín. Este último es una acrodermatitis aguda, inusual y benigna, que puede asociarse a aftas orales, fiebre y otros síntomas constitucionales. Existen casos atípicos como la púrpura febril en otras localizaciones, sin cumplir la distribución característica en guante y calcetín de forma simétrica o con un mayor componente de eritrodermia. Presentamos el caso de una adolescente de 12 años con un síndrome papular purpúrico de distribución atípica por parvovirus B19.

Abstract Parvovirus B19 is the cause of a variety of exanthematous diseases during childhood and adolescence, such as erythema infectiosum and papular purpuric gloves and socks syndrome. This is an unusual, benign and acute acrodermatitis. Aphtous stomatitis, fever and other systemic symptoms can be associated with the eruption of the purpuric rash. Uncommon patterns such as asymmetrical distribution or erythematous involvement llave recently been described as additional features of PVB19-associated purpuric petechial eruption. This is a case report of a 12-year-old female with an atypical involvement of a papular-purpuric syndrome caused by human parvovirus B19.

Generalized papular-purpuric eruption due to Solenopsis fugax bites

Abstract: A 59-year-old atopic man referred to for the onset of a diffused itching papular-purpuric eruption involving his trunk and legs but without systemic symptoms. History revealed that he started feeling itching after spending few hours in his basement. Direct examination of the environmental dust (www.edpa.it) showed high level of infestation of Solenopsis fugax, a small Myrmicinae ant. The skin eruption completely healed without scarring in 2 weeks. Specific disinfestation measures were performed and the patient did not comply of any recurrence during a 6-months follow-up.

Púrpura por Strongyloides stercoralis en un paciente inmunocompetente / Purpura due to Strongyloides stercoralis in an immunocompetent patient

Resumen La infección por Strongyloides stercoralis es una parasitosis frecuente en las regiones tropicales y subtropicales, incluyendo la Amazonía peruana. En pacientes con inmunocompromiso, las manifestaciones clínicas son variadas y es frecuente la diseminación sistémica de la enfermedad, con compromiso de diversos órganos. Las manifestaciones cutáneas son infrecuentes y se describen en pacientes con algún grado de inmunosupresión. Se presenta el caso de un paciente inmunocompetente que desarrolló una púrpura reactiva por una infección por Strongyloides stercoralis crónica. Ante ello, es posible el compromiso cutáneo en pacientes inmunocompetentes con reagudización sistémica por este parásito.

Infection with Strongyloides stercoralis is a common parasitic infection in tropical and subtropical regions, including the Peruvian Amazon. The clinical manifestations are varied in patients with immunocompromised disease, and the systemic spread of the disease is frequent, compromising different organs and systems. Cutaneous manifestations are infrequent, being described in patients with some degree of immunosuppression. We present the case of an immunocompetent patient who developed a reactive purpura due to chronic Strongyloides stercoralis infection. Thus, skin involvement is possible in immunocompetent patients with systemic exacerbation due to this parasite.

Pigmented purpura and cutaneous vascular occlusion syndromes

Abstract: Purpura is defined as a visible hemorrhage in the skin or mucosa, which is not evanescent upon pressure. Proper classification allows a better patient approach due to its multiple diagnoses. Purpuras can be categorized by size, morphology, and other characteristics. The course varies according to the etiology, as do the diagnostic approach and treatment. This review discusses pigmented purpuras and some cutaneous vascular occlusion syndromes.

Hemorragia cerebrovascular asociada con infección por citomegalovirus en un lactante menor / Cerebrovascular hemorrhage associated with acquired cytomegalovirus infection in an infant

El citomegalovirus es el agente de infección perinatal más frecuente y una de las principales causas de infecciones virales adquiridas. En la presentación del siguiente caso se describe el amplio espectro clínico de la infección por citomegalovirus. La clasificación correcta de la infección como congénita o adquirida y el tratamiento oportuno pueden evitar complicaciones y secuelas en los casos graves. Se describe el caso de un lactante menor que presentaba una infección por citomegalovirus con la manifestación poco frecuente de hemorragia cerebral. Después del tratamiento con ganciclovir, los síntomas clínicos evolucionaron favorablemente. La infección por citomegalovirus es muy frecuente en la edad pediátrica, tanto en la forma congénita como en la adquirida. La forma adquirida, como la de este caso, se caracteriza principalmente por el compromiso hematológico, al producirse una importante trombocitopenia, lo que puede originar, aunque infrecuentemente, sangrado del sistema nervioso central; la mayoría de las infecciones adquiridas, sin embargo, son de resolución espontánea y no requieren tratamiento. En este paciente no se presentaron repercusiones clínicas de importancia.

