RESUMO
OBJECTIVE: To determine whether a combination of a single intramuscular (IM) dose of pentamidine (7 mg/kg) followed by oral tamoxifen 40 mg/day for 20 days is non-inferior to three IM doses of pentamidine 7 mg/kg in the treatment of cutaneous leishmaniasis with a margin of 15%. METHODS: Phase II, randomised, controlled, open-label, non-inferiority clinical trial. Primary outcome was the complete healing of the lesions 6 months after starting treatment. Secondary outcomes were healing 3 months after starting treatment and determining the presence and severity of adverse effects (AE). RESULTS: The research was concluded with 49 patients; Leishmania (Viannia) guyanensis was the most frequent species isolated. In the primary outcome, 18 (72%) (95% CI: 52.4%-85.7%) of the 25 patients allocated to the intervention group and 24 (100%) (95% CI: 86.2%-100%) of the control group (p = 0.015) met the established criteria of cure. There was no AE with tamoxifen. CONCLUSION: Although a 72% cure rate presented by the combination of tamoxifen and pentamidine was lower than in the control group that achieved a 100% cure, it is still a safe and is a clinically relevant result. It indicates that the therapeutic scheme evaluated may be a promising option for populations in remote areas, however it should be further studied, in order to include a larger number of patients.
Assuntos
Antiprotozoários , Leishmania guyanensis , Leishmaniose Cutânea , Humanos , Leishmaniose Cutânea/tratamento farmacológico , Leishmaniose Cutânea/patologia , Pentamidina/uso terapêutico , Tamoxifeno/uso terapêuticoRESUMO
Abstract Patients with lepromatous or borderline leprosy may present two types of vasculonecrotic reactions: Lucio's phenomenon (LP) and necrotic erythema nodosum leprosum (nENL). These are serious conditions, which mostly lead to life-threatening infectious and thrombotic complications. The authors report the case of a patient with leprosy recurrence associated with an atypical type II reaction with LP characteristics on histopathology.
RESUMO
Patients with lepromatous or borderline leprosy may present two types of vasculonecrotic reactions: Lucio's phenomenon (LP) and necrotic erythema nodosum leprosum (nENL). These are serious conditions, which mostly lead to life-threatening infectious and thrombotic complications. The authors report the case of a patient with leprosy recurrence associated with an atypical type II reaction with LP characteristics on histopathology.
Assuntos
Eritema Nodoso , Hanseníase Dimorfa , Hanseníase Virchowiana , Hanseníase Multibacilar , Hanseníase , Eritema Nodoso/patologia , Humanos , Hanseníase/complicações , Hanseníase Virchowiana/complicações , Hanseníase Virchowiana/patologia , Hanseníase Multibacilar/complicações , NecroseRESUMO
Abstract Chromoblastomycosis is a subcutaneous mycosis with chronic evolution that mainly affects the lower limbs and, less frequently, the auricles. Clinically, it presents with papillary verrucous, nodular, and/or tumoral lesions, whether isolated or infiltrated, forming plaques and, sometimes, atrophic in some areas. Histopathologically, it is characterized by a dermal granulomatous inflammatory infiltrate, and the diagnosis can be confirmed by the presence of fumagoid bodies in anatomopathological or direct mycological exams. The treatment to be indicated will depend on the extent and location of the lesions, using systemic antifungals, surgical removal, cryotherapy, thermotherapy, and immunoadjuvants. The present study reports an atypical presentation of chromoblastomycosis on the auricle.
Assuntos
Humanos , Masculino , Cromoblastomicose , Pavilhão Auricular , Itraconazol , Orelha Externa , Pessoa de Meia-Idade , AntifúngicosRESUMO
Chromoblastomycosis is a subcutaneous mycosis with chronic evolution that mainly affects the lower limbs and, less frequently, the auricles. Clinically, it presents with papillary verrucous, nodular, and/or tumoral lesions, whether isolated or infiltrated, forming plaques and, sometimes, atrophic in some areas. Histopathologically, it is characterized by a dermal granulomatous inflammatory infiltrate, and the diagnosis can be confirmed by the presence of fumagoid bodies in anatomopathological or direct mycological exams. The treatment to be indicated will depend on the extent and location of the lesions, using systemic antifungals, surgical removal, cryotherapy, thermotherapy, and immunoadjuvants. The present study reports an atypical presentation of chromoblastomycosis on the auricle.
Assuntos
Cromoblastomicose , Pavilhão Auricular , Antifúngicos , Orelha Externa , Humanos , Itraconazol , Masculino , Pessoa de Meia-IdadeAssuntos
Artrópodes/patogenicidade , Eritema/etiologia , Pele/lesões , Acidentes , Adulto , Animais , Eritema/patologia , Humanos , MasculinoAssuntos
Humanos , Animais , Masculino , Adulto , Artrópodes/patogenicidade , Pele/lesões , Eritema/etiologia , Acidentes , Eritema/patologiaAssuntos
Neurilemoma/diagnóstico , Neoplasias do Sistema Nervoso Periférico/diagnóstico , Nervo Tibial , Neuropatia Tibial/diagnóstico , Humanos , Hanseníase/complicações , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neurilemoma/complicações , Neurilemoma/diagnóstico por imagem , Neoplasias do Sistema Nervoso Periférico/complicações , Neoplasias do Sistema Nervoso Periférico/diagnóstico por imagem , Neuropatia Tibial/complicações , Neuropatia Tibial/diagnóstico por imagem , UltrassonografiaRESUMO
As autoras discutem sobre algumas formas de queilite que, por suas manifestações clínicas, freqüência e potencial de malignização, têm maior relevância tanto para o clínico geral quanto para os especialistas que lidam diretamente com lesões da mucosa oral - como os dermatologistas, otorrinolaringologistas, cirurgiões de cabeça e pescoço, dentistas e estomatologistas, entre outros