JAK inhibitors: a novel, safe, and efficacious therapy for pyoderma gangrenosum.

BACKGROUND: Pyoderma gangrenosum currently lacks standardized therapy. New safer and more efficacious therapies are welcome. AIMS: To present two new PG cases treated with JAK inhibitors, adding to the small existing experience METHODS & METHODS: Two case reports of PG patients successfully treated with tofacitinib and baricitinib. RESULTS: Both patients were cured and presented no relapse. Patient # 1 used baricitinib 2 mg bid for 39 days while patient # 2 was treated with tofacitinib 5 mg bid for 120 days. No adverse reactions were seen. DISCUSSION: The increasing usage of JAKi to treat inflammatory diseases had a positive reflex on PG therapy. Fifteen PG cases treated with these drugs had been found in literature and the two new cases here described add to the limited existing experience. CONCLUSION: This is a novel use of tofacitinib and baricitinib beyond the approved indications. JAKi are a welcome addition to our options to manage patients with PG.

Susceptibility of sequential Fonsecaea pedrosoi isolates from chromoblastomycosis patients to antifungal agents.

Fourteen Fonsecaea pedrosoi isolates from six chromoblastomycosis patients were submitted to susceptibility testing. Some patients were undergoing treatment with itraconazole (ITZ) and/or cryosurgery with liquid nitrogen. The antifungal agents amphotericin B (AMB), ITZ, fluconazole (FCZ), ketoconazole (KCZ), 5-fluorocytosine (5-FC), and terbinafine (TBF) were tested. AMB and FCZ showed less activity for all isolates. The most active agents were KCZ and TBF. Sequentially isolates from four patients presented ITZ minimal inhibitory concentration (MIC) higher than the previous ones; for two of these patients, response to therapy with this agent was not observed. These results suggest development of microbiologic resistance to ITZ in four instances, two of them coinciding with lack of clinical response to this drug.

Células fúngicas permanecem viáveis por até dozes dias em lesões de cromomicose tratadas pela criocirurgia com nitrogênio líquido / Fungal cells remain viable for up to 12 days in chromomycosis lesions treated by cryosurgery with liquid nitrogen

A criocirurgia com nitrogênio líquido (C-N2L) é um método terapêutico que vem sendo usado com freqüência crescente no tratamento da cromomicose. Acreditava-se anteriormente que as temperaturas baixas poderiam destruir o agente infectante, mas foi demonstrado que as culturas fúngicas em temperaturas tão baixas como -196°C não causaria a morte do mesmo. Apesar da comprovada eficácia, ainda não se conhece o exato mecanismo de cura.Avaliar o período de persistência de fungos viáveis em lesões de cromomicose tratadas pela C-N2L.Cinco pacientes com cromomicose tiveram suas lesões tratadas pela C-N2L. Foram colhidos, em diferentes intervalos de tempo após a criocirurgia, fragmentos do tecido tratado. A coleta, realizada com punch de 4mm, foi feita em três períodos diferentes: de 0 a 48h, de cinco a sete dias e de 10 a 14 dias após a realização da criocirurgia. Os fragmentos obtidos foram inoculados em Agar Sabouraud para verificação de crescimento de colônias fúngicas. Cada paciente teve um total de três amostras colhidas, uma em cada um dos três períodos mencionados.O crescimento de colônias foi maior nas coletas mais precoces, enquanto nas amostras colhidas entre o pós-operatório imediato e o quinto dia de pós-operatório o índice de viabilidade foi de 7/8 (87,5 por cento), e naquelas colhidas a partir do sexto dia de pós-operatório foi de apenas 2/7 (28,5 por cento). O maior período de pós-operatório que demonstrou positividade foi de 12 dias.Os resultados confirmam os achados anteriores, os quais demonstraram que as baixas temperaturas alcançadas pela C-N2L não são responsáveis pela destruição dos fungos nas lesões de cromomicose. Os autores acreditam que fenômenos biológicos tardios, como necrose ou imunoestimulação sejam os verdadeiros responsáveis pela erradicação dos fungos nas lesões de cromomicose

Treatment of chromomycosis by cryosurgery with liquid nitrogen: 15 years' experience.

