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Objectives: To evaluate vaccination among patients with inflammatory rheumatic diseases initiating disease-modifying antirheumatic drugs (DMARD) Methods: Data from the real-world life PANLAR's register of consecutive patients diagnosed with RA, PsA, and axSpa (2010 ACR-EULAR /2006 CASPAR-2009 ASAS) from Dec 2021 to Dec 2022 were analyzed. Prevalence of recommended vaccinations were compared between different inflammatory rheumatic diseases. Categorical variables were expressed as %. Tables were analyzed with chi2 or Fisher tests, continuous variables (median, IQR)with the Kruskal-Wallis test, according with the variables type. A p value <=0.05 was considered significant. Result(s): 608 patients were included. Among patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), and axial Spondyloarthritis (axSpA) are presented in the table. RA and axSpA seemed to have lower vaccination rate of pneumococcal vaccines than PsA. (p = 0.045 for conjugate anti pneumococcal vaccine in RA vs PsA). A large percentage of the population was vaccinated against COVID-19. There was a high rate of influenza vaccination in all three diseases. Conclusion(s): In Latin America, anti-pneumococcal vaccination is low, especially in patients with RA and axSpA. For other vaccines there was an acceptable level of vaccination without differences between diseases.
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Introduction: Following the inception of the COVID-19 pandemic, chloroquine compounds were proposed as potential therapeutic strategies, at the cost of a potential increase in cardiovascular risk. We aimed to evaluate clinical outcomes of patients with COVID-19, comparing those using chloroquine compounds to individuals without specific treatment. Method(s): Outpatients with suspected COVID-19 in Brazil who had at least 1 ECG transmitted to a Telehealth Network, were prospectively enrolled in 2 arms (G1: treatment with chloroquine compounds and G2: without specific treatment) and G3: registry of other specific treatments. Outcomes were assessed through follow-up phone calls on days 3 and 14, and also administratively collected from national mortality and hospitalization databases. The primary outcome was composed of: hospitalization and all-cause death. The association between treatment groups and the primary outcome was evaluated by logistic regression. Significant variables (p<0.10) were included in 4 multivariate models: 1: unadjusted;2: adjusted for age and sex;3: adjusted for model 2 plus cardiovascular risk factors and 4: adjusted for model 3 plus COVID-19 symptoms (when available from phone contact). Result(s): In 303 days, 712 (10.2%) patients were allocated in G1 (chloroquine), 3623 (52.1%) in G2 (control) and 2622 (37.7%) in G3 (other treatments). Median age was 49 (IQR 38 - 62) years, 57% women. Of these, 1969 had successful phone contacts (G1: 260;G2: 871;G3: 838). The primary outcome was more frequent in groups 1 and 3 compared to the control group, when assessed exclusively by phone (G1: 38,5% vs. G2: 18,0% vs. G3: 34,2%, p<0,001) or combined with administrative data (G1: 19,5% vs. G2: 11,0% vs. G3: 18,2%, p<0,001). In the adjusted models, chloroquine independently associated with a greater chance of the primary outcome: phone contact (model 4): OR=3.24 (95% CI 2.31 - 4.54), p<0.001;phone + administrative data (model 3): OR=1.99 (95% CI 1.61 - 2.44), p<0.001. Chloroquine also independently associated with higher mortality, as assessed by phone + administrative data (model 3): OR=1.67 (95% CI 1.20 - 2.28). Conclusion(s): Chloroquine compounds associated with a higher risk of poor outcomes in outpatients with COVID-19 compared to standard care.
