Abstract Leprosy is one of the neglected diseases in the world and Brazil is the second country with more cases. A retrospective study was conducted based on the medical records of 196 leprosy patients diagnosed during the course of 13 years at a university hospital. The aim was to describe the adverse effects of polychemotherapy, as well the most prevalent and most vulnerable populations. In the study, dapsone was the most implicated drug, especially in women, and the risk increased with age. The authors conclude that with this patient profile, greater vigilance should be taken regarding possible adverse effects, especially anemia.

Abstract Leprosy is a chronic disease characterized by manifestations in the peripheral nerves and skin. The course of the disease may be interrupted by acute phenomena called reactions. This article reports a peculiar case of type 2 leprosy reaction with Sweet's syndrome-like features as the first clinical manifestation of leprosy, resulting in a delay in the diagnosis due to unusual clinical presentation. The patient had clinical and histopathological features reminiscent of Sweet's syndrome associated with clusters of vacuolated histiocytes containing acid-fast bacilli isolated or forming globi. Herein, it is discussed how to recognize type 2 leprosy reaction with Sweet's syndrome features, the differential diagnosis with type 1 leprosy reaction and the treatment options. When this kind of reaction is the first clinical presentation of leprosy, the correct diagnosis might be not suspected clinically, and established only with histopathologic evaluation.

Abstract Cytomegalovirus is an opportunistic virus that commonly affects immunosuppressed patients. Cutaneous involvement by this virus is rare and occurs in significantly immunocompromised hosts, with a poor prognosis. Skin ulcers may represent the first sign of systemic infection by cytomegalovirus in these patients. Herein, a case of a systemic infection by Cytomegalovirus presenting as genital and oral ulcers in a kidney-transplant recipient is reported.

Síndrome de Berardinelli-Seip é doença genética autossômica recessiva rara, caracterizada por ineficiência em metabolizar e estocar material lipídico adequadamente nos adipócitos, gerando acúmulo de gordura em órgãos não habituais, como fígado, baço, pâncreas, coração, endotélio arterial e pele. Classicamente, os portadores nascem ou manifestam lipoatrofia generalizada até os 2 anos e, geralmente na adolescência, desenvolvem marcada resistência insulínica com rápida progressão para diabetes e dislipidemia. Relatamos um caso de portadora da síndrome de Berardinelli-Seip, de 17 anos, com xantoma eruptivo associado à hipertrigliceridemia grave. Ressalta-se o xantoma eruptivo como manifestação dermatológica não enfatizada nos casos relatados sobre esse distúrbio metabólico genético.

Berardinelli-Seip syndrome is a rare autosomal recessive disease characterized by inadequate metabolism and inefficient storing of lipids in fat cells, generating accumulation of fat in organs such as the liver, spleen, pancreas, heart, arterial endothelium and skin. Classically, patients manifest generalized lipoatrophy at birth or until 2 years of age, and in adolescence usually develop marked insulin resistance with rapid progression to diabetes and dyslipidemia. We report the case of a 17-year-old Berardinelli-Seip syndrome patient with eruptive xanthoma associated with severe hypertriglyceridemia. It is worth noting Eruptive xanthoma as a dermatological manifestation that is not generally highlighted in the reports of cases of this genetic metabolic disorder.

OBJETIVO: Descrever dois casos de hanseníase em menores de 15 anos, sendo um de paciente com 18 meses de idade e outro de 13 anos, diagnosticados por modos de detecção diferentes, ressaltando a importância de examinar os contatos. DESCRIÇÃO DO CASO: Um dos casos foi diagnosticado precocemente por meio do exame de contatos intradomiciliares, enquanto o outro foi diagnosticado por demanda espontânea após quatro anos de aparecimento das lesões e, apesar de ser contato de um ex-paciente, não foi examinado na época. COMENTÁRIOS: Em países endêmicos, a alta detecção da hanseníase em menores de 15 anos revela a persistência na transmissão do bacilo e as dificuldades dos programas de saúde para o controle da doença. O maior tempo para diagnóstico ocasiona sequelas e deformidades e, dessa forma, a busca dos contatos constitui importante método para o diagnóstico precoce da doença na infância, quando os sinais clínicos nem sempre são fáceis de serem identificados e há grande diversidade de formas clínicas em que a doença pode se apresentar.

OBJECTIVE: To describe two cases of leprosy in children under 15 years old, being one patient aged with 18 months and other 13 years, diagnosed by different modes of detection, emphasizing the importance of examining the contacts. CASE DESCRIPTION: One of the cases was diagnosed early by examining household contacts, while the other was diagnosed by spontaneous demand, after four years of the onset of lesions, although he had been a former patient contact who was not examined at the time. COMMENTS: In endemic countries, the high detection of leprosy in children under 15 years old reveals the persistence of the bacillus transmission and the difficulties encountered by public health programs to control the disease. Delay in leprosy diagnosis leads to sequels and deformities and, thus, the search for contacts is important as an effective method for early diagnosis of the disease in childhood, where clinical signs are not always easy to be identified due to the great variety of clinical forms in which the disease may occur.

