RESUMO
Introduction Chronic cutaneous lupus erythematosus (CCLE) usually presents as characteristic erythematous patches and infiltrated coin-shaped plaques. However, there are some atypical clinical variants that may mimic other dermatological conditions. Haroon et al. reported in 1972 an unusual presentation of CCLE with hypertrophic follicular scars seen in acne vulgaris. Acneiform presentation is one of the most rarely reported and one of the most confusing, as it resembles a very common inflammatory skin disease. A brief review of the literature using PubMed found only nine other reports. Case report A 32-year-old woman presented with two-year pruritic infiltrated acneiform and comedonal eruption on the right chin treated as acne with isotretinoin without improvement. On examination the patient presented with erythematous-infiltrated plaque, papules, open comedones, pitting scars and hypopigmented atrophic scars on the right chin area and scalp hair loss. An incisional skin biopsy on the chin and scalp lesions was performed and the anatomopathological and immunofluorescence exam showed findings that are consistent with CCLE. Additional tests ruled out systemic involvement. The patient was treated with prednisone and chloroquine diphosphate with great improvement. After four years the lesion is stable, with some scarring. Discussion In a literature review we found nine other cases of acneiform presentation of lupus erythematosus: Three cases were systemic lupus erythematosus (SLE) and seven others were diagnosed as CCLE (including our patient). All three patients who had SLE tested positive for antinuclear antibodies (ANA), and only one patient with CCLE, had a low titer of positive ANA (1:80). Ages varied from 24 to 60 years old, with a median of 32 years old, the same as our patient's age and consistent with the literature. Seven were females and three were males, with a ratio of 2.3:1. Most cases, such as our patient, showed acneiform lesions mainly on the face, a common site of typical CCLE. The present case and literature review illustrates the need to expand the differential diagnosis of atypical acneiform and comedonal lesions. CCLE should be considered especially in a localized lesion, which can be itchy and does not improve with conventional treatment for acne vulgaris.
Assuntos
Erupções Acneiformes/diagnóstico , Lúpus Eritematoso Cutâneo/diagnóstico , Pele/patologia , Erupções Acneiformes/patologia , Adulto , Anti-Inflamatórios não Esteroides/uso terapêutico , Biópsia , Cloroquina/análogos & derivados , Cloroquina/uso terapêutico , Doença Crônica , Erros de Diagnóstico , Quimioterapia Combinada , Feminino , Imunofluorescência , Glucocorticoides/uso terapêutico , Humanos , Lúpus Eritematoso Cutâneo/tratamento farmacológico , Lúpus Eritematoso Cutâneo/patologia , Valor Preditivo dos Testes , Prednisona/uso terapêutico , Pele/efeitos dos fármacos , Resultado do TratamentoRESUMO
Paracoccidioides brasiliensis, a thermodimorphic fungus, is the causative agent of paracoccidioidomycosis (PCM), the most prevalent systemic mycosis in Latin America. Pathogenicity appears to be intimately related to the dimorphic transition from the hyphal to the yeast form, which is induced by a shift from environmental temperature to the temperature of the mammalian host. Little information is available on the P. brasiliensis genes that are necessary during the pathogenic phase. We have therefore undertaken Suppression Subtraction Hybridization (SSH) and macroarray analyses with the aim of identifying genes that are preferentially expressed in the yeast phase. Genes identified by both procedures as being more highly expressed in the yeast phase are involved in basic metabolism, signal transduction, growth and morphogenesis, and sulfur metabolism. In order to test whether the observed changes in gene expression reflect the differences between the growth conditions used to obtain the two morphological forms rather than differences intrinsic to the cell types, we performed real-time RT-PCR experiments using RNAs derived from both yeast cells and mycelia that had been cultured at 37 degrees C and 26 degrees C in either complete medium (YPD or Sabouraud) or minimal medium. Twenty genes, including AGS1 (alpha-1,3-glucan synthase) and TSA1 (thiol-specific antioxidant), were shown to be more highly expressed in the yeast cells than in the hyphae. Although their levels of expression could be different in rich and minimal media, there was a general tendency for these genes to be more highly expressed in the yeast cells.
Assuntos
DNA Complementar/análise , DNA Fúngico/análise , Perfilação da Expressão Gênica , Genes Fúngicos/fisiologia , Paracoccidioides/genética , DNA Complementar/isolamento & purificação , Regulação Fúngica da Expressão Gênica , Hibridização de Ácido Nucleico , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Saccharomyces cerevisiae/genética , Técnica de SubtraçãoRESUMO
Formaldehyde vapor levels were evaluated in a histological fixative laboratory and environments where anatomical pieces treated with this fixative are stored or handled. Formaldehyde concentration in the air may reach values up to 9 times higher than that established (0.3 ppm) by the international official surveillance bureaus. These results emphasize the need to perform these activities in an environment with good exhaust conditions in view of the deleterious effects of formaldehyde. Therefore, we designed a practical modular mechanical device to carry out transcardiac fixative perfusion inside an exhaust hood. This device is coupled to accessories that help surgical procedures, animal head tissue cooling and collection of organic and chemical residues for posterior discharge or treatment. In addition, as it was designed to be readily assembled and disassembled it releases the hood for other tasks.