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Embora os transtornos depressivos e de ansiedade, bem como os casos de TEPT ja se constituissem como endemicos no Brasil, com a pandemia da Coronavirus Disease 2019 (COVID 19), o aumento de casos foi exponencial. Na fase inicial da pandemia na China (2020), houve um aumento de 50% de pacientes apresentando sintomas moderados a severos de ansiedade, depressao e estresse. No inicio de maio de 2020, segundo a Associacao Brasileira de Psiquiatria, 48% dos psiquiatras apontavam um aumento de cerca de 25% no numero de consultas, sendo que 89% desses pacientes com diagnostico previo apresentavam sintomas agravados. Este trabalho tem como objetivo apresentar o aumento da incidencia de pacientes atendidos com queixas psicologicas nas unidades de pronto atendimento (Pronto Socorro) e os esforcos emergenciais em nivel de gestao e acompanhamento psicologico da nova realidade no Hospital Geral, referenciada como 4onda da pandemia Covid 19. Os dados coletados referem-se ao periodo de janeiro a julho de 2021, comparando-se ao ano de 2022, tendo sido avaliados 772 pacientes. A partir de avaliacao psicologica clinica e levantamento de prontuarios de atendimentos psicologicos no Pronto Socorro Adulto, comparando-se os anos de 2021 e 2022, constatou-se um aumento medio de 27,5% pacientes no periodo, com prevalencia de sintomas que incluiam mal estar subito e sensacoes de perigo recorrentes e imprevisiveis, incapacidade de relaxar, sensacoes de sufocamento, dor toracica, distorcoes cognitivas e intensa angustia de morte. Historia de doencas psiquiatricas diagnosticadas;perdas financeiras advindas da pandemia;temor aumentado e exacerbado de ser infectado pelo virus, adoecer e morrer;luto patologico (pela perda de familiares e amigos);sobrecarga e fadiga;estresse;ma qualidade do sono;desesperanca;comportamentos evitativos e irritabilidade tambem constituiram os achados clinicos. A sistematizacao da presenca do Psicologo como profissional de referencia no Pronto Socorro, foi fator fundamental para o melhor cuidado e encaminhamento seguro dos casos. Entender como se apresentou a pandemia em termos de estagios de evolucao do problema foi fundamental para nos preparar para o implemento de estrategias de controle. Passamos a avaliar a situacao critica como momentos encadeados e progressivos, o que facilitou o entendimento de especificidades de fatores estressores relativos a pandemia e o cuidado que deveria ser prestado intra e pos crise. Copyright © 2022
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The main objective of this investigation is to understand how the posts in form of stories published by brands associated with the COVID-19 pandemic affected engagement with their consumers. Regarding the stories, plot, characters and verisimilitude have been evaluated. With regard to consumer engagement (CE), affective, emotional and cognitive involvement have been assessed. This study uses a qualitative methodology with a netnographic approach that takes into account the comments of the advertisements published on two social networks, Facebook and Instagram, by nine Portuguese brands. The results of this research reveal that in order for the stories associated with COVID-19 to have a greater level of influence on the customer, they must use their elements as a whole, to encourage positive consumer engagement. © Universidade de Santiago de Compostela.
