Síndrome de Sweet en pediatría: a proposito de un caso / Sweet syndrome in pediatrics: a case report

INTRODUCCIÓN: El Síndrome de Sweet es una dermatosis muy infrecuente en pediatría, de patogenia desconocida, caracterizado clínicamente por fiebre, neutrofilia, placas solevantadas y dolorosas en piel de cara, cuello y extremidades e histológicamente por infiltración dérmica de neutrófilos. OBJETIVO: Presentación de un caso clínico de Síndrome de Sweet en paciente pediátrico. CASO CLÍNICO: Prees colar femenino de 3 años, portador de cromosomopatía compleja 46XX add(8). Consultó por cuadro clínico de 7 días de evolución caracterizado por placas y ampollas localizadas en dorso y posterior mente en extremidades, asociado a fiebre alta, sin respuesta a tratamiento antibiótico indicado por sospecha de impétigo ampollar. Al examen físico presentaba múltiples placas eritemato-violáceas, con centro ampollar en dorso, extremidades superiores e inferiores, junto a placas y nódulos eritematosos en brazo y muslo izquierdo. En los exámenes de laboratorio destacó leucocitosis con neutrofilia (RAN 45954/mm3) y PCR elevada (347 mg/L). Se realizó biopsia de lesiones cutáneas con hallazgos histopatológicos compatibles con Síndrome de Sweet. Se indicó tratamiento con prednisona 1 mg/ kg/día, con buena respuesta clínica. A las 2 semanas de tratamiento presentaba placas costrosas de menor tamaño, sin lesiones ampollares. CONCLUSIONES: El síndrome de Sweet corresponde a una dermatosis infrecuente en pediatría, por lo que se debe tener un alto índice de sospecha ante la presencia de fiebre asociado a lesiones cutáneas persistentes. Si bien la mayoría de los casos son idiopáticos, se debe realizar el tamizaje de condiciones asociadas, principalmente de trastornos proliferativos, infecciones e inmunodeficiencias.

INTRODUCTION: Sweet's syndrome is a very rare dermatosis in pediatrics, of unknown pathogenesis, clinically characterized by fever, neutrophilia, raised and painful plaques on the skin of the face, neck, and limbs, and histologically by dermal infiltration of neutrophils. OBJECTIVE: To present a clinical case of Sweet Syndrome in a pediatric patient. CLINICAL CASE: 3-years-old female child, with history of complex chromosomopathy 46XX add(8), with a 7-day history of plaques and blisters on the back and later also on the limbs, associated with high fever, without response to antibiotic treatment pres cribed due to suspicion of bullous impetigo. Physical examination showed multiple erythematous- violaceous plaques, with bullous center on the back, upper and lower limbs, along with plaques and erythematous nodules on the left arm and thigh. Laboratory tests showed leukocytosis with neutro philia (absolute neutrophil count 45954/mm3) and elevated CRP (347 mg/L). Biopsy of skin lesions reported histopathological findings compatible with Sweet's Syndrome. Treatment with prednisone 1 mg/kg/day was indicated with good clinical response. After two weeks of treatment, she presented crusty plaques of smaller size, without bullous lesions. CONCLUSIONS: Sweet's syndrome is an uncom mon dermatosis in pediatrics, therefore, a high index of suspicion should be held in the presence of fever associated with persistent skin lesions. While most cases are idiopathic, screening for associated conditions, mainly proliferative disorders, infections, and immunodeficiencies must be performed.