Cytomegalovirus is the most frequent causative agent of perinatal infection and a major cause of acquired viral infections. This case report aims to show the broad clinical spectrum of the presentation of cytomegalovirus infection. The correct classification of congenital or acquired infection and its prompt treatment can prevent complications and sequelae in severe cases. We report the case of an infant with acquired cytomegalovirus infection, which presented an unusual feature of cerebral hemorrhage. The patient was treated with ganciclovir, with a favorable evolution of the clinical symptoms. Cytomegalovirus infection is common in children, both in its congenital and acquired forms. Acquired infection, as portrayed in this case, is mainly characterized by hematological compromise given by the marked thrombocytopenia, which may rarely result in cases of bleeding in the central nervous system. In this patient, no important clinical implications occurred. In addition, most of the acquired infections are self-limited and require no treatment.

Envenoming caused by a Portuguese man-o'-war (Physalia physalis) manifesting as purpuric papules / Envenenamento por caravela (Physalia physalis) manifestando-se com erupção papulopurpurica

We report the case of a 42-year old woman who was envenomed by a Portuguese man-o'-war (Physalia physalis). She presented an anomalous reaction manifested by purpuric papules that appeared after the initial phase of envenoming (around 24 hours later), when linear erythematous and edematous papules were observed. Late-onset reactions in accidents involving cnidarians commonly include chronic eruptions and local pigmentation.

Os autores relatam um envenenamento causado por um cnidário, a caravela (Physalia physalis), em uma mulher de 42 anos. A paciente apresentou uma reação incomum manifestada por pápulas purpúricas surgidas após a fase inicial de envenenamento (cerca de 24 horas depois) quando foram observadas pápulas lineares edematosas e eritematosas. As reações tardias nos acidentes por cnidários comumente apresentam erupções recorrentes e pigmentações locais.

Estimation of salivary amylase and total proteins in leukemia patients and its correlation with clinical feature and radiographic finding.

Background: Leukemia is a fatal disease. The oral manifestations of the leukemias occur early in the course of the disease and these oral features can at times act as a diagnostic indicator. Saliva has been used as a diagnostic aid in a number of systemic diseases. Materials and Methods: In our study, samples of unstimulated saliva of 30 leukemia patients who were not on chemotherapy were collected and analyzed for salivary amylase and total protein. The oral manifestations and radiographic changes (OPG) were recorded. The correlation between the oral manifestations and the salivary components (salivary amylase and total protein) was assessed for prognostic significance. Results: In the present study when the mean values of salivary amylase (1280±754 U/ml) and total protein (647.2±320.7 mg%) were compared with that in control subjects. There was a statistically significant difference for amylase levels (P<.05). On intraoral examination the study subjects showed pallor, gingivitis, gingival enlargement, petechiae, and ecchymosis. On the OPG, the radiographic features included generalized rarefaction of bone (20%), thinning of lamina dura (3.4%), generalized alveolar crest bone resorption (30%), thinning of walls of alveolar crypts (6.7%), besides others, e.g., periapical abscess (10%). Conclusions: The saliva of leukemic patients demonstrated obvious changes in composition. A rise in salivary amylase and total protein levels was evident, with the increase in amylase levels being statistically significant.

Rifampicin induced thrombocytopenia.

Thrombocytopenia is an uncommon but potentially life threatening complication of certain anti-tubercular drugs and is characterized by rapid destruction of platelets whenever an offending drug is taken by a susceptible person. Here is a case report of Rifampicin induced Thrombocytopenia. This case is being reported for purpose of its rare occurrence and documentation.

