Presentación caso clínico / Clinical Case

Paciente femenino de 23 años, sin antecedentes de relevancia, que comienza con cuadro progresivo de múltiples lesiones eritematosas en mama derecha sin comprometer ninguna otra localización. Se realiza tratamiento antibiótico sin mejoría clínica, por lo que se decide internación y toma de biopsia cutánea. La paciente comienza con cuadro neurológico progresivo homolateral al compromiso mamario, con dificultad respiratoria, parestesias bucales, alopecía parcheada y dificultad a la marcha con debilidad funcional homolateral. Se solicitan estudios complementarios de imágenes y laboratorio con resultados dentro de parámetros normales. El resultado de la biopsia informa "Eritema multiforme". Se indica tratamiento psiquiátrico para el componente neurológico y tratamiento sintomático para su patología de base, obteniéndose curación completa en 21 días.

23-year-old female patient, with no relevant medical history, starts with multiple progressive erythematous lesions in the right breast without compromising any other location. An antibiotic treatment is started without clinical improvement, so it's decided to hospitalize and take a skin biopsy. During her stay, the patient begins with ipsilateral progressive neurological symptoms, including respiratory distress, oral paresthesia, alopecía, walking difficulties, among others. cat, mri, laboratory and other test are requested with no abnormal results. The skin biopsy reports Erythema Multiforme. A psychiatric treatment is started for the neurological component and symptomatic treatment for the em, obtaining complete cure in 21 days.

Anal squamous cell carcinoma in HIV/AIDS patients in the HAART era: Report of 8 cases and literature review.

BACKGROUND: Anal squamous cell carcinoma is a rare neoplasm with a higher incidence in the HIV-seropositive population. PATIENTS AND METHODS: Epidemiologic, clinic, immunologic, virologic and therapeutic characteristics of 8 HIV-positive patients with anal squamous cell carcinoma were descriptively and retrospectively analyzed from 2005 to 2011. RESULTS: Median of age ofpatients was 39 years, 75% were male and 83% were men who have sex with men. Median elapsed time from HIV infection to anal cancer diagnosis was 10.5 ± 9.5 years. Anal pain and local large tumors detected by physical examination were the most common clinical manifestations; pain with or without itching was marginally correlated with poor survival. The median of CD4 T-cell countfor the whole study group was 330 cells/µL. At the time ofthe neoplasm diagnosis, CD4 T-cell count was more than 200 cell/µL in 62.5% of the patients. In the descriptive analysis, higher CD4 T-cell count was significantly associated with a prolonged survival. In the overall population, 71% were receiving highly active antiretroviral therapy (HAART) and all of them had undetectable viral load at the time ofneoplasm diagnosis. HAART was correlated with better survival in the overallpopulation. Histopathologic examination showed that 4 cases (50%) had in situ carcinoma and 4 patients (50%) had diagnosis of invasive anal carcinoma. One patient underwent surgical tumorectomy plus HAART, 2 patients received chemotherapy plus HAART and 3 patients were treated with fractionated radiotherapy plus systemic chemotherapy plus HAART. One patient died without the possibility of treatment due to his poor clinical condition and for one patient was no available data. After a follow up of 2 years, overall survival rate was 71%. CONCLUSION: A carefully evaluation of anal infiltrative or tumoral lesions is necessary to achieve an early diagnosis and to improve the survival in this kind of patients.

Anal squamous carcinoma: a new AIDS-defining cancer? Case report and literature review / Carcinoma de células escamosas do canal anal: a nova neoplasia associada com AIDS?

Squamous anal cell carcinoma is a rare malignancy that represents the 1.5% to 2% of all the lower digestive tract cancers. However, an increased incidence of invasive anal carcinoma is observed in HIV-seropositive population since the widespread of highly active antiretroviral therapy. Human papillomavirus is strongly associated with the pathogenesis of anal cancer. Anal intercourse and a high number of sexual partners appear to be risk factors to develop anal cancer in both sexes. Anal pain, bleeding and a palpable lesion in the anal canal are the most common clinical features. Endo-anal ultrasound is the best diagnosis method to evaluate the tumor size, the tumor extension and the infiltration of the sphincter muscle complex. Chemoradiotherapy plus antiretroviral therapy are the recommended treatments for all stages of localized squamous cell carcinoma of the anal canal in HIV-seropositive patients because of its high rate of cure. Here we present an HIV patient who developed a carcinoma of the anal canal after a long time of HIV infection under highly active antiretroviral therapy with a good virological and immunological response.

O carcinoma de células escamosas do canal anal é uma malignidade rara que representa 1,5% a 2% de todos os cânceres do trato gastrointestinal inferior. Entretanto, é observada uma incidência aumentada do carcinoma anal invasivo, na população soropositiva para o HIV desde a difusão da terapia antirretroviral altamente ativa. O vírus do papiloma está fortemente associado com a patogênese do câncer anal. Sexo anal e um alto número de parceiros sexuais parecem ser os fatores de risco para desenvolver câncer anal em ambos os sexos. Dor anal, sangramento e lesão palpável no canal anal são as manifestações clínicas mais comuns. O ultrassom endoanal é o melhor método diagnóstico para avaliar o tamanho do tumor, sua extensão e a infiltração para o complexo do músculo esfincteriano. A quimioradioterapia mais terapia antirretroviral é o tratamento recomendado para todos os estádios do carcinoma localizado de células escamosas do canal anal nos pacientes HIV soropositivos, devido a sua alta taxa de cura. Apresentamos um paciente que desenvolveu carcinoma do canal anal depois de um longo tempo de infecção por HIV sob tratamento com a terapia antirretroviral altamente ativa, com boa resposta virológica e imunológica.

Anal squamous carcinoma: a new AIDS-defining cancer? Case report and literature review.

Squamous anal cell carcinoma is a rare malignancy that represents the 1.5% to 2% of all the lower digestive tract cancers. However, an increased incidence of invasive anal carcinoma is observed in HIV-seropositive population since the widespread of highly active antiretroviral therapy. Human papillomavirus is strongly associated with the pathogenesis of anal cancer. Anal intercourse and a high number of sexual partners appear to be risk factors to develop anal cancer in both sexes. Anal pain, bleeding and a palpable lesion in the anal canal are the most common clinical features. Endo-anal ultrasound is the best diagnosis method to evaluate the tumor size, the tumor extension and the infiltration of the sphincter muscle complex. Chemoradiotherapy plus antiretroviral therapy are the recommended treatments for all stages of localized squamous cell carcinoma of the anal canal in HIV-seropositive patients because of its high rate of cure. Here we present an HIV patient who developed a carcinoma of the anal canal after a long time of HIV infection under highly active antiretroviral therapy with a good virological and immunological response.