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Histoplasmosis is a systemic mycosis caused by inhalation of Histoplasma capsulatum microconidia. The disease does not normally affect immunocompetent individuals after a single, transient inhalation exposure. However, longer exposure may cause chronic or disseminated acute pulmonary infection. Herein, we report the case of a 24-year-old immunocompetent patient, who presented fever, cough and dyspnea for one month. The chest radiography revealed interstitial infiltrate and diffuse micronodules. The patient reported having had close and prolonged contact with bats. Diagnosis was confirmed by positive double immunodifusion and immunoblotting assays. She was treated with ketoconazole (400 mg) and there was complete resolution of the disease.

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BACKGROUND: Drug exposure is one of the main aetiologies of urticaria and represents the second most common cause in acute urticarias. Studies involving the ultrastructural aspects of urticaria are relatively rare in the literature. Most of the articles published report on skin biopsies of experimentally induced urticaria, and acute urticaria has been studied even less from a morphological point of view. OBJECTIVES: The aims of this study were to observe ultrastructural cell characteristics in five patients with drug-induced acute urticaria and possible aspects of the inflammatory skin response. METHODS: Clinical manifestations, light microscopy and transmission electron microscopy were evaluated. RESULTS: With light microscopy, a mild perivascular lymphocyte-monocyte infiltrate was observed with few neutrophils and dermal oedema in skin biopsies of five patients. With electron microscopy, a mild vascular dilatation was observed, with platelets in the lumen and several lymphocytes and dendritic cells close to the superficial dermal vessels. Some mast cells appeared normal, whereas others were granule-depleted. In some areas, mast cells, lymphocytes and satellite dendritic cells were closely associated, as well as some macrophages. A significant number of plasma cells, eosinophils and polymorphonuclear neutrophils were not observed; however, the presence of lymphocytes and macrophages was significant. The epidermis and the dermal-epidermal junction were preserved, except for a discrete oedema in keratinocytes. CONCLUSIONS: The ultrastructural aspect of drug-induced acute urticaria is similar to that observed in urticaria caused by Urtica dioica, intradermal histamine and cold urticaria. The presence of the cellular triad with mast cells, dendritic (or satellite) cells and lymphocytes suggests a functional interaction of these cells. These findings support the possible existence of mechanisms in the dermis that may participate in protective and/or injurious vasocentric immune reactions.

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Aspergillus candidus, a common contaminant of grain dust, may represent an important respiratory hazard to grain workers, considering its immunomodulating capability by producing p-terphenyl metabolites and terprenins, potent cytotoxic substances. However, there are only three cases of A. candidus infection in the English literature, one fatal solitary brain mass and two onychomycosis. We describe the first case of invasive pulmonary infection and skin abscesses due to A. candidus, determination of minimal inhibitory concentration for anti-fungals, and the successful treatment with liposomal amphotericin B and itraconazole. Possible mechanisms involved in the dissemination of infection in an immunocompetent host are discussed.

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BACKGROUND: The autoantibody-mediated disease in fogo selvagem (FS) is aggravated by sunlight exposure. OBJECTIVE: The aim of this study was to test whether UVB exposure of uninvolved skin of patients with FS (n = 21) enhances epidermal acantholysis and in vivo binding of FS autoantibodies as compared with a control group (n = 4). Another control group included 8 patients with pemphigus vulgaris (PV). RESULTS: Exposure of uninvolved skin of FS to UVB induces acantholysis (15/21 patients) with in vivo binding of IgG and C3 to the epidermal intercellular spaces (17/21 patients). Similar results were found in PV (6/8 patients). The test was negative in the control group. CONCLUSION: Sunlight exposure is harmful in the clinical course of patients with FS and those with PV. Protection from sunlight should be part of the treatment of these patients.

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Pityrosporum folliculitis is caused by the fungus Pityrosporum ovale. It is characterized by the presence of pruriginous follicular papulae and papulae-pustules in face, upper part of the trunk, and upper limb root. It is more prevailing in places with hot and humid climates. Its incidence can be associated with either immunosuppressive or chemotherapy states secondary to pathologies. We report herewith a case of pityrosporum folliculitis in a patient who had previously underwent kidney transplantation and these result of the itraconazol therapeutics given.