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Introduction: COVID-19 is a respiratory tract infection caused by the Coronavirus (SARS-CoV-2) and its main clinical manifestations are respiratory. The cardiovascular system can also be affected, especially in patients with severe acute respiratory syndrome [1].On the other hand, cardiovascular disease (CVD) and risk factors have been shown to be predictors of poor outcomes in COVID-19 [2]. Diverse electrocardiographic abnormalities can be found in this condition [3], although their value as a prognostic predictor have not been properly established due to heterogeneity in abnormalities evaluation and small sample sizes in related studies [4]. Purpose: The aim of the present study is to evaluate the association of electrocardiogram (ECG) findings to poor COVID-19 outcomes Methods: This is a multicentric cohort study that followed hospitalized adults due to COVID-19, from low-middle and high-income countries as part of the World Heart Federation (WHF) Global Study on CVD and COVID-19 initiative [5]. Participants were followed up from hospital admission until 30 days post discharge. For the present study, participants with a valid ECG were included. ECG findings were described according to standardized measurements [heart rate, PR interval, QRS duration and axis, corrected QT interval (QTc)] and abnormalities (according to the Minnesota code system). Abnormalities utilized were grouped into ischemic abnormalities (q waves and ST-T abnormalities), atrial fibrillation (AF), prolonged QTc, sinus tachycardia (defined for the study as above 120 bpm), right and left bundle branch block and presence of any major abnormality. The primary outcome was defined as death from any cause. The secondary outcomes were intensive care unit (ICU) admission and cardiovascular events (myocarditis, pericarditis, myocardial infarction, acute heart failure, ischemic and hemorrhagic stroke). Multiple logistic regression was used to evaluate the association of ECG abnormalities to the outcomes of interest. Adjustments were made in a step by step fashion including gender, age, country of residence, cardiovascular risk factors (diabetes, hypertension, tobacco use) and presence of comorbidities (CVD, asthma, cancer, immunosuppression and chronic kidney disease). Results: The clinical characteristics of the cohort are described in table 1. Figure 1 represents the odds ratio and its 95% confidence interval of having the defined outcomes when presenting a ECG abnormality for the final regression model. Conclusion: ECG abnormalities were independently related to poor outcomes in COVID-19 after accounting for multiple confounders. Significant associations were more frequently found for ischemic abnormalities, heart rate above 120 bpm, atrial fibrillation and having at least one major electrocardiographic abnormality. Funding Acknowledgement: Type of funding sources: Other. Main funding source(s): Pfizer and Sanofi PasteurWorld Heart FederationFigure 1. Odds ratios for ECG abnormalities
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Objective: To analyze the impacts of the COVID-19 pandemic on Brazilian nurses' life, health and work. Methods: This is research with a qualitative and social-historical approach, guided by the New History framework. The study had 22 participants, with a prevalence of females. Data collection took place in December 2020, through semi-structured interviews, in a virtual environment, using an electronic instrument created in Google Forms and processed via email. The analysis was conducted using the oral history methodology, with data transcription, transcreation and categorization. Results: The pandemic had an impact on the personal, professional and educational dimensions of nurses. In the personal dimension, there were changes in the routine of life, fear of contamination, physical and mental exhaustion. In professional assistance, there was a work overload, shortage of personnel and material, a high number of contaminations and deaths of team members due to COVID-19. In professional training, adaptations to remote learning were necessary. Given the uniqueness and lethality of coronavirus, specialized nursing knowledge was essential in promoting confidence in the reception and care of patients in the community. Conclusion: The study valued Brazilian nurses' narratives about coping with the COVID-19 pandemic and expanded the discussion on labor deficiencies experienced by nurses and their aggravation in the pandemic context. The situation presented is worrisome and demands a critical look from those involved in the health and human care management process, aiming at adequate and safe working conditions for nursing professionals, with protection of workers' health and life.