BACKGROUND: Chromomycosis is a chronic fungal infection of the skin and subcutaneous tissue caused by various dematiaceous fungi, the most common of which is Fonsecaea pedrosoi. The disease is difficult to treat. METHODS: Twenty-two chromomycosis patients treated by cryosurgery with liquid nitrogen as the sole or associated therapy were studied. Diagnosis was confirmed by direct examination of KOH cleared specimens, culture, and histology, according to a method previously described by Pimentel et al. (Pimentel ERA, Castro LGM, Cucé LC, Sampaio SAP. Treatment of chromomycosis by cryosurgery with liquid nitrogen. J Dermatol Surg Oncol 1989; 15: 72-77). Small lesions were frozen in a single session, whilst larger lesions were frozen in small parts. All patients received double freeze-thaw cycles. An author-created severity index, based on the extent of the diseased area, number of lesions, presence of complications (lymphedema, ulceration, and secondary infection) and unresponsiveness to previous treatments, was used to determine disease severity. RESULTS: Fonsecaea pedrosoi was isolated from all but one patient. Caucasian (50.0%) males (4.5 : 1.0) were most commonly affected. The average number of cryosurgery sessions per patient was 6.7, varying from one to 22 sessions. The duration of treatment lasted for up to 126 months. Nine patients (40.9%) were considered to be cured (clinically disease-free period of at least 3 years), eight (36.4%) were under observation (clinically disease-free but less than 3 years of follow-up), two (9.1%) were under treatment (still with active lesions), and three (13.6%) were classified as unsuccessful. The average cure period was 7.5 years, varying from 3 to 16 years. Five (55.6%) of the nine cured patients had been cured for periods exceeding 9 years. Six (66.7%) of the nine cured patients were classified as having mild, two (22.2%) severe, and one (11.1%) moderate disease. CONCLUSIONS: Cryosurgery with liquid nitrogen is an option in the treatment of chromomycosis.

Acquired reactive perforating collagenosis associated with congestive heart failure

Os autores apresentam um caso de colagenose reativa perfurante adquirida em um paciente masculino de 53 anos. O diagnóstico foi confirmado pelo exame anatomopatológico.O início e a resolução do quadro coincidiram temporalmente com quadro de descompensação e posterior compensação de insuficiência cardíaca congestiva. A colagenose reativa perfurante adquirida costuma ser observada em associação com diabetes e/ou insuficiência renal, mas nunca foi descrita associada a quadro de insuficiência cardíaca congestiva

Mycetoma in an HIV-infected patient

Although oportunistic fungal infections occur commonly in immunocompromised hosts, mycetoma has never been reported in association with HIV infection. The authors present a case that to their knowledge is the first reported case of mycetoma associated with HIV infection. Diagnosis was confirmed by direct examination of grains and histologic examination. Precise identification of the agent, an actinomycete, was not possible. The unusual site of infection may probably be related to the use of contaminated needless and sirynges for HIV drug injection

Soropositividade par HIV em doentes de herpes zoster / HIV seropositivity in patients with herpes zoster

Os autores estudaram a relaçäo de zoster com soropostividade para HIV. Foram testados soros de 66 pacientes (31 homens e 35 mulheres) com quadro agudo de zoster, usando-se o método de ELISA para detectar anticorpos anti-HIV. Näo houve seleçäo dos pacientes, evitando assim lidar com amostra viciada. Entre os 7 HIV+, 6 pertenciam a grupo de risco para AIDS, todos eram do sexo masculino e seis tinham idade entre 19 e 39 anos (idade media de 31,7 anos). Os resultados sugerem que o diagnóstico de herpes zoster em pacientes jovens näo se vincule necessariamente à infecçäo pelo HIV. Quando, no entanto, o doente pertence a grupo de risco para AIDS, independentemente de sua idade, existe associaçäo estatisticamente significativa, tornando-se imperativa a pesquisa de anticorpos anti-HIV