Manifestaciones mucocutáneas de intoxicación por metotrexato / 4pp Mucocutaneous manifestations of methotrexate toxicity

El metotrexato es un antimetabolito análogo al ácido fólico que inhibe competitivamente la enzima dihidrofolato reductasa y timidilato sintetasa, indispensables para la síntesis de ADN y ARN. Se utiliza ampliamente en dermatología y sus efectos adversos en la piel y mucosas son variados, incluyendo reacciones leves y graves. Las erosiones y úlceras cutáneas como manifestación de citotoxicidad por metotrexato son infrecuentes y representarían un signo cutáneo temprano de pancitopenia por toxicidad medular secundaria a dicha droga. En la mayoría de los casos existen enfermedades cutáneas previas a la ulceración, principalmente psoriasis. En ausencia de dermatitis subyacente, la presencia de ulceraciones es excepcional. Se presentan ocho casos de pacientes con signos cutáneos de intoxicación por metotrexato, con y sin dermatosis previas. En la mayoría hubo asociación de mucositis y compromiso medular. Se recomiendan pautas de tratamiento.

Methotrexate is an antimetabolite analog to folic acid that competitively inhibits the enzyme dihydrofolate reductase and thymidylate synthetase, essential for the synthesis of DNA and RNA. It is widely used in dermatology and its adverse effects on the skin and mucous membranes are varied, including mild and severe reactions. The appearance of erosions and skin ulcers as a manifestation of methotrexate cytotoxicity are quite infrequent. These would represent an early cutaneous sign of pancytopenia due to marrow toxicity secondary to this drug. In most of the cases there are cutaneous diseases prior to ulceration, mainly psoriasis. In the absence of underlying dermatitis, the presence of ulcerations is very rare. We present eight cases of patients with cutaneous signs of methotrexate poisoning, with and without previous dermatoses. Most of them associated mucositis and bone marrow involvement. Treatment guidelines are recommended.

Canine sporotrichosis: report of 15 advanced cases / Esporotricose canina: descrição de 15 casos avançados

Sporotrichosis is a chronic, granulomatous and usually lymphocutaneous infection of animals and humans, caused by a dimorphic fungus, Sporothrix schenckii complex. The disease in dogs is considered rare, however, in the last years a crescent registration of cases was observed in Brazil, especially in the city of Rio de Janeiro. Fifteen dogs with ulcerated cutaneous lesions were seen at the Dermatology Service in the Small Animal's Hospital at Universidade Federal Rural do Rio de Janeiro, between January 2014 and October 2015. Most lesions were located on the head, mainly the nose. Lesions were even seen on the chest, disseminated on the body and on the limbs. Three dogs (20%) exhibited the cutaneous-lymphatic form, with lesions initially on the distal aspect of one leg and ascending via lymphatics up the leg to the trunk and head. It was not ruled out the disseminated form in at least 3 dogs (20%). They had consistent signs of generalized or disseminated disease exhibiting respiratory symptoms (nasal discharge, sneezing, stertorous breathing), anorexia and weight loss. Draining tracts and cellulitis were very common. Some had large areas of skin necrosis with exposure of muscle and bone. Definitive diagnosis was obtained by cytological examination of exudates, histological examination, and/or isolation of S. schenckii complex by fungal culture. Because of the severity of the lesions that mimic other disorders like neoplasms or autoimmune skin diseases, and due to the difficulties of getting an accurate diagnosis, this study describes 15 advanced cases of canine sporotrichosis.(AU)

A esporitricose é uma doença infecciosa crônica, granulomatosa e frequentemente linfocutânea, causada por um fungo dimórfico do Complexo Sporothrix schenckii. A doença em cães é considerada rara, no entanto, nos últimos anos, um número crescente de casos foi registrado no Brasil, especialmente no Rio de Janeiro. Quinze cães com lesões cutâneas ulceradas foram atendidos no Setor de Dermatologia do Hospital Veterinário de Pequenos Animais da Universidade Federal Rural do Rio de Janeiro, entre Janeiro de 2014 e Outubro de 2015. Todos os animais foram submetidos ao exame clínico e dermatológico. A maioria das lesões estava localizada na cabeça, principalmente no plano nasal. Havia também lesões no tórax, disseminada pelo corpo e nos membros. Três cães (20%) apresentaram a forma cutâneo-linfática, com lesões inicialmente nos membros e se propagavam via vasos linfáticos para o tronco e a cabeça. Não foi descartada a forma disseminada em pelo menos 3 cães (20%). Estes cães apresentaram sinais consistentes de doença generalizada ou disseminada, exibindo sinais respiratórios (descarga nasal, espirros, estertoração), anorexia e perda de peso. Fístulas e celulite eram muito comuns. Alguns tinham grandes áreas de necrose que desencadearam a exposição de músculo e osso. O diagnóstico definitivo da infecção foi obtido por exame citológico de exsudato e por exame histológico, e/ou apenas isolamento do complexo S. schenckii pela cultura de fungos. Por causa da severidade das lesões que imitam outras enfermidades, principalmente neoplasias e doenças autoimunes, e pela dificuldade de se obter o diagnóstico correto, este estudo descreve 15 casos avançados de esporotricose canina.(AU)

