Farmacodermia: la otra "gran simuladora" / Pharmacodermia: the other "great simulator"

Dentro de las reacciones adversas a fármacos (RAM), se destacan las farmacodermias por su frecuencia de presentación y por sus variantes clínicas que abarcan manifestaciones agudas graves y crónicas leves, que pueden simular gran variedad de patologías cutáneas. Presentamos el caso de una paciente de sexo femenino de 37 años de edad, con una farmacodermia leve y crónica secundaria a hidroxicloroquina. (AU)

Among adverse drug reactions (ADRs), pharmacodermatics are noteworthy because of their frequency of presentation and their clinical variants that include mild acute and chronic manifestations, which can mimic a wide variety of skin pathologies. We present the case of a female patient of 37 years of age, with a mild and chronic pharmacodermia secondary to hydroxychloroquine. (AU)

[Paraneoplastic dermatomyositis related to breast cancer: rare clinical association in two patients]. / Dermatomiositis paraneoplásica relacionada a cáncer de mama: asociación clínica en dos pacientes.

Paraneoplastic dermatomyositis is an inflammatory disease of the connective tissue that is caused by inmmunologic events in the presence of malignant tumors. It is more likely to happen in middle aged women and is related to ovarian, pancreatic, stomach and colon cancer and non Hogdkin lymphoma. We present two cases of dermatomyositis, with amyopathic origin associated to breast cancer. The first case occurs as the neoplasia evolves and the second one as an initial manifestation that leads to the search and subsequent diagnosis of cancer.

[Subacute diseminated histoplasmosis in HIV patients]. / Histoplasmosis diseminada subaguda en pacientes VIH.

Histoplasmosis is a cosmopolitan mycosis caused by Histoplasma capsulatum. It is endemic of Río de la Plata's riverbed and in immunocompromised patients may be deadly. We present two patients with Human Immunodeficiency Virus diagnosed with subacute disseminated histoplasmosis, which is a marker of Acquired Human Immunodeficiency Syndrome. This situation increases the morbimortality, thus forcing clinicians to diagnose and treat rapidly in order to avoid fatal outcomes.

La histoplasmosis es una micosis cosmopolita causada por el Histoplasmacapsulatum. Es un hongo endémico de la cuenca del Río de La Plata que si afecta a inmunosuprimidos puede ser mortal. Presentamos dos pacientes con Virus de Inmunodeficiencia Humana con diagnóstico de histoplasmosis diseminada subaguda. Esta situación los cataloga en estadío de Síndrome de Inmunodeficiencia Adquirida y requiere pronta acción médica para evitar complicaciones.

Histoplasmosis diseminada subaguda en el contexto de VIH y porfiria cutánea tarda. A Propósito de un caso / Subacute disseminated histoplasmosis in a patient with HIV and porphyria cutanea tarda. A case report

La histoplasmosis es una micosis sistémica endémica en la República Argentina.Es la infección micótica profunda más ampliamente extendida en el mundo. Se ha convertido en una infección oportunista cada vez más frecuente entre los pacientes con un sistema inmune deteriorado por agentes farmacológicos o por el virus de la inmunodeficiencia humana (VIH).Presentamos un caso de histoplasmosis diseminada subaguda en un paciente con antecedentes de Porfiria Cutánea Tarda(PCT) e infección por VIH que representó un desafío diagnóstico dado a la similitud de las lesiones de histoplasmosis con PCT.

Histoplasmosis is a deep fungal endemic infection in Argentina and world widely. It has become an opportunistic infectionincreasingly among patients with an impaired immune system due to pharmacological agents or HIV.A case of subacute disseminated histoplasmosis in a patient with a history of HIV and Porphyria Cutanea Tarda (PCT), representinga diagnostic challenge by the similar clinical appearance between histoplasmosis and PCT lesions is reported.

Dermatosis perforantes: presentación de 8 casos / Perforating dermatosis: report of 8 cases

Las dermatosis perforantes (DP) o enfermedades por eliminación transepidérmica son un grupo de entidades caracterizadas por la extrusión de material dérmico alterado a través de la epidermis que incluye a la colagenosis perforante reactiva, la elastolisis perforante serpiginosa, la foliculitis perforante y la enfermedad de Kyrle. Se caracterizan por la aparición de pápulo-nódulos centrados por tapones o costras queratósicas, pruriginosos. Entre las opciones terapéuticas se describen los antihistamínicos, fototerapia y corticoides intralesionales, con resultados variables. Objetivos. Describir 8 casos de dermatosis perforante diagnosticados en nuestro servicio. Materiales y Métodos. Se realizó un estudio retrospectivo, observacional y descriptivo que evaluó las características clínicas, histológicas y la asociación con patología sistémica de los pacientes con diagnóstico histológico de dermatosis perforante que concurrieron a nuestro servicio entre septiembre de 2006 y julio de 2010.Resultados. Se diagnosticaron 8 pacientes con dermatosis perforante. Del total, 5 (62,5%) fueron hombres y 3 mujeres (37,5%). La edad media de presentación fue de 57,12 años (37-71 años); 6 (75%) correspondían a enfermedad de Kyrle y 2 (25%) a foliculitis perforante; 6 (75%) se asociaban a insuficiencia renal crónica, 6 (75%) a diabetes mellitus, 1 (12,5%) a insuficiencia renal aguda y 6 (75%) a enfermedad cardiovascular. Conclusiones. Si bien la mayoría de nuestros pacientes tenían antecedentes de diabetes y/o insuficiencia renal crónica como se describe en la literatura, cabe destacar que en uno de ellos no se encontró ninguna de estas asociaciones. Adicionalmente, el 75% de los pacientes tenía antecedentes de enfermedad cardiovascular. Encontramos una mayor incidencia en hombres (62,5%) a diferencia de lo reportado en algunos trabajos (AU)