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The profile of 247 patients with erythroderma during a 23 year period from January, 1962 through March, 1985, with a follow-up period ranging from 1 to 26 years were analysed. The patients presented with diffuse erythema, scaling and pruritus of more than 2 months' duration, and the age ranged from 16 to 60 years. Psoriasis was the most frequent underlying disease with an estimated frequency of 44.9%, the reaction to the use of drugs appeared in 7.3% of total cases and association with reticulosis showed a frequency of 4.1%. The cause of the erythroderma could not be determined in 29.2% of the cases. Six differences in terms of underlying diseases were not observed. One or more skin biopsies along with clinical findings were diagnostic or suggestive of the underlying disease in 63.6% of the cases. Repeated skin biopsies are recommended as the best method for etiologic diagnosis of erythroderma. At P = 0.05 significance level, masculine/feminine ratio of 2:1 was found. The question arises whether causal agent of erythroderma may not be somehow related to different exposure by sex to environmental antigens.

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One untested but widely held opinion in Brazil is that oral use of vitamin B complex is useful as a mosquito repellent. We exposed Balb-C mice to a large number of Culex quinquefasciatus females, after giving vitamin B complex to mice (drops by mouth). There was no difference between mice attractiveness to mosquitoes in the vitamin B group compared to normal, but very few of the females bite mice in both groups, so the experiment was inconclusive. We suggest further experiments in this subject, using other models were the animals are more attractive to mosquitoes.

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Lateral cephalometric radiographs were obtained from 30 individuals that were equally divided into groups by gender. Their ages varied from 18 to 31 years. All were white Brazilians with normal dental occlusions and good facial profiles. A combination of angles and linear measurements from Steiner's and Downs' analyses were determined. Means and standard deviations were calculated for the sample. Student's t test did not show a statistically significant difference between men and women. The entire sample was compared with the North American standards reported by Steiner and Downs. Statistically significant differences were found for GoGn/SN and SND angles. The statistically greater values of 1/NA(mm), 1/NB(mm), and 1/NA(degrees) for the Brazilians indicate typical morphological aspects with protrusive incisors. These differences and the great variation within the sample should be taken into account when formulating an orthodontic treatment plan for Brazilians.

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A case of rhinofacial entomophthoromycosis caused by Conidiobolus coronatus is reported in a 30-years-old male from São Paulo, Brazil. The patient was successfully treated with oral fluconazole in a prolonged regimen. The diagnosis was confirmed by histopathological and mycological data.

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To evaluate factors that might be related to the pathogenesis of hypertension in spontaneously hypertensive rats (SHR), mineral balance studies were conducted in SHR and control Wistar-Kyoto (WKY) rats at the ages of 9, 13 and 16 wk. During the first balance period, before onset of hypertension, Na, Ca, Mg and P balances were all significantly more positive in SHR than in WKY rats. Percentage of absorbed Na excreted in urine was correlated with the rise in blood pressure of SHR but not of WKY rats during the first 4 wk of the study. At 13 wk balances of all four nutrients still tended to be higher in SHR. During the 16th wk of life, after onset of hypertension, Na, Ca and P balances were similar in SHR and WKY rats, but Mg balance was significantly lower in SHR. The percent urinary excretion of absorbed Na was lower in SHR at 9 wk of age, but after onset of hypertension it was similar to that in WKY rats. Food intake was always greater in SHR, whereas growth during the study was less, and absorption of Ca, Mg and P declined more rapidly with age in SHR than in WKY rats. The data suggest that nutrient malabsorption in SHR, if it occurs at all, is most likely an effect of, rather than a cause of, hypertension.

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The authors studied two patients with bullous lesions with onset at adult age. There were no relatives with bullous disease. After minor traumas, mainly in hands, feet, elbows and knees, one could see the onset of the blisters, which vanished leaving atrophic scars. Nails and mucosae were involved in both patients. The female patient had cyst of milia. One of the patients had lymph node tuberculosis as associated disease. Through exhaustive clinical examination and laboratory investigation, the authors excluded other types of bullous diseases. Histopathology of the lesions, electron microscopy, direct and indirect immunofluorescence, supported the diagnosis of Acquired Dermolytic Bullous Dermatosis.