Síndromes em Odontologia - revisão de literatura / Syndromes in Dentistry - literature review

Objetivo: o presente trabalho teve por objetivos descrever as principais síndromes de acometimento bucal primário, relatando seus sinais, sintomas, métodos de diagnóstico e tratamento e ressaltar a importância do cirurgião-dentista no diagnóstico de alterações sistêmicas. Métodos: foi realizada uma pesquisa bibliográfica acerca de cinco síndromes de acometimento bucal primário, para isso, realizou-se uma busca de informações nas bases de dados eletrônicas Scielo, Bireme, Pubmed entre 2000 a 2017. Revisão de Literatura: Entende-se por "síndrome" um conjunto de sinais e sintomas que caracterizam determinada enfermidade, essas, podem ocorrer de forma isolada ou manifestar seus primeiros sintomas na cavidade oral, os quais são indícios de alterações sistêmicas que possam estar ocorrendo. Entre tantas, destacam-se a seguir cinco das principais síndromes de acometimento bucal primário: Síndrome de Behçet, Síndrome de Sjögren, Síndrome de Peutz-Jeghers, Doença de Addison, e Síndrome de Gardner. Considerações finais: a partir da revisão de literatura foi possível notar que as síndromes podem ocorrer de forma isolada ou manifestar seus primeiros sintomas na cavidade oral. Como suas primeiras manifestações são orais, é imprescindível que o cirurgião-dentista tenha conhecimento sobre elas para que seja elaborado um diagnóstico e protocolo de tratamento corretos e de rápida execução, já que sua terapia será executada com auxílio de vários profissionais da área da saúde.

Objective: the objective of this study was to describe the main syndromes of primary oral affection, reporting its signs, symptoms, methods of diagnosis and treatment, and to emphasize the importance of the dental surgeon in the diagnosis of systemic alterations. Methods: we carried out a literature search about five syndromes of primary oral affection. For this, a search of information was made in the electronic databases Scielo, Bireme, Pubmed between 2000 and 2017. Literature Review: "Syndrome" is understood as a set of signs and symptoms that characterize a particular disease; these can occur in isolation or manifest their first symptoms in the oral cavity, which are indications of systemic changes that may be occurring. Among so many, five of the main syndromes of primary buccal involvement are: Behçet's Syndrome, Sjögren's Syndrome, Peutz-Jeghers Syndrome, Addison's Disease, and Gardner's Syndrome. Final considerations: from the literature review it was possible to note that the syndromes may occur in isolation or manifest their first symptoms in the oral cavity. Since the first manifestations are oral, it is essential that the dentist know about them so that a correct diagnosis and protocol of treatment is elaborated and fast execution, since its therapy will be executed with the help of several professionals of the health area.

Presentación atípica de neoplasia de pulmón / Atypical Presentation of Lung Neoplasia

Se presentó un paciente de 65 años de edad de la raza negra, con antecedentes de alcoholismo y ex-fumador, que hace seis meses comenzó con aumento del volumen del cuello, refirió pelotas duras, niega dolor y aumento de temperatura local, se constató pérdida de peso de unas 30 libras, negó otra sintomatología. Acudió al área de salud de Velasco, municipio Gibara sin diagnóstico concluso, se decidió su remisión cuando las lesiones se abrieron al exterior y sangraban, manifestaciones ganglionares en el cuello, lateral derecho, supraclaviculares, ulceradas, no movibles, adheridas a planos profundos y no dolorosos. Presentó otras en el izquierdo, con circulación colateral tipo vena cava superior, sin dificultades respiratorias, se estudió para encontrar posible causa. Los exámenes realizados corroboraron el diagnóstico: cáncer de pulmón de forma ganglionar ulcerado. Se remitió a la Consulta de Oncología para seguimiento y tratamiento.

