First report of an autochthonous human visceral leishmaniasis in a child from the South of Minas Gerais State, Brazil.

American visceral leishmaniasis (VL) is a vector-borne disease transmitted by some species of phlebotomine sandflies from the genus Lutzomyia. This neglected tropical zoonosis shows increasing urbanization process, since the end of the 1980s. After the emergence of foci of the disease in urban areas, VL has assumed an important role in public health. Although VL is widely prevalent in several parts of the world, diagnosing the illness is still difficult. We present a case of a 12-year-old girl with a history of recurrent fever, anorexia, cachexia, chronic fatigue, weight loss, left palpebral unilateral edema, persistent cough and pancytopenia. A diagnosis of VL was performed using a reference immunochromatographic rapid test. Identification of the infecting protozoan was directly obtained by PCR of bone marrow. The patient responded favorably to treatment using liposomal amphotericin B. This is the first report of human visceral leishmaniasis in the city of Lavras in the South of Minas Gerais State. This first report of VL highlighted the need of maintenance of permanent surveillance and control programs in the city of Lavras, including the active search of sandflies, human and canine cases. The current situation of Lavras should also be taken as an alert to other near cities where favorable eco-epidemiological conditions may exist.

Linfoma não-Hodgkin de células do manto: relato de caso / Mantle cell non-Hodgkin's lymphoma: case report

Relata-se o caso clínico de paciente feminino, de 80 anos de idade, com o diagnóstico inicial de pênfigo vulgar. Após um ano de evolução, identificou-se linfoma de células do manto. Trata-se de linfoma não Hodgkin agressivo com resposta quimioterápica limitada e prognóstico ruim. A obtenção do diagnóstico exigiu extensa propedêutica inicial (biópsias de lesão de pele de medula óssea e de linfonodo inguinal e ultrassonografia abdominal), que não estabeleceu diagnóstica. Evoluiu com linfocitose, tendo sido submetida à imunofenotipagem, que permitiu o diagnóstico. A quimioterapia inicial consistiu de fludarabina, entretanto, em decorrência de efeito adverso (pancitopenia), necessitou de hemotransfusão e fator estimulador de colônia de granulócitos (G-CSF).

An eighty-year-old woman initially presented with skin lesions suggestive of Pemphigus vulgaris, one year later diagnosed as mantle cell lymphoma. Even after extensive investigation (skin lesion biopsy, abdominal ultra-sound, myelogram, bone marrow biopsy and inguinal lymph node biopsy) no diagnosis could still be firmed. At that time, however, the patient presented lymphocytosis, which leads to immunophenotyping, eventually defining the above-mentioned diagnosis. Fludarabine was selected for initial therapy, but the patient didn?t tolerate it well (pancytopenia) and needed to receive blood transfusion and granulocyte colony-stimulating factor (G-CSF). It is a non-Hodgkinïs agressive lymphoma with bad response to chemotherapy and poor prognoses.