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Os autores apresentam quatro criancas sendo duas gemeas, com distrofia das 20 unhas Varios diagnosticos diferenciais sao discutidos. O acometimento das unhas em criancas e em duas gemeas leve a considerar uma condicao familial

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Twelve hanseniasis patients, undifferentiated group, with negative bacilloscopy and having undergone no prior treatment, were submitted to a biopsy of the cubial epineurium for histopathological study. All subjects were clinically observed after one month, and six of them were examined 4 to 5 years afterwards. Histopathology of the epineurium presented acid-fast bacilli in one patient and tuberculoid granuloma formation tendency in another. Epineural thickening was observed in nine patients and perivascular lymphomonocuclear inflammatory infiltration in six. The clinical examination after 1 month in the 12 patients as well as after 4 to 5 years in 6 of them, demonstrated innocuousness of the performed biopsy. Four to five years after the initial observation, the clinical examination showed that two patients who remained Mitsuda negative did not present histopathologically thickened epineurium at the beginning, while in four patients who then presented positive Mitsuda, the initial histopathological examination showed epineural thickening. Among the nine patients having a histopathologically thickened epineurium, six did not present initial lesions in the upper limbs. Therefore, the study of the cubital epineurium early thickening deserves special mention, and should be performed in a larger number of patients, as well as in control groups, since the follow-up of four among six patients showed epineural thickening and reversal of the Mitsuda reactions to positivity.

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Normal skin biopsy specimens obtained from 5 representative species of mammals, including man, were studied by the silver impregnation technique for reticulin fibers, by the histochemical Picrosirius-polarization method which is specific for collagen, and by transmission electron microscopy. The finely woven meshwork of argyrophilic reticulin fibers present in the adventitial dermis showed characteristics which are typical of collagen type III, when studied by aid of the Picrosirius-polarization method and by electron microscopy. On the other hand, the coarse collagen fibers of the deeper layers displayed ultrastructural and histochemical aspects which are characteristic of collagen type I. The foregoing observations support previous biochemical and immunohistologic findings, strongly suggesting that collagen type III is found mainly in the upper dermis while collagen type I predominates in the deeper layers.

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Os autores estudam 75 doentes com fotoalergia, com quadro dermatologico representado por lesoes eczematosas em areas expostas. Relacionam os doentes quanto a sexo, idade, cor e epoca do ano em que se manifestou a doenca. Ha maior incidencia em mulheres, na faixa etaria de 51 a 60 anos, em individuos brancos e maior frequencia nos meses de janeiro, abril, junho e dezembro. Relacionam tambem as substancias que produziram o quadro de fotoalergia. Concluem os autores ser a causa de fotoalergia mais frequente a prometazina de uso topico, seguindo-se os sulfamidicos. Em relacao a droga de uso sistemico houve maior incidencia, no grupo estudado, dos sulfamidicos

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Doze doentes de hanseniase, grupo indiferenciado, com baciloscopia negativa e virgens de tratamento, foram submetidos a biopsia de epineuro cubital para estudo histopatologico. Todos os doentes foram observados clinicamente um mes apos, e seis destes puderam ser examinados 4 a 5 anos apos. A histopatologia do epineuro mostrou existencia de bacilos alcool-acido -resistentes em um doente e tendencia a formacao de granuloma tuberculoide em outro. Em nove doentes, pode-se observar espessamento epineural e, em seis, infiltrado inflamatorio linfomononuclear perivascular. O exame clinico apos 1 mes nos 12 doentes e tambem apos 4 a 5 anos em 6 deles demonstrou a inocuidade da biopsia realizada. Quatro a cinco anos apos a observacao inicial, o exame clinico mostrou que dois doentes que permaneciam Mitsuda negativos nao apresentavam epineuro histopatologicamente espessado no inicio, enquanto que em quatro doentes, que passaram a apresentar Mitsuda positivo, o exame histopatologico inicial revelara espessamento epineural. Dos nove doentes que apresentavam epineuro histopatologicamente espessado, seis nao mostravam lesoes iniciais nos membros superiores. O estudo do espessamento precoce do epineuro cubital merece, portanto, especial destaque, devendo ser realizado em maior numero de doentes e em grupo de controle, pois no seguimento de quatro dos seis doentes, observou-se espessamento epineural e viragem da reacao de Mitsuda

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