Perforating dermatosis (DP) comprises a group of diseases characterized by the extrusion of dermic debris through the epidermis. It includes reactive perforating collagenosis, perforating folliculitis, elastosis perforans serpiginosa and Kyrle's disease. It presents as multiple pruritic papulo nodules centered by a keratotic plug. Antihistamines, phototherapy and intralesional steroids are among the therapeutic options described, with variable results. Objectives. To describe 8 cases of perforating dermatosis diagnosed in our department. Materials and Methods. We conducted a retrospective, observational and descriptive study evaluating clinical and histological features and association with systemic disease, of the patients with a biopsy confirmed, perforating dermatosis between September 2006 and July 2010. Results. Eight patients with perforating dermatosis were diagnosed. Of them, 5 (62,5%) were male and 3 female (37,5%). Mean age of presentation was 57,12 years (37-71 years); 6 (75%) corresponded to Kyrle's disease and 2 (25%) to perforating folliculitis; 6 (75%) were associated with chronic renal insufficiency, 6 (75%) with diabetes mellitus, 1 (12,5%) with acute renal insufficiency and 6 (75%) with cardiovascular disease. Conclusions. Although most of our patients had a history of chronic renal insufficiency or diabetes, as described in the literature, in one of them no associated disease was found. Furthermore, 75% of the patients presented with cardiovascular disease. Unlike previous reports, we found agreater incidence in men (62,5%) over women (AU)

Antisilicone antibodies in patients with silicone implants for retinal detachment surgery.

A modified ELISA assay was used to detect IgG binding to silicone and IgG subtypes in serum of patients bearing silicone bands, silicone sponges and intraocular silicone oil. Presence of autoantibodies (rheumatoid factor, antinuclear antibody, and SCL 70) and signs and symptoms of autoimmune diseases were also checked. Antisilicone antibodies were detected in 35.7% of patients with solid silicone and in 83% in those with silicone oil. This increase in IgG is mainly due to IgG1. Nevertheless no positive results were found in detecting signs and symptoms of autoimmune diseases.

Derivatives of gallic acid induce apoptosis in tumoral cell lines and inhibit lymphocyte proliferation.

The effect of gallic acid (3,4,5-trihydroxybenzoic acid) and its alkyl esters (methyl, propyl, octyl, and lauryl) has been studied on several tumoral and nontumoral cells. Three types of behavior have been observed; the first type is represented by the mouse B cell lymphoma Wehi 231 cell line in which death occurs according to the biochemical characteristics of classical apoptosis showing the DNA ladder fragmentation pattern. The second type is represented by the mouse fibroblast L929 cell line in which morphological characteristics such as cell shrinkage, chromatin condensation, and appearance of apoptotic bodies can be evidenced by microscopical observation. However, the typical DNA fragmentation is absent. Peripheral blood lymphocytes are representative of a third type of behavior. In a resting state they can withstand higher concentrations of these compounds. If the drug is washed, they proliferate normally upon the addition of the mitogen phytohemagglutinin (PHA). However, if the drug is added in the presence of PHA, a clear antiproliferative effect can be demonstrated. A special interest for these compounds stems from the fact that some of them are currently used as antioxidant food additives with the European Community codes E-310 (propylgallate), E-311 (octylgallate), and E-312 (laurylgallate).

Increased soluble serum HLA class I antigens in patients with lymphoma.

sHLA are soluble forms of class I histocompatibility antigens detected in human serum and cerebrospinal fluid. These molecules are secreted by B and T lymphocytes and the secretion increases dramatically upon mitogenic activation of these cells. sHLA was quantified by an ELISA sandwich method in sera from healthy blood donors, and from patients with Non Hodgkin's Lymphoma (NHL) and Hodgkin's Disease (HD) both at diagnosis and at remission. Pretreatment sHLA serum levels in NHL and in HD were compared with the values found in controls. sHLA levels are increased in patients with NHL (low grade: 6.68 +/- 1.80; high grade: 2.65 +/- 0.53 microg/ml X +/- S.E.) and HD (6.44 +/- 0.98) at diagnosis and in relapses when compared with controls (0.89 +/- 0.08). This increment is statistically significant (low grade NHL: p = 0.0038; high grade NHL: p = 0.0049 and HD: p = 0.0005 versus control group). No statistical differences between titers of sHLA after complete remission and sHLA in the control group were found. The high levels of sHLA detected in patients with lymphoma are mainly due to low molecular weight HLA molecules (55 KD) (60-75% of the HLA present in serum in the control group and 75-100% in serum of patients with lymphoma).

