Chagas' disease reactivation with skin symptoms in a patient with kidney transplant.

Immunodepressed patients in the intermediate phase of Chagas' disease may undergo reactivation of the disease together with atypical symptoms. The case of an immunodepressed kidney transplant patient with reactivation of Chagas' disease with skin symptoms is reported. A 65-year-old man presented with infiltrated erythematous lesions on the anterior aspect of the right thigh of 2 weeks' duration. The lesions later extended to the abdomen, thorax, and lower limbs. In the histologic skin examination, amastigotes and Trypanosoma cruzi trypoamastigotes were observed. A fresh smear showed positive parasitemia. Using the Strout hemoconcentration method, multiple Trypanosoma cruzi trypoamastigotes with motility could be seen. Polymerase chain reaction was positive for Trypanosoma cruzi. An immunofluorescence test was positive (1 : 64) and there was hemoagglutination (1 : 32). Treatment was started with benznidazole, 7 mg/kg/day. The patient did not evolve favorably and died 20 days after hospitalization. Skin lesions may be a manifestation of the reactivation of Chagas' disease in immunosuppressed patients. All patients with positive Chagas' serology who require immunosuppressant drugs should receive specific treatment for Chagas' disease.

Angioma en penacho (angioblastoma de Nakagawa). Consideraciones sobre la influencia de las hormonas sexuales femeninas en su evolución / Tufted angioma. Consideration of the influence of female sexual hormones in its evolution

El angioma en penacho es un tumor que afecta principalmente a niños y adultos jóvenes, de carácter lentamente progresivo, aunque carente de malignidad. Se presenta frecuentemente antes de los 5 años de edad y su localización habitual es en cara, cuello, hombros y región superior del tórax. Se puede presentar como mácula, pápula, placa, nódulo o tumor; del color de la piel normal, eritematosa, eritemato-violácea, azulada o parduzca. Es posible observar infiltración, ingurgitación, petequias y/o telangiectasias. El angioma puede presentarse con aumento local de temperatura e hiperhidrosis; puede ser pruriginoso (sobre todo al comienzo) y doloroso, aunque en la mayor parte de los casos es asintomático. Histopatológicamente se caracteriza por presentar lobulillos (“penachos”) de tejido angiomatoso capilar, que se ubican en dermis o hipodermis, con la luz de los vasos estrecha, rodeados de colágeno, lo que le confiere el aspecto de “bala de cañón”. En general no presenta componentes inflamatorios ni atipias. Presentamos 2 pacientes de sexo femenino con diagnóstico clínico e histopatológico de angioma en penacho, cuya evolución tuvo un significativo cambio relacionado a situaciones de variaciones hormonales como la menarca y el embarazo. Intentamos explicar el posible rol de las hormonas sexuales femeninas en el crecimiento de ambos angioblastomas

Tufted angioma is a benign slow progressing tumour that affects mainly children and young adults. It appears frequently before the age of 5 years. Its clinical appearence is as macule, papule, plaque or nodule; skin coloured, erithematous, bluish, and localizes usually in the face, neck, shoulders or upper part of the chest. Local hyperhidrosis, infiltration, increased temperature, telangiectasies and petechias may be observed. Other important clinical manifestations include pruritus and/or pain. Tufts of capilar vessels in the dermis or subcutis is the main histological feature. The light of these vessels is reduced, rounded by colagen, giving the appearence of cannon bullet. Two female patients with diagnosis of tufted angioma whose evolution were significantly affected by hormonal changing situations are reported. We theorize about the possible rol of female sexual hormones in the growing of this angioblastoma

Cutaneous leishmaniasis: successful treatment with itraconazole.

BACKGROUND: Leishmaniasis is a disease produced by several species of protozoa of the Leishmania genus. These protozoa are injected into the human bloodstream by sandflies. The symptomathology, either cutaneous, mucocutaneous or visceral, depends on the infective species and the immune status of the patient. Antimonial drugs are the mainstay treatment for all the clinical forms of the disease. Amphotericin B is the second-choice drug. METHODS: We report two clinical cases of cutaneous leishmaniasis treated with itraconazole. One case was a relapsing form unresponsive to conventional therapy. RESULTS: Both patients achieved fast resolution of their lesions with no secondary effects. CONCLUSIONS: Itraconazole may be a valid option for the treatment of cutaneous leishmaniasis, mainly in those cases unresponsive to conventional drugs.