Case report: multifocal chronic paracoccidioidomycosis in an adult / Informe de caso: paracoccidioidomicosis crónica multifocal del adulto

Paracoccidioides brasiliensis is the ethiological agent of one of the most prevalent systemic mycosis in Latin America, where around ten-million individuals are affected. Brazil has the highest incidence but in Venezuela, Colombia, Ecuador, and Argentina cases have also been reported. We describe a 56-year-old male with a one year history of lip, oral mucosa, and lung lesions. Granulomas and multinucleated giant cells were observed in histopathological evaluation with haematoxilyn-eosin stain. Mycologic studies (KOH and Gomori Grocott stain) showed blastoconidias with multiple budding. Serologic tests for paracoccidioidine were reactive. A diagnosis of chronic multifocal paracoccidioidomycosis was made. Initially, amphotericin B 0.7 mg/kg per day was started for fifteen days and consecutively itraconazole (400 mg/day) was administered orally with improvement of skin and lung lesions; however, an important residual fibrosis was observed. The patient was lost to follow up. We highlight the importance of an early diagnosis and adequate treatment to decrease sequelae in patient quality of life.

Paracoccidioides brasiliensis es el agente causal de una de las micosis sistémicas con mayor prevalencia en Latinoamérica. Existen alrededor de 10 millones de afectados y la mayor incidencia se presenta en Brasil y se han observado casos en Venezuela, Colombia, Ecuador y Argentina. Se presenta el caso de un hombre de 56 años con lesiones de un año de evolución en labios, mucosa oral y pulmón. El estudio histopatológico con hematoxilina-eosina informó la presencia de granulomas y células gigantes multinucleadas. Los estudios micológicos (KOH y tinción de Gomori Grocott) mostraron blastoconidias con gemación múltiple. Las pruebas serológicas para paracoccidioidina fueron reactivas. Se diagnosticó un caso de paracoccidioidomicosis multifocal crónica y se inició tratamiento anfotericina B 0.7 mg/kg/día durante 15 días, luego itraconazol 400 mg diarios. Las lesiones cutáneas y pulmonares mejoraron; sin embargo, presentaba una fibrosis residual importante en la región oral y no continuó el seguimiento. Se resalta la importancia de realizar un diagnóstico temprano y disminuir las posibles secuelas que van a repercutir directamente sobre la calidad de vida del paciente.

Pioderma gangrenoso tratado con rifampicina / Treatment of gangrenous pioderma with rifampicine

El pioderma gangrenoso es una enfermedad de etiología desconocida, con variedad de manifestaciones clínicas especialmente cutßneas, de difícil diagnóstico y un amplio diferencial y en la cual no existe un tratamiento claro de elección. Su respuesta a la terapia es muy variable con fracaso en muchas oportunidades. Se presenta el caso de una mujer de 40 a±os de edad con 5 a±os de evolución de pioderma gangrenoso extenso y severo, con mala respuesta terapéutica a múltiples medicaciones y que respondió en forma dramßtica a la terapia con rifampicina.

Pyoderma gangrenosum is an entity of unknown etiology, with diverse expressions, mainly on skin. Their differential diagnosis are difficult and broad, and do not have a clear therapy of choice. The response to therapy is variable, with failure in many opportunities. A case of a 40 year old woman with extensive and severe pyoderma gangrenosum having 5 years of evolution is discussed. Her therapy response to multiple medications had been poor but she showed a dramatic answer to rifampicine.

HLA-DQ3 is associated with idiopathic guttate hypomelanosis, whereas HLA-DR8 is not, in a group of renal transplant patients.

BACKGROUND: The etiology of idiopathic guttate hypomelanosis (IGH) remains uncertain; however, solar exposure and heredity have been proposed as causative factors. OBJECTIVE: To explore the genetic predisposition to the development of IGH. METHODS: A comparative case-control study was performed at a dermatology department at a university hospital. Forty-seven subjects (22 renal transplant patients and 25 controls) were enrolled. Clinical examination and human leukocyte antigen (HLA) determination were performed. RESULTS: In the group of subjects with HLA-DQ3 (10/13, P = 0.025), there was a statistically significant (P < 0.05) positive association for the presence of IGH; in the group of subjects with HLA-DR8 (6/6, P = 0.023), there was a statistically significant negative association for the presence of IGH. CONCLUSIONS: The presence of HLA-DQ3 in patients with IGH suggests a genetic basis in a group of renal transplant subjects. HLA-DR8 was found in patients without IGH, and it could play a role as a "protective factor" preventing subjects from developing IGH.