Immunopathological insights into villitis of unknown etiology on the basis of transplant immunology.

Villitis of unknown etiology (VUE) is an inflammatory disease characterized by the infiltration of maternal CD8 +T cells into the placental villi. Although the pathogenesis of VUE is still debated, dysregulation of the immune system appears to be an important factor in the development of the disease. Interaction of maternal T cells with the fetal antigens seems to be the trigger for the VUE onset. In this context, graft vs host disease (GVHD) and allographic rejection seem to share similarities in the VUE immunopathological mechanism, especially those related to immunoregulation. In this review, we compared the immunological characteristics of VUE with allograft rejection, and GVHD favoring a better knowledge of VUE pathogenesis that may contribute to VUE therapeutics strategies in the future.

Exclusively oral manifestation of secondary syphilis / Manifestação exclusivamente oral de sífilis secundária

Introduction: Syphilis is at an epidemic level in the Brazilian public health and it occurs, mainly, in the genital region. However, about 5% of the syphilitic lesions are oral. Objective: To report a clinical case of secondary syphilis with exclusively manifestation in the oral cavity. Case report: A 32-yearold woman who attended the Dentistry Clinic of the Universidade Estadual do Oeste do Paraná (UNIOESTE) complaining of "sores in the mouth". Physical examination revealed a number of ulcerated, pseudomembranous and painful lesions at apex, lateral border, belly, floor and lingual frenulum. After the diagnostic hypothesis of syphilis was raised, serological tests for human immunodeficiency virus (HIV) 1, HIV-2, Venereal Disease Research Laboratory (VDRL) and complete blood count were requested. With the positivity up to the 1/32 titration of the VDRL examination, the patient was referred to the Parasitic Infectious Diseases Center of Cascavel, where a general physical examination and antibiotic therapy with benzathine penicillin were carried out. Subsequent to the drug treatment, the patient returned to the UNIOESTE Dentistry Clinic, where the total remission of the lesions was observed, confirming the diagnosis of secondary syphilis exclusively in the mouth. Conclusion: This report illustrates the importance of each phase of the disease, noting that in some cases the manifestations of the infection may be solely oral, with the dentist having a notable role in the diagnosis and reference to the adequate treatment, and the responsibility to control the necessary diagnostic procedures.

Introdução: A sífilis encontra-se em estado epidêmico na saúde pública brasileira. Ela ocorre principalmente em região genital, todavia cerca de 5% das lesões sifilíticas são orais. Objetivo: Relatar um caso clínico de sífilis secundária com manifestação exclusivamente em cavidade oral. Relato de caso: Mulher, 32 anos, compareceu à Clínica de Odontologia da Universidade Estadual do Oeste do Paraná (UNIOESTE) com queixa de "feridas na boca". Ao exame físico, observaram-se inúmeras lesões ulceradas, pseudomembranosas e doloridas em ápice, borda lateral, ventre, assoalho e frênulo lingual. Depois de levantada a hipótese diagnóstica de sífilis, foi solicitada a realização de exames sorológicos para vírus da imunodeficiência adquirida (HIV) 1, HIV-2, Venereal Disease Research Laboratory (VDRL) e hemograma completo. Com a positividade até a titulação de 1/32 do exame VDRL, a paciente foi encaminhada ao Centro de Doenças Infecto-Parasitárias de Cascavel, sendo ali realizados exame físico geral e antibioticoterapia com penicilina benzatina. Posteriormente ao tratamento medicamentoso, a paciente retornou à Clínica de Odontologia da UNIOESTE, sendo observada a remissão total das lesões, confirmando o diagnóstico de sífilis secundária exclusivamente bucal. Conclusão: O relato ilustra a importância do conhecimento das características clínicas de cada fase da doença, ressaltando que em alguns casos as manifestações da infecção podem ser unicamente orais, tendo o cirurgião-dentista notável papel no diagnóstico e referência ao tratamento adequado, além da responsabilidade de dominar as manobras diagnósticas necessárias.