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Background: We recently reported an attenuate immunogenicity in patients with autoimmune rheumatic diseases. However, the effect of spondyloarthritis (SpA) and its treatment on COVID-19 vaccine immunogenicity remains to be determined for this group of patients. We therefore aimed to evaluate humoral immune responses to inactivated SARS-CoV-2 vaccine (CoronaVac) in patients with SpA (axial spondyloarthritis and psoriatic arthritis) taking DMARDs and commonly used targeted biological therapies, compared with a control group(CG). Objectives: Evaluate immunogenicity and safety of CORONAVAC (Sninovac, Beijing) in Spondyloarthritis (SpA) patients. Methods: Prospective observational cohort patients diagnosed with 194 SpA and 183 CG were vaccinated with CoronaVac in two doses with a 28-days interval. 194 patients completed the study and could be paired with CG for immunogenicity analysis. Blood samples were collected in the days 0, 28 and 69 (D69) to evaluate anti-SARS-CoV-2 IgG seroconversion(SC) and presence of neutralizing antibodies (NAb) in participants with negative IgG and NAb at baseline. Results: Patients and GC were comparable regarding age (p=0.93) and sex (p=1.00). Immunogenicity at D69 showed a moderate/high SC (80.2% vs. 95.7%, p<0.0001) and Nab positivity (61.6% vs. 82.7%, p<0.0001) in SpA but lower than CG. Factors associated with lower immunogenicity were older age (56.8 vs. 51.4;p=0.03318) and higher frequencies of prednisone (25.7% vs 4.2%;p=0.0004), methotrexate (51.4% vs 40.1%, p=0.0016) and TNF inhibitor (TNFi) (62.9% vs 34.5%, p=0.0035). Likewise, prednisone (17.6% vs. 2.8%, p=0.0013) and TNFi (50% vs 33.9%;p=0.0408) were associated with diminished NAb positivity. Sulfasalazine was associated with higher SC rates (8.6% vs. 26.8%, p=0.0246) and NAb positivity (13.2% vs. 29.4%, p=0.0168). The multivariate analysis revealed that older age (p=0.037), prednisone (p=0.001), TNFi (p=0.016), and methotrex-ate(p=0.017) were independently associated with lower SC while prednisone (p=0.006) and TNFi (p=0.027) were also associated with reduced NAb response. Conclusion: Our fnding of an excellent safety and moderate/high SC rate in SpA supports the recommendation of CoronaVac vaccination. The impaired immune response in the minority of patients under immunosuppressive and biological therapy requires novel strategies to enhance antibody response in this subgroup of patients.
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Background: Patients with rheumatoid arthritis (RA) on methotrexate have reduced vaccine responses. Temporary discontinuation has improved immuno-genicity of anti-infuenza vaccine, but this strategy has not been evaluated in anti-SARS-CoV-2 vaccines. Objectives: To evaluate the effect on immunogenicity and safety of 2-week methotrexate (MTX) discontinuation after each dose of the Sinovac-CoronaVac vaccine versus MTX maintenance in rheumatoid arthritis (RA) patients. Methods: This was a single-center, prospective, randomized, investigator-blinded, intervention study (#NCT04754698, CoronavRheum), including adult RA patients (stable CDAI≤10, prednisone ≤7.5mg/day), randomized (1:1) to withdraw MTX (MTX-hold) for 2 weeks after each vaccine dose or maintain MTX (MTX-maintain), evaluated at D0, D28 and D69. Co-primary outcomes were anti-SARS-CoV-2 S1/S2 IgG seroconversion(SC) and neutralizing antibody (NAb) positivity at D69. Secondary outcomes were geometric mean titers (GMT) and fare rates. For immunogenicity analyses, we excluded patients with baseline positive IgG/NAb, and, for safety reasons, those who fared at D28 (CDAI>10) and did not withdraw MTX twice. Results: Randomization included 138 patients with 9 exclusions (5 COVID-19, 4 protocol violations). Safety evaluation included 60 (MTX-hold) and 69 (MTX-maintain) patients. Further exclusions: 27 patients [13 (21.7%) vs. 14 (20.3%), p=0.848] with positive baseline IgG/NAb and 10 patients (21.3%) in MTX-hold with CDAI>10 at D28. At D69, MTX-hold (n=37) had a higher rate of seroconversion than MTX-maintain (n=55) group [29 (78.4%) vs 30 (54.5%), p=0.019], with parallel augmentation in GMT [34.2 (25.2-46.4) vs 16.8 (11.9-23.6), p=0.006]. No differences were observed for NAb positivity [23 (62.2%) vs 27 (49.1%), p=0.217]. At D28 fare, rates were comparable in both groups (CDAI, p=0.122;DAS28-CRP, p=0.576), whereas CDAI>10 was more frequent in MTX-hold at D69 (p=0.024). Conclusion: We provide novel data that 2-week MTX withdrawal after each Sinovac-CoronaVac vaccine dose improves anti-SARS-CoV-2 IgG response. The increased fare rates after second MTX withdrawal may be attributed to the short-term interval between vaccine doses. This strategy requires close surveillance and shared decision making due to the possibility of fares.