OBJETIVO: Describir dos casos de enfermedad de Hansen en menores de 15 años, siendo uno de paciente con 18 meses de edad y otro de 13 años, diagnosticados por modos de detección distintos, subrayando la importancia de examinar a los contactos. DESCRIPCIÓN DEL CASO: Uno de los casos tuvo diagnóstico temprano mediante examen de contactos intradomiciliares, mientras que el otro fue diagnosticado por demanda espontánea después de cuatro años de surgimiento de las lesiones y, a pesar de ser contacto de un ex-paciente, no fue examinado en la época. COMENTARIOS: En países endémicos, la alta detección de enfermedad de Hansen en menores de 15 años revela la persistencia en la transmisión del bacilo y las dificultades de los programas de salud para el control de la enfermedad. El mayor tiempo para diagnóstico ocasiona secuelas y deformidades y, de ese modo, la búsqueda por los contactos constituye importante método para el diagnóstico temprano de la enfermedad en la infancia, cuando las señales clínicas no siempre son fáciles de identificarse y hay gran diversidad de formas clínicas en que la enfermedad puede presentarse.

A hanseníase é uma doença infectocontagiosa, com período de incubação médio de dois a cinco anos, causada pelo Mycobacterium leprae, o qual possui tropismo para a pele, as mucosas e os nervos periféricos. Quando manifestada em crianças abaixo de quinze anos, reflete a intensidade e longo período de exposição à grande carga bacilar. Representa, então, um importante evento de alerta que aponta para uma dificuldade no controle da doença. Os autores relatam três casos de hanseníase, em menores de quinze anos, provenientes do Município de Itaguaí, Rio de Janeiro. Discutem-se as implicações epidemiológicas da detecção de novos casos nessa faixa etária e o papel fundamental do exame de contatos e da busca do caso fonte no controle da Hanseníase.

Leprosy is an infectious disease with an average incubation period of two to five years. It is caused by Mycobacterium leprae, mainly affecting skin, mucous membranes and peripheral nerves. When it occurs in children under fifteen, it reflects an intense and long contact period, with a high bacillary load. Therefore, it is considered an important alert sign that points to the challenge of controlling the disease. The authors report three cases of leprosy in children under fifteen that occurred in the Itaguaí district, Rio de Janeiro. The epidemiologic implications of new cases detected at this age and the fundamental role of examining the patients' close contacts and the possible identification of source cases as an effort for leprosy control are discussed.

O Dermatomiofibroma está incluído no grupo de lesões neoplásicas mesenquimais benignas de linhagem fibroblástica e miofibroblástica da pele. É uma doença rara, havendo aproximadamente 100 casos descritos na literatura mundial até o momento. Este artigo relata o caso de uma mulher jovem com apresentação clínica típica e diagnóstico histopatológico de dermatomiofibroma. Foram realizadas colorações especiais que mostraram preservação das fibras colágenas e a imunohistoquímica revelou positividade para vimentina e negatividade para actina e S100. Por se tratar de doença rara, os achados histopatológicos são de grande importância, mas a supeição clínica é possível em casos típicos como este.

Dermato myofibroma is included in the group of benign cutaneous mesenchymal neoplastic lesions of fibroblastic and myofibroblastic lineage. It's a rare disease and there are approximately only one hundred cases described worldwide in the medical literature up to now. The present study reports the case of a young woman with typical clinical cutaneous lesion and histopathological diagnosis of dermato myofibroma. Special stains were carried out which showed preserved collagen fibers and immunohistochemistry was positive for vimentin and negative for actin and S100. As it is a rare disease, the histopathological findings are of great importance but clinical suspicion is possible in typical cases such as this one.

A hidradenite supurativa é doença inflamatória de difícil tratamento. Recentemente, a terapia anti-TNF alfa, com anticorpos monoclonais ("terapia biológica"), tem sido apontada como uma alternativa. No entanto, ensaios clínicos avaliando a eficácia destas drogas na hidradenite supurativa, ainda não foram publicados. Apresentamos um caso no qual o uso do infliximabe não resultou em melhora clínica expressiva.

Hidradenitis suppurativa is an inflammatory disease with difficult treatment. Currently, the anti-TNF alfa therapy, with monoclonal antibodies ("biological therapy"), has been shown as a new alternative. However, clinical trials assessing the efficacy of these drugs to treat hidradenitis suppurativa have not yet been published. A case in which the use of infliximab did not result in significant clinical improvement is described.