Thioesterase and protein deacylase activities of porcine pancreatic phospholipase A2.

The thioesterase activity of porcine pancreatic phospholipase A2 has been investigated with non-phospholipid substrates. The acyl-CoA hydrolase activity towards acyl-CoA derivatives is specific for long chain fatty acids (14 C, 16 C) but is unable to hydrolyze short chain acyl-CoA compounds (below 8 C). The same enzyme also shows protein deacylase activity liberating [3H]palmitic acid from [3H]palmitoyl-acyl carrier protein.

[Immunologic changes in chronic post-transfusion positive hepatitis C and non-A non-B non-C hepatitis]. / Alteraciones inmunológicas en la hepatitis crónica postransfusional C positiva y no-A no-B no-C.

OBJECTIVES: To study some aspects of the immunological abnormalities of C and non-A non-B non-C posttransfusional chronic hepatitis through the spontaneous and mitogen-stimulated "in vitro" production of immunoglobulins by peripheral blood lymphocytes. EXPERIMENTAL DESIGN: Peripheral blood lymphocytes from non-A non-B posttransfusional chronic hepatitis patients and from healthy volunteers were cultured in presence and absence of Pokeweed mitogen and the secreted immunoglobulins (IgG, IgA and IgM) were measured by ELISA in the supernatants. The results in both groups were compared. PATIENTS: 23 posttransfusional chronic hepatitis patients, 11 males and 12 females with an average age of 46.73 +/- 11.2 yrs (range: 24-69 yrs), have been studied. The histological diagnosis was chronic active hepatitis (CAH) in 13 cases, CAH with bridge necrosis in 6 patients and CAH with associated cirrhosis in 4 cases. The control group was composed by 11 healthy volunteers, 5 male and 6 female, with an average age of 38.45 +/- 12.77 yrs (range: 26-65 yrs). No one of the control group was positive for anti-HCV antibodies while in the posttransfusional chronic hepatitis patients group, 19 were positive and 4 negative. RESULTS: No significant differences in the spontaneous production of immunoglobulins between both groups has been found, however, when peripheral blood lymphocytes were stimulated with Pokeweed mitogen, a statistically significant lower production of immunoglobulins was observed in chronic hepatitis patients when compared with the control group. In non-A non-B posttransfusional chronic hepatitis patients, no relation has been found between the immunoglobulins production and histological findings or anti-HCV antibody titles. CONCLUSIONS: In the chronic phase of C and non-A non-B non-C posttransfusional chronic hepatitis, stimulated immunoglobulin production is significantly decreased for each immunoglobulin compared with the control group. These results suggest a failure in T-B lymphocyte cooperation in these infections since 82.6% of our patients were positive for HCV serological markers.

Covalent-binding native blot in the determination of specific IgE to latex gloves allergens. Comparison with other methods.

Six sera from patients with clinical symptoms of latex hypersensitivity and latex-RAST values ranging from class 1 to 4 were used to characterize latex-glove allergens by immunoblotting. Twelve % acrylamide-SDS-PAGE of the latex glove crude extract revealed a single band with an estimated mol wt lower than 14,000 D. The proteins bound to nitrocellulose after electrical transfer as shown by Ponceau red staining of the membrane. However, standard immunoblotting methods using alkaline-phosphatase anti-IgE did not detect the presence of specific IgE. Different variants of SDS-PAGE immunoblotting were also unsuccessful. On the other hand, the use of IEF and capillary transfer (native blot) to a covalent-binding hydrophilic membrane was found to be the method of choice for the study of this allergen. The authors believe that this procedure can be helpful in the study of other antigen-antibody systems, particularly when standard immunoblotting assays fail.

Intrathecal synthesis of soluble class I antigens in multiple sclerosis.

We have studied the intrathecal synthesis of soluble class I antigens (sHLA), reflected by the index IH = (CSF sHLA/serum sHLA)/(CSF albumin/serum albumin), in multiple sclerosis (MS). IH was increased in patients in relapse, but normal in patients in remission; these findings show that there is a high lymphocyte activation within the central nervous system in patients with clinically active MS.

Immunological abnormalities in acute post-transfusion hepatitis non-A non-B.

A variety of immunological parameters has been serially examined in the blood of 12 patients with acute post-transfusion hepatitis non-A non-B (PTHNANB). Several alterations of these tests were transiently detected when comparing with healthy, extensively transfused subjects as well as with normal volunteers: 1. Low proportions of CD8+ T lymphocytes were observed at the disease onset, and these returned to normal after 1 month; 2. A diminution of the proliferative response of blood lymphocytes to mitogens was detected during the same period of time; 3. By the third month of disease, an enhanced spontaneous IgG secretion by cultured lymphocytes was found, and this observation was restricted to those patients who had not recovered. These alterations suggest that the immune system might be involved in the course of hepatitis C virus infection.