A 65-year-old black patient with chronic alcoholic history and ex-smoker was reported in this paper. The patient presented an increase in the volume of the neck and hard nodules six months ago. The patient denied the pain and local temperature increase as well as other symptoms. Weight loss of about 30 pounds was observed. This patient was attended at Velasco health area, Gibara municipality without conclusive diagnosis and was referred when injuries were opened with bleeding, lymph node manifestations in the neck, right lateral supraclavicular, ulcerated, not moving, adhered to deep planes and not painful. Other manifestations were observed on the left side, with collateral circulation of superior vena cava, without respiratory distress. The patient was studied to find possible cause. Tests corroborated the diagnosis: lung cancer of ulcerated nodular form. The patient was referred to the Oncology Consultation for monitoring and treatment.

Aplicação de pomada a base de extrato de camomila* como coadjuvante na redução de sintomatologia dolorosa das lesões ulceradas de mucosa oral / Application of the ointment base of chamomile extract as adjunctive in reducing symptoms of the painful, ulcerated lesions of the oral mucosa

As lesões ulceradas de mucosa bucal freqüentemente incomodam os pacientes por elas acometidos. Sua sintomatologia normalmente é acompanhada de dor, dificuldades mastigatórias, alterações ganglionares.Diversos medicamentos e substâncias já foram utilizados na tentativa de tratamento ou cura de lesões ulceradas recorrentes de mucosa bucal e aftas, porém nenhum apresentou real eficácia.As ulcerações aftosas podem ser classificadas como aftas, ulcerações aftosas recorrentes, e gengivoestomatite herpética. O presente trabalho tem como objetivos a utilização de uma pomada com substância natural, à base de camomila, a fim de se avaliar sua eficácia analgésica em lesões comunas da cavidade oral e o potencial de adesão ao tratamento, considerando-se sua facilidade de aplicação, gosto e textura. Foram avaliados 32 pacientes, de ambos os sexos, com mais de dez anos de idade, portadores de úlceras aftosas recorrentes, aftas ou úlceras bucais traumáticas. Pôde-se concluir que a aplicação do produto demonstrou excelente eficácia em relação à diminuição de dor e uma elevada taxa de aderência ao tratamento.

A Case of Chromomycosis Showing Ulcerative Lesions on Dorsa of Hands / 대한피부과학회지

Chromomycosis is a chronic mycosis of the skin and subcutaneous tissue characterized by a brown, thick-walled, round, nonbudding form of causative fungi in the tissue. We report a case of chromomycosis caused by Fonsecaea pedrosoi in a 56-year-old Korean woman who showed 3 x 4cm sized deep ulcerations on the dorsa of both hands. Histopathologically, chronic granulomatous inflammation and sclerotic cells were observed. Fonsecaea pedrosoi was grown into typical black colonies in fungus culture. She was treated with pedicle flap graft followed by oral itraconazole, and showed clinical improvement.

Atypical clinical manifestations of amebic colitis

Amebic colitis is a disease revealing diverse clinical manifestations and endoscopic gross features and often confused with other types of colitis. In case of misdiagnosis as an idiopathic inflammatory bowel disease or delayed recognition of intestinal amebiasis, an undesirable outcome may occur resulting from erroneous administration of steroids or delayed antiamebic treatment. To demonstrate the pitfalls in the diagnosis and treatment of intestinal amebiasis, 3 cases of amebic colitis with atypical clinical manifestations are presented in this paper. In conclusion, despite the low sensitivities of routine stool examination for parasite and histopathologic confirmation in biopsy specimen, every effort must be made to find amebic trophozoites either in fresh stool or biopsy specimens for prompt and correct diagnosis of amebic colitis when we manage patients with chronic intestinal ulcerations, even though their clinical course and endoscopic findings are not typical of amebiasis. Moreover, following initial successful anti-amebic therapy, more careful clinical, endoscopical, and parasitological follow-up should be done for the early detection of recurrence.

Unusual Cutaneous Manifestions of Connective Tissue Disease: II. Multiple Cutaneous Ulcerations in Dermatomyositis / 대한피부과학회지

The second case of this serial reports under the title of unusual cutaneous manifestations of connective tissue diseases is a woman with primary idiopathic dermatomyositis who developed cutaneous ulcerations on her arms and legs, which is thought to b a rare manifestation of adult dermatomyositis. These multiple ulcerations are about bean sized, polymorphous, and grouped on the poikilodermatous lesional skin. In this patient these ulcerative lesions became regressive and healed with disfiguring scars after the activity of the disease has controlled by prednisolone and methotrexate.