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Background: The SARS-CoV-2 virus has caused a worldwide health crisis. Patients with infammatory arthritis are at higher risk of hospitalization and death by COVID-19 due to comorbidities or immunosuppressive treatments. Vaccination is one the most important strategies to control the pandemic. Objectives: To evaluate the incident cases of SARS-CoV-2 infection in a multi-centric cohort of infammatory arthritis in Brazil. Methods: BiobadaBrasil is a multicentric registry-based cohort study of Brazilian patients with rheumatic diseases starting their frst bDMARD or tsDMARD (1). The present analysis is a retrospective evaluation of adult patients with infam-matory arthritis (rheumatoid arthritis-RA, spondylarthritis-SpA and psoriatic arthritis-PsA) that were alive since the beginning of the COVID-19 pandemics in Brazil in February 2020. We evaluated the incidence and severity of COVID-19 infection and the adherence to anti-SARS-CoV-2 vaccines schedules, up to January 2022. Results: A total of 300 patients were interviewed and 69 (23.0%) reported con-frmed anti-SARS-CoV infection and 5 (1.7%) had a second infection. Among known infected patients, 18.8% need hospitalization and oxygen support, 7.2% were admitted at ICU, and 5.8% died. After COVID-19 infection, 31.8% reported worsening of disease activity but only 6.1% had modifcation in medication due to disease activity. Distribution of cases followed the pattern of waves observed in Brazil (Figure 1). Regarding vaccination, 285 (95%) reported to have received at least one dose of any anti-SARS-CoV-2 vaccine: 43% received the frst with the adenovirus ChAdOx1 nCoV-19 (AstraZeneca) adenovirus vaccine, 32% received the Sinovac-CoronaVac inactivated vaccine, 22% received the BNT162b2 (Pfzer-BioNtech) mRNA vaccine and 3% received the BNT162b2 (Pfzer-BioNtech) adenovirus vaccine. Almost all (98.1%) of these patients had already received the second dose of vaccine and after the frst and second vaccine doses, 6% and 4% of patients, respectively, reported worsening of articular disease activity, while, after the third dose, no patient reported disease activity worsening. Conclusion: During the pandemics, patients with infammatory arthritis had a pattern of distribution of cases very similar to general population. Adherence to vaccination is high and well tolerated.
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Background: Arthritis by Paracoccidioides brasiliensis is a remarkably unusual etiology of infectious joint disease. While osseous lesions can be present in systemic disease, intra-articular-restricted disease without typical lung or lymph node involvement is mostly anecdotal1,2. Objectives: We hereby describe a case of this fungal arthritis in a patient with rheumatoid arthritis (RA) without signifcant immunosuppression. Methods: Patient records review. Written informed consent was obtained. Results: A 65-year-old female Brazilian patient with a 35-year history of seropositive RA complained of a painful knee edema for the last three weeks. Skin surrounding the joint was erythematous, warm, and tender to the touch, which initially raised the suspicion of cellulitis. She had already received a 10-day course of amoxicillin-clavulanate, with no improvement. C-reactive protein was 17.8 mg/L, rest of blood chemistry panel was within reference range. Point-of-care ultrasound revealed joint effusion, and a diagnostic arthrocentesis was performed. Synovial fluid was slightly turbid, with 10,100 cells per mm3, of which 80% were lymphocytes. Cultures for bacteria and mycobacteria yielded negative results, but culture for fungi detected growth of P. brasiliensis. The patient had been solely on prednisone 5 mg once daily for the last year, given that, due to covid-19 pandemics, she lost regular follow-up and abandoned treatment with immunosuppressants. Aside from mild RA-related interstitial lung disease, she had no other comorbidity. She denied local trauma to the knee, which made hematogenous dissemination of the fungi the most probable source. Comprehensive work-up to search for organic involvement of paracoccid-ioidomycosis, including chest computed tomography and transthoracic echocardiogram, did not evidence any visceral compromise. Voricona-zole 200mg t.i.d. was started, with good response. Three months after the beginning of the azole, tofacitinib was started for moderate RA disease activity, which also responded satisfactorily. Repeat arthrocentesis and synovial biopsy were performed eight months after the start of antifun-gal treatment, the former being normal (770 cells per mm3, negative cultures), and the later only demonstrating non-specific chronic synovitis with fibrosis. Conclusion: We reported an exceedingly rare presentation of P. brasiliensis infection with exclusive joint involvement.
