Mucocutaneous Manifestations of Infection by Histoplasma capsulatum in HIV-Negative Immunosuppressed Patients. / Manifestaciones mucocutáneas de la infección por Histoplasma capsulatum en pacientes inmunosuprimidos.

Histoplasmosis is a systemic mycosis caused by the dimorphous fungus Histoplasma capsulatum (H. capsulatum). The fungus enters the body through the respiratory tract in the form of microconidia, which are transformed into intracellular yeast-like structures in the lungs before disseminating hematogenously. Primary infection is usually asymptomatic and self-resolving. Some patients develop severe disease with acute or chronic respiratory involvement. Immunosuppressed patients, mainly those with altered cellular immunity, may have disseminated disease with variable mucocutaneous involvement characterized by papules, nodules, gummas, or ulcers with a granulomatous base. We report the case of 3 HIV-negative patients infected by H capsulatum in whom diagnosis based on the skin lesions proved essential for early initiation of treatment.

[Differences in the electrophysiological patterns in the distinct variations of the presentation of chronic inflammatory demyelinating polyneuropathy]. / Diferencias del patrón electrofisiológico en las variantes de presentación de la polineuropatía desmielinizante inflamatoria crónica.

INTRODUCTION: Chronic inflammatory demyelinating polyneuropathy (CIDP) is a mixed (predominantly motor) neuropathy, with an autoimmune aetiology and different forms of clinical presentation including the idiopathic form and one related to concurrent diseases. Neurophysiological studies play a decisive role in its diagnosis. AIM: To evaluate the differences in the electrophysiological patterns in the two forms of presentation of the disease, based on the variables that were analysed by studying nerve conduction and the F wave. PATIENTS AND METHODS: The study involved 27 patients with a diagnosis of probable CIDP, according to American Academy of Neurology criteria from 1991. Of all the patients included in the study group, 17 presented primary CIDP and in 10 cases it was related to other diseases, such as diabetes mellitus, adenocarcinoma, multiple sclerosis and human immunodeficiency virus infection. Motor and sensory nerve conduction studies were performed, as well as F wave studies of the nerves in the four limbs. Statistical methods were applied to compare the neurophysiological variables in the two groups of patients. RESULTS: Significant differences were found to exist between the two groups. The sensory study was more affected in patients with primary CIDP, whereas the motor and F wave study were affected to a greater extent in patients with secondary CIDP; these cases displayed a predominantly axonomyelinic pattern, with greater involvement of the proximal motor segment. CONCLUSION: The different variant forms of presentation of CIDP display distinct electrophysiological behaviours.

Is androgenic alopecia a result of endocrine effects on the vasculature?

Androgenic alopecia is a condition of concern for many patients. Though much has been learned about this condition, the exact pathophysiological mechanism is yet to be established. Currently most study concerning androgenic alopecia has focused on the effects of androgens on the pilosebaceous unit itself. An area of study that has received considerably less attention is that of androgens inducing baldness by indirect effects, that is, effects on tissues other than the pilosebaceous unit. In this paper, the author offers a novel hypothesis in which androgenic hair loss is mediated via the effects of androgens on the vasculature supplying the scalp. In this new hypothesis androgens effect anatomical changes in the vasculature of susceptible individuals, resulting in an environment in which hair growth is hindered and eventually ceases. The author discusses past studies demonstrating the effects of androgens on vessels and how these effects may relate to anatomical changes in the vasculature leading to hair loss. Also included is a discussion on future experimentation to test this new hypothesis.

Primary Kaposi's sarcoma of lymph nods.

An example of Kaposi's sarcoma with primary involvement of lymph nodes is reported. The patient, a woman, was admitted because of generalized lymphadenopathy and anemia. She was also known to have congestive heart failure of rheumatic origin. SMA-12 screening disclosed hypercalcemia on several occasions during her hospitalization. Levels of circulating parathormone and prostaglandins E2 and F were markedly increased. Total bone scan was negative for involvement by tumor. Electronmicroscopic examination of an involved lymph node disclosed secretory bodies in the cytoplasm of malignant cells and other cells, with clear indication of endothelial origin. The rarity of Kaposi's sarcoma with primary lymph nodal involvement in the United States is discussed. So far as is known by the authors, no example of Kaposi's sarcoma has been associated with hypercalcemia due to ectopic endocrine production.