Dermatitis flagelada inducida por bleomicina: a propósito de un caso / Bleomycin-induced flagellated dermatitis: a case report

INTRODUCCIÓN: La Dermatitis Flagelada es una patología infrecuente, con lesiones cutáneas características, que se desarrolla por el uso de Bleomicina. Clínicamente se presenta como maculas eritematosas o hiperpigmentadas de disposición lineal con patrón flagelar, en tronco y/o extremidades superiores. Presenta evolución autolimitada por lo que su tratamiento varía desde conducta expectante hasta uso de corticoides tópicos u orales. OBJETIVO: Presentación de un caso clínico de Dermatitis flagelada secundaria a Bleomicina en paciente pediátrico con antecedentes de neoplasia de sistema nervioso central. CASO CLÍNICO: Escolar de 8 años, sexo femenino, con antecedentes de tumor prima rio de células germinales mixto intracraneal (selar y supraselar) y panhipopituitarismo secundario. Recibe tratamiento quimioterapéutico según protocolo PEB, con uso de Bleomicina EV por 3 días. A los 2 días posteriores, inicia prurito intermitente, asociado a máculas eritematosas y pigmentadas de distribución lineal, siguiendo patrón flagelado, con aislados signos de excoriación, en región abdominal y dorso alto. Se indica tratamiento tópico con corticoides de moderada potencia por 10 días, con respuesta clínica satisfactoria. CONCLUSIONES: Se debe tener una alta sospecha diagnóstica en pacientes pediátricos con historia de administración previa del fármaco y aparición de lesiones cutáneas características, lo que permitirá una conducta adecuada respecto a su manejo y a la continuidad de la quimioterapia.

INTRODUCTION: Flagellated dermatitis is an infrequent pathology, with characteristic skin lesions, which is developed due to the use of bleomycin. Clinically it occurs as erythematous or hyperpigmented maculae of linear disposition with flagellar pattern, in trunk and/or upper extremities. It presents self-limited evolution, therefore, its treatment varies from expectant management to the use of topical or oral corticosteroids. OBJECTIVE: Presentation of a clinical case of flagellated dermatitis secondary to bleomycin in a pediatric patient with history of central nervous system neoplasia. CLINICAL CASE: 8 years, schoolchild, female, with a history of primary intracranial mixed germ cell tumor (sellar and suprasellar) and secondary panhypopituitarism. She receives chemotherapeutic treatment according to the PEB protocol, with use of IV bleomycin during three days. After two days, intermittent pruritus begins, associated with erythematous and pigmented maculae of linear distribution, followed by a flagellated pattern, with isolated signs of excoriation, in the abdominal region and upper back. Topical treatment with mild potency corticosteroids is indicated for ten days, with a satisfactory clinical response. CONCLUSIONS: There should be a high diagnostic suspi cion in pediatric patients with a history of prior administration of the drug and the appearance of characteristic skin lesions, which will allow adequate behavior regarding its management and the continuity of chemotherapy.

Análisis epidemiológico de onicomicosis diagnosticada por laboratorio en pacientes menores de 15 años / Epidemiological analysis of onychomycosis diagnosed by laboratory in patients under 15 years

Onychomicosis was considered uncommon in children. During recent years an increase in its frequency has been reported in children worldwide. This survey was carried out to estimate the frequency of causal agents of fungal nail infections in children and adolescents (0-15 years of age) during the period 2006-2016 in the Skin Laboratory of Clinical Hospital, University of Chile. It was a descriptive, retrospective analysis of all positive culture of children nails. A total of 1626 culture was analyzed. Cultures were positive in 417 cases (25,6%). Average age of patients with positive culture was 9,37 ages. Of the total positive culture, 42,9% was females and 57,1% was males. Toenails were more affected (90,6%) than finger nails. Trichophyton rubrum (66,9%), was the predominant pathogen isolated followed by Candida spp (26,1%) Trichophyton rubrum + Candida spp (3,8%) Trichophyton mentagrophytes (2,6%) and Trichophyton rubrum + Trichophyton mentagrophytes (0,5%). Fungal fingernail infection by Candida spp. was the most common (66,7%) and Trichophyton rubrum was the most common in toenail (70,6%). We found a decrease of Candida spp. with age. The results of our study show that onycomichosis in children and adolescents is not exceptional and should be considered in the differential diagnosis of nail plate disorder in children. (AU)