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Background and aims: Liver injury is common in patients with coronavirus disease-2019 (COVID-19) infection. Recently, few studies have reported the development of autoimmune hepatitis (AIH) following COVID-19 vaccination. However, there is a lack of studies reporting the outcomes of AIH following ChAdOx1 (vector-based) and BBV152 (inactivated virus) from India. Herewe aimed to describe the clinical profile of patients who developed AIH following COVID-19 vaccination. The causal association is attributed based on the temporal relationship in patients with no prior liver diseases. Method: Patients presenting with deranged liver functions following COVID-19 vaccination to hepatology clinic were included. Virus infections were ruled out in all patients either by serology or viral quantification methods. We aimed to assess the demographics, clinical profile, and outcome of patients with vaccine-induced AIH (V-AIH) in the absence of known liver disease. Results: A total of 31 patients presented with altered liver chemistries following vaccination. Seventeen patients were diagnosed with VAIH (age-39.8 ± 11.4 years;males-70.4%). None of the patient had history of alcohol overconsumption. Seventy six percent of patients had received ChAdOx1 and 23.53% had received BBV152 vaccine (Table). Seventy six percent of patients following first dose of vaccine and 23.5% following second dose of vaccinewere diagnosed as V-AIH. Mean duration for development of symptoms after first dosewas 25.7 days. Common symptom at presentation was jaundice in 82.3% of patients. Antinuclear antibodywas positive in 71% of patients and 17% patients were negative for all serological markers of autoimmune hepatitis but had elevated IgG levels. Fifty-nine percent of patients required immunosuppression of which 41% percet of patients received oral steroids, 17% patients received intravenous steroids for 3 days followed by oral steroid, 12% patients received azathioprine. One patient succumbed to pneumonia with multiorgan failure by day 30. At 3 months, it was observed that only 17% patients needed prolonged immunosuppression and had deranged liver functions until last follow-up. Mean duration of recovery amongst rest of 76.4% patients was 5.15 ± 3.1 weeks.
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Wound infection hinders adequate healing, being particularly grievous and prevalent in burn wounds and chronic wounds. Wound infection extends inflammation, preventing epithelialization and angiogenesis. Therefore, infection prolongs healing time, steeply increases treatment costs and degrades patients wellbeing. One successful strategy to control wound infection is to apply an active wound dressing, able to eliminate or significantly reduce the microbial population present at the infection site. Silver nanoparticles (AgNPs) are a multipurpose antimicrobial agent with a wide scope of applications which include wound dressings. Nevertheless, several studies denote AgNPs dose-dependent cytotoxicity, and their capability to bypass the blood-brain barrier and induce a neurotoxic effect. Hence, we propose to adopt two different strategies to attempt the simultaneously immobilize and increase the load of AgNPs within the wound dressing fabric. Thus, the envisaged objective is to prevent potential systemic cytotoxicity/through immobilization and to improve its antimicrobial capability due to the higher concentration of AgNPs. Two different approaches were used: i. AgNPs were suspended in an alginate (ALG) solution, ii. AgNPs were embedded in Mordenite (MOR) zeolite, followed by the addition of an ALG solution. Both suspensions were incorporated into polyester fabric assisted by its surface activation by dielectric barrier discharge (DBD) plasma treatment. The bactericidal and virucidal effectiveness of each composite was tested against bacteria species known to induce nosocomial infections and a bacteriophage that is a potential surrogate of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Two distinct antimicrobial analyses were used to provide insights on the antimicrobial effectiveness of the obtained composites and to indirectly assess the release of AgNPs.
