Pulmonary Kaposi's sarcoma-an atypical clinical presentation.

HIV-associated Kaposi's sarcoma is an angioproliferative neoplasia caused by infection with human herpesvirus 8. It typically presents with mucocutaneous involvement. Pulmonary Kaposi's sarcoma is rare, and an uncommon form of initial presentation of the disease. The authors present the clinical case of an HIV-positive patient with Kaposi's sarcoma who had exclusively pulmonary involvement at diagnosis. This case is highlighted for its rarity, by the diagnostic challenge it presented, and for the important role of bronchoscopy as a diagnostic tool for this pathology. Bronchoscopy allows direct visualization of the lesions and the ability to perform a bronchoalveolar lavage and directed biopsies.

Mycobacterium chelonae cutaneous infection: An opportunistic disease in an immunosuppressed patient with myasthenia gravis.

Mycobacterium chelonae can cause chronic skin, soft-tissue or bone infections. and is often associated with the immunocompromised state.We describe a case of a 58-year-old male patient with myasthenia gravis, chronically immunosuppressed, with a four month progression of growing erythematous, nodular and hard cutaneous lesions in the left forearm, leg and foot. He was receiving immunoglobulin every four weeks (2 g/kg) and prednisolone 25 mg/day and had an important previous history of several opportunistic infections while he was receiving corticosteroids. Histopathological examination of a biopsy showed acid-fast bacilli and tissue culture identified a Mycobacterium spp. within seven days of incubation, with Mycobacterium chelonae being identified by polymerase chain reaction assay. Antimicrobial susceptibility testing was performed showing no resistance and the patient was successfully treated during four months with ciprofloxacin, clarithromycin and trimethoprim-sulfamethoxazole with regression of the lesions, leaving some hyperpigmentation scars and without unbalancing his neurological disease. Patients with myasthenia gravis should be closely monitored because first line treatments for M. chelonae infection may be associated with myasthenic crisis.

Cutaneous leishmaniasis in non-endemic countries: An emerging yet neglected problem.

Cutaneous leishmaniasis (CL) is the most common leishmaniasis syndrome, yet a neglected disease in industrialized non-endemic countries, where it has become an emergent problem. The lack of clinical experience, evidence-based literature and availability of some treatments complicates its management. We report a CL case in a 30 year-old man returned from Brazil, with a cutaneous ulcerated lesion, where it was possible to isolate Leishmania braziliensis/guyanensis complex (subgenus Viannia). An initial course of treatment with miltefosine was attempted, but considering the lack of response, liposomal amphotericin B was used, with very good results. Our report highlights the obstacles faced in the diagnosis and treatment of New World CL in non-endemic countries and the need for more funding and research.