Methylene blue for clinical anaphylaxis treatment: a case report

CONTEXT AND OBJECTIVE: Nitric oxide has a pathophysiological role in modulating systemic changes associated with anaphylaxis. Nitric oxide synthase inhibitors may exacerbate bronchospasm in anaphylaxis and worsen clinical conditions, with limited roles in anaphylactic shock treatment. The aim here was to report an anaphylaxis case (not anaphylactic shock), reversed by methylene blue (MB), a guanylyl cyclase inhibitor. CASE REPORT: A 23-year-old female suddenly presented urticaria and pruritus, initially on her face and arms, then over her whole body. Oral antihistamine was administered initially, but without improvement in symptoms and signs until intravenous methylprednisolone 500 mg. Recurrence occurred after two hours, plus vomiting. Associated upper respiratory distress, pulmonary sibilance, laryngeal stridor and facial angioedema (including erythema and lip edema) marked the evolution. At sites with severe pruritus, petechial lesions were observed. The clinical situation worsened, with dyspnea, tachypnea, peroral cyanosis, laryngeal edema with severe expiratory dyspnea and deepening unconsciousness. Conventional treatment was ineffective. Intubation and ventilatory support were then considered, because of severe hypoventilation. But, before doing that, based on our previous experience, 1.5 mg/kg (120 mg) bolus of 4 percent MB was infused, followed by one hour of continuous infusion of another 120 mg diluted in dextrose 5 percent in water. Following the initial intravenous MB dose, the clinical situation reversed completely in less than 20 minutes, thereby avoiding tracheal intubation. CONCLUSION: Although the nitric oxide hypothesis for MB effectiveness discussed here remains unproven, our intention was to share our accumulated cohort experience, which strongly suggests MB is a lifesaving treatment for anaphylactic shock and/or anaphylaxis and other vasoplegic conditions.

CONTEXTO E OBJETIVO: O óxido nítrico (NO) tem papel fisiopatológico na modulação das alterações sistêmicas associadas à anafilaxia. Inibidores da sintase do NO podem exacerbar a broncoconstrição na anafilaxia e piorar as condições clínicas e têm um papel limitado no tratamento do choque anafilático. O objetivo deste relato foi o de apresentar um caso de anafilaxia (não-choque anafilático) revertido pela inibição da guanilato ciclase pelo azul de metileno. RELATO DE CASO: Mulher de 23 anos apresentou repentina urticária e prurido, inicialmente localizados na face e nos braços, que se estenderam para quase todo o corpo. Utilizou-se, inicialmente, anti-histamínico, mas pequena melhora só foi observada após o uso endovenoso de 500 mg metilprednisolona. Após duas horas, os sintomas voltaram acompanhados de vômitos. Observou-se dificuldade respiratória alta, sibilos respiratórios, estridores laríngeos, angioedema facial, incluindo eritema, edema de lábios e, nos locais de intenso prurido, observaram-se petéquias. O quadro agravou-se com dispnéia, taquipnéia, parestesia peroral, edema laríngeo, grave dispnéia expiratória com crescente perda da consciência. O tratamento convencional não foi efetivo. Considerou-se intubação pela grave hipoventilação. Com base em nossa prévia experiência, um bolo endovenoso de 1,5 mg/kg (120 mg) de azul de metileno a 4 por cento diluído em soro glicosado 5 por cento, seguido de outros 120 mg infundidos durante uma hora. Após a dose endovenosa inicial do azul de metileno, a situação clínica reverteu-se completamente, evitando-se a intubação traqueal. CONCLUSÃO: Embora a hipótese da eficácia da relação entre o óxido nítrico e o azul de metileno ainda esteja por ser provada, nossa intenção foi de compartilhar nossa experiência acumulada, que sugere fortemente que o azul de metileno seja um tratamento salvador de vidas para o choque anafilático e/ou anafilaxia e outras condições vasoplégicas.

Cutaneous vasculitis as a presenting feature of multiple myeloma: a report of 2 cases.

We report two male patients who presented with symmetrical, painful purpura that evolved into bullae and necrotic ulcers, predominantly on the extremities, over two months in spite of conventional therapy including oral steroids. Examination showed livedoid and purpuric patches with necrotic centers in starburst pattern over the extremities and buttocks. The first case also had similar lesions over the ears. The clinical presentation and the histopathological examination suggested a diagnosis of necrotizing leukocytoclastic vasculitis (LCV). Blood testing ruled out connective tissue disease, hepatitis B or C infection or streptococcal infection as underlying cause of vasculitis. Serum antinuclear factor, antineutrophilic cytoplasmic antibody and anticardiolipin anticoagulant were negative in both cases. Cryoglobulins were positive in case 2. An incidental finding was raised serum proteins and globulins in case 2. Further investigations revealed M band on electrophoresis and features of multiple myeloma on bone marrow biopsy in both cases. These cases emphasize the importance of simple investigations like serum proteins in the evaluation of LCV.