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Introdução: Leucemia cutânea é caracterizada pela infiltração por leucócitos neoplásicos na pele. As formas mais comuns de leucemia que acometem a pele são Leucemia linfocítica crônica (LLC) e Leucemia mielóide aguda (LMA), dentre essas com morfologia monocítica ou mielomonocítica. Geralmente, o acometimento cutâneo é indicativo de doença avançada. Relato: Paciente masculino, 62 anos, sem comorbidades ou uso de medicações. Encaminhado da UPA para emergência do HCPA referindo astenia progressiva, perda ponderal de 12 kg há 2 meses com surgimento de “equimoses” em membros inferiores há 3 semanas, febre e secreção nasal recorrente. Ao exame: mau estado geral, desidratado, extremidades frias. Sinais vitais com taquicardia leve (FC 110) demais estáveis. Exames externos: Hb 5,8 g/dL, VCM 102, RDW 18,8%, leucócitos totais 11080/uL com diferencial de neutrófilos 665 /uL, monócitos 6759/uL, plaquetas 35.000/uL. Recebeu suporte transfusional após exames admissionais: Hb 3,7, plaquetas 26.000, demais sem alterações significativas. Exames de investigação: tomografia compatível com rinossinusite fúngica invasiva. Iniciado voriconazol empírico e realizada turbinectomia, etmoidectomia anterior, uncinectomia e antrostomia maxilar. Realizou medulograma com celularidade diminuída nas três séries com 4% de blastos e 60,5% de monócitos atípicos, sugestivo de Leucemia Mielomonocítica Crônica e imunofenotipagem compatível com LMA de comprometimento da linhagem monocítica (43,7% de células monocíticas com expressão de HLADR, CD64 forte, CD33 forte e coexpressão de CD56). Lesões de pele avaliadas pela dermatologia: máculas e manchas purpúricas e confluentes em coxas e pernas, com descamação. Lesões semelhantes de aspecto residual em abdome e membros superiores. Pápulas com brilho perolado em face, com telangiectasias a dermatoscopia. Biópsia de pele com punch de 4 mm teve o resultado do anatomopatológico de infiltrado mononuclear intersticial discreto com células maduras incluindo plasmócitos e células de tamanho médio e padrão imaturo e a imunohistoquímica demonstrou infiltração dérmica por células imaturas de perfil mielomonocítico, compatível com sarcoma mielóide. Devido a infecção fúngica invasiva foi optado por não iniciar quimioterapia até sua resolução. Paciente apresentou piora do padrão ventilatório no dia 05/07 tendo PCR para SARS-CoV-2 positivo, sendo transferido a UTI e evoluindo a óbito por complicações do quadro pulmonar. Discussão: A leucemia de apresentação cutânea é rara e na LMA está presente em 13% dos casos. As formas de apresentação mais comuns são pápulas e nódulos (60%) e em casos mais raros ocorre eritema, eritrodermia ou úlceras. A lesão do paciente era atípica e inicialmente foi avaliada como equimose, o que corrobora a importância de diagnósticos diferenciais de lesões cutâneas. O tratamento se dá através de protocolos guiados para a leucemia de base com quimioterápico sistêmico agressivo, que no caso do nosso paciente seria o protocolo 7+3. Em alguns casos, pode-se realizar radioterapia, porém ela é mais usada no tratamento de casos refratários ou paliativos. Leucemia cutânea geralmente tem o prognóstico desfavorável e o follow-up de dois anos dos pacientes com LMA demonstrou 6% de taxa de sobrevivência para casos com acometimento cutâneo versus 30% sem tal apresentação.