[Cutaneous histoplasmosis in nine patients with AIDS]. / Histoplasmosis cutánea en nueve pacientes con SIDA.

UNLABELLED: In AIDS patients the diagnosis of systemic mycosis is a clinical challenge. When cutaneous affection occurs, the diagnosis is difficult because of the non-specific clinical findings. We describe nine patients with AIDS and cutaneous histoplasmosis as the initial clinical manifestation. These patients were diagnosed from 1987 to 1998. In all the diagnosis of histoplasmosis was done by skin biopsy and fungal isolation. The main skin lesions were papules combined with pustules or nodules in 6 of 9 patients, ulcers (1/9), erythematous plaques (1/9) and nodules (1/9). Head and trunk were the main anatomical locations of the lesions. All had fever, 7/9 had liver and spleen enlargement and 5/9 had weight loss. At the time of diagnosis all patients had a low CD4+ lymphocyte counts with a mean of 47 cells/microL. Amphotericin B was the initial treatment followed by itraconazole. Five patients died, one day after diagnosis and four after 5, 8, 11 and 12 months. Four are alive at 3, 3, 19 and 26 months of follow-up. CONCLUSIONS: In AIDS patients the skin involvement by histoplasmosis should always be included among the differential diagnoses specially in patients with face and trunk papules and fever and hepatosplenomegaly. Skin and bone marrow cultures were the most reliable diagnostic methods, but skin biopsy was the fastest procedure.

[Hypersensitivity syndrome caused by allopurinol. A case of massive hepatic necrosis]. / Síndrome de hipersensibilidad por alopurinol. Un caso de necrosis hepática masiva.

Adverse drug reactions have a wide variety of clinical manifestations mainly related to the affected organ. The skin is one of the most common organs involved due to the visibility of the lesions to the observer. These untoward drug cutaneous responses may mimic any known dermatosis, and may be a clue to a serious systemic disease. We present the case of a 72 year-old woman with erythema multiforme, liver and renal failure due to a unknown dosage of allopurinol self-medication for two weeks. The clinical course was characterized by a Stevens-Johnson syndrome and severe drug-induced liver disease with massive hepatic necrosis corroborated by a transjugular liver biopsy; finally she died of gastrointestinal bleeding. Consent for a postmortem study was not obtained. The clinical course as well as the cutaneous, renal and hepatic drug-related complications corresponds to an allopurinol hypersensitivity syndrome. The relevance of this case was the extension of the liver damage apparently due to the allopurinol, which is an infrequent hepatotoxic complication. In some cases, like the present case, it can be a serious and fatal complication.