From a neutrophilic synovial tissue infiltrate to a challenging case of rheumatoid arthritis.

The herein report illustrates how a synovial tissue heavily infiltrated by neutrophils in the first weeks of arthritis, can evolve in few months to a synovial infiltration by lymphocytes with a characteristic pattern of rheumatoid arthritis (RA). This observation suggests a critical initial role of neutrophils in RA onset, which is eventually surpassed by the activation of the adaptive immune system. In addition, this patient, despite the absence of rheumatoid factors and anti-cyclic citrullinated peptide antibodies, progressed to a highly destructive and disabling disease, that was only controlled adequately with rituximab, due to the lack of response to methotrexate and serious adverse effects with TNF blockers therapy.

Granulomatous rosacea in infants. Report of three cases and discussion of the differential diagnosis.

Granulomatous rosacea is a variant of rosacea characterized by hard cutaneous papules and nodules in relatively normal-appearing skin that is rarely diagnosed in childhood. The differential diagnosis essentially includes perioral dermatitis and sarcoidosis. Despite the differences in clinical presentation and histopathology, there is similar responses to the same therapies used in rosacea. Therapeutic failure should lead to the investigation of other rare and controversial conditions, such as acne agminata.

[Genital ulcers caused by sexually transmitted diseases: current therapies, diagnosis and their relevance in HIV pandemy]. / Ulceras genitais causadas por infecções sexualmente transmissíveis: actualização do diagnóstico e terapêuticas, e a sua importância na pandemia do VIH.

The sexual transmitted pathogens associated with genital ulcers are Treponema pallidum, Haemophilus ducreyi, Calymmatobacterium granulomatis, Chlamydia trachomatis and Herpes simplex virus type 1 or 2. Although geographic differences still exist, herpetic infections prevalence is growing worldwide as the most frequent ulcerative sexual transmitted disease. The failure of the many different used guidelines in achieving a sustained reduction in the number of new cases, in particular the WHO syndromic management, leads into an over treatment of bacterial agents and missing of viral agents. This situation is also associated with poor efficacy and wasting of economical resources. Ulcerative and non-ulcerative sexual transmitted diseases are important in the world HIV pandemy because they promote HIV transmission and are also associated with the disease evolution. Portugal had until recently the highest incidence of HIV infection in Europe and that points out to importance of treating and control of both ulcerative and non-ulcerative sexual transmitted diseases in order.