Assuntos
Neoplasias Faciais/cirurgia , Lipoma/cirurgia , Osteoma/cirurgia , Neoplasias Cutâneas/cirurgia , Neoplasias Cranianas/cirurgia , Neoplasias Faciais/patologia , Testa , Osso Frontal , Humanos , Lipoma/patologia , Osteoma/patologia , Neoplasias Cutâneas/patologia , Neoplasias Cranianas/patologia , Osso TemporalRESUMO
Primary cutaneous infection with Cryptococcus neoformans is uncommon, but can occur following an inoculation injury to the skin. Tumor necrosis factor-alpha (TNF-alpha) is important in the immune response to Cryptococcus, and patients taking inhibitors of TNF-alpha may have increased susceptibility to cryptococcal infection. We report a case of primary cutaneous cryptococcosis in a patient taking adalimumab, methotrexate, and hydroxychloroquine for rheumatoid arthritis.
Assuntos
Anticorpos Monoclonais/uso terapêutico , Criptococose/diagnóstico , Dermatomicoses/diagnóstico , Metotrexato/uso terapêutico , Adalimumab , Anticorpos Monoclonais Humanizados , Antifúngicos/uso terapêutico , Antirreumáticos/uso terapêutico , Artrite Reumatoide/complicações , Artrite Reumatoide/tratamento farmacológico , Criptococose/complicações , Criptococose/tratamento farmacológico , Cryptococcus neoformans/efeitos dos fármacos , Cryptococcus neoformans/crescimento & desenvolvimento , Cryptococcus neoformans/isolamento & purificação , Dermatomicoses/complicações , Dermatomicoses/tratamento farmacológico , Feminino , Traumatismos dos Dedos/complicações , Traumatismos dos Dedos/diagnóstico , Traumatismos dos Dedos/microbiologia , Fluconazol/uso terapêutico , Humanos , Hidroxicloroquina/uso terapêutico , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Calciphylaxis is characterized by ischemic cutaneous ulceration, high mortality, and ineffective treatment. METHODS: We conducted a retrospective study of 64 patients with calciphylaxis (including 49 dialysis patients age- and sex-matched to 98 dialysis controls). RESULTS: The estimated 1-year survival rate of calciphylaxis was 45.8%. Risk factors for calciphylaxis included obesity, liver disease, systemic corticosteroid use, calcium-phosphate product more than 70 mg(2)/dL(2), and serum aluminum greater than 25 ng/mL. Survival rates were similar for 16 patients who received parathyroidectomy and 47 who did not. An estimated 1-year survival rate of 61.6% was observed for 17 patients receiving surgical debridement compared with 27.4% for the 46 who did not (P = .008). LIMITATIONS: The study was limited by its retrospective design and there was no control group for the 15 nondialysis cases. CONCLUSIONS: Calciphylaxis is multifactorial and usually fatal. Prevention of calciphylaxis may include correction of risk factors identified in this study. Surgical debridement was associated with improved survival, but parathyroidectomy was not.
