Desafió Diagnóstico / Diagnostic Challenge

Paciente masculino de 6 meses de edad, con antecedentes personales patológicos de infección por SARS CoV-2 en diciembre de 2020. Acude por cuadro de 4 días de evolución de eritema peribucal, prurito en ambos ojos, tratado de manera ambulatoria con levocetirizina sin mejoría. Presenta hiporexia, edema bipalpebral, lesiones ampollares y eritemato-costrosa en área peribucal, cuello y tórax anterior y posterior. Signo de Nikolsky: positivo en tórax posterior y cuello.

Male patient, 6 months old, with a personal pathological history of SARS CoV-2 infection in December 2020. He presented with 4 days of peribuccal erythema, pruritus in both eyes, treated on an outpatient basis with levocetirizine without improvement. She presents hyporexia, bipalpebral edema, blistering and crusted erythematous lesions in peribuccal area, neck and anterior and posterior thorax. Nikolsky's sign: positive in posterior thorax and neck.

Síndrome de Stevens-Johnson associada à alopurinol e nimesulida: relato de caso / Stevens-Johnson Syndrome associated with allopurinol and nimesulide: case report

A síndrome de Stevens-Johnson (SSJ) é uma variante do eritema multiforme pela conformação e distribuição das lesões cutâneas e maior gravidade do envolvimento mucoso. É caracterizada pela ação de anticorpos IgG ou IgM específicos para drogas. Apresenta importante papel na Odontologia pois que muitas vezes as primeiras manifestações desta doença ocorrem na mucosa bucal. O objetivo deste trabalho é apresentar um relato de um paciente portador da SSJ, sexo masculino, 53 anos, com queixa inicial de dor e ardência bucal. Ao exame clínico verificou-se lesões e crostas hemorrágicas evidentes no vermelhão dos lábios e mucosa bucal. Relatou que foi atendido anteriormente em um serviço oftalmológico e diagnosticado com conjuntivite e que estava sob uso das seguintes medicações: alopurinol, nimesulida, sinvastatina, omeprazol e frontal. O quadro do paciente evoluiu rapidamente para as lesões em pele e por esta razão internado e submetido a protocolo do setor de queimados de um hospital particular. Atualmente o paciente apresenta as seguintes sequelas: cegueira do olho esquerdo, simbléfaro e pterígio nasal. O conhecimento dessa síndrome, pelo cirurgião-dentista é de fundamental importância, vez que, o estabelecimento do diagnóstico precoce pode minimizar as sequelas e até mesmo evitar casos extremos de óbito. Por fim, esclarecer e conscientizar os profissionais quanto ao uso indiscriminado de medicamentos, causa hoje reconhecida para esta síndrome... (AU)

The Stevens-Johnson syndrome (SJS) is a variant of erythema multiforme by the conformation and distribution of skin lesions and more severe mucosal involvement. It is characterized by the action of specific drugs for IgG or IgM antibodies. Plays an important role in dentistry since often the first manifestations of this disease occur in the oral mucosa. The objective of this paper is to present a report of a patient with SJS, male, 53 years, with an initial complaint of pain and burning mouth. On clinical examination there was injury and hemorrhagic crusts evident in the vermilion of the lips and buccal mucosa. Reported that previously serviced on an eye care center and diagnosed with conjunctivitis and was under use of the following medications: allopurinol,nimesulide, simvastatin, omeprazole and front. The patient's condition progressed rapidly to skin lesions and for this hospital and subjected to the burning of a private hospital sector protocol reason. Currently the patient has the following consequences: blindness of the left eye, nasal pterygium and symblepharon. Knowledge of this syndrome, the dentist is crucial, since the establishment of early diagnosis can minimize sequelae and even prevent extreme cases death. Finally, clarify and educate professionals about the indiscriminate use of medicines, now recognized to cause this syndrome... (AU)

Clinical and cyto-histopathological evaluation of skin lesions with special reference to bullous lesions.

Aim: Cytopathology of skin has been documented to be useful in the diagnosis of several skin lesions. This study aims to evaluate cytopathology as a quick non-invasive method for early diagnosis of bullous lesions, neoplastic and preneoplastic skin lesions and to correlate the clinical, cytological and histopathological findings of various skin lesions. Materials and Methods: Eighty five patients of skin lesions were included in the study. Skin scraping, Tzanck smears, slit smears and fine needle aspiration cytology (FNAC) were done to obtain material for cytological examination. Excisional biopsy, incisional biopsy and punch biopsy were done to obtain tissue for histopathological examination. The slides were stained with routine stains and special stains as and when required. Results: Of the 85 patients, 45 were males and 40 females. The most common non-neoplastic lesions observed were vesicobullous lesions which comprised of 41 cases followed by neoplastic lesions which consisted of 24 cases, of which six were benign and 18 malignant. Concordant results between cytology and histopathology was seen in majority (91.7%) of lesions studied. Conclusion: Cytology (scrape/imprint/slit smears and FNAC), performed skillfully and with perfection, leads to an early diagnosis in majority of the lesions, as the observed cytomorphological features of various skin lesions were fairly distinctive making cytology a fairly sensitive 'patient compliant' technique for rapid diagnosis of skin lesions.

Two Cases of Henoch-Sch nlein Purpura Presenting as Bullous Lesions / 대한피부과학회지

Characteristic skin lesions of Henoch-Sch nlein purpura consist of small hemorrhagic macules, papules, palpable purpura, or urticarial lesions that appear in a symmetric distribution over the buttocks and extensor surfaces of the extremities. In rare cases, some lesions may become nodular, bullous, and ulcerative, especially in severe cases of leukocytoclastic vasculitis. We report two cases of Henoch-Sch nlein purpura presenting as bullous lesions, which should be differentiated from other bullous diseases such as bullous pemphigoid and impetigo.