Aplastic anemia is a bone marrow failure syndrome characterized by peripheral cytopenias and hypocellular bone marrow. Although aplastic anemia is idiopathic in most cases, rheumatic diseases such as systemic lupus erythematosus are recognized as causes of aplastic anemia, with their possible etiological mechanisms being T and B lymphocyte dysfunction and pro-inflammatory cytokines and autoantibody production directed against bone marrow components. In the course of the human immunodeficiency virus infection/acquired immunodeficiency syndrome, the identification of autoantibodies and the occurrence of rheumatic events, in addition to the natural course of systemic lupus erythematosus which is modified by immune changes that are characteristic of human immunodeficiency virus infection/acquired immunodeficiency syndrome, make the diagnosis of systemic lupus erythematosus challenging. This study reports the case of a woman with acquired immunodeficiency syndrome treated with a highly active antiretroviral therapy, who had prolonged cytopenias and hypocellular bone marrow consistent with aplastic anemia. The clinical picture, high autoantibodies titers, and sustained remission of the patient's hematological status through immunosuppression supported the diagnosis of systemic lupus erythematosus-associated aplastic anemia. This is the first report of aplastic anemia concurrent with systemic lupus erythematosus and acquired immunodeficiency syndrome, providing additional evidence that immune dysfunction is a key part of the pathophysiological mechanism of aplastic anemia.

FUNDAMENTOS: O corno cutâneo é lesão acentuadamente hiperqueratótica, cônica e circunscrita, que pode ocultar tanto lesões benignas como malignas. OBJETIVO: Identificar histopatologicamente as principais dermatoses que se apresentam clinicamente como corno cutâneo. MÉTODOS: Estudo histopatológico retrospectivo de 222 cornos cutâneos, a partir de laudos anatomopatológicos do Hospital de Clínicas de Uberlândia entre os anos de 1990 e 2006. RESULTADOS: A média de idade dos pacientes foi de 67,42 anos. O sexo feminino foi mais acometido (64,86%). O tempo médio de evolução foi de 16,92 meses. As localizações mais frequentes das lesões foram: cabeça (35,14%) e membros superiores (31,08%). Observaram-se lesões histopatologicamente benignas em 41,44% e lesões prémalignas ou malignas em 58,56% dos cornos cutâneos estudados. Entre as lesões pré-malignas, a queratose actínica foi encontrada em 83,84% dos casos; entre as malignas, o carcinoma espinocelular correspondeu a 93,75% dos casos. CONCLUSÕES: Este estudo mostrou que a maioria dos cornos cutâneos surgiu sobre áreas do corpo expostas à luz solar, predominantemente, cabeça e membros superiores. Considerando-se a elevada frequência de lesões prémalignas e também a presença de lesões malignas, sugere-se exérese cirúrgica seguida de estudo histopatológico dos cornos cutâneos, para confirmação de diagnóstico específico.

BACKGROUND: Cutaneous horn is a keratotic, conical and circumscribed lesion that can hide both benign or malignant lesions. OBJECTIVE: To identify,from a histopathological point of view, the main clinical dermatoses that are presented ,from a clinical point of view, as cutaneous horn. METHODS: RETROSPECTIVE HISTOPATHOLOGICAL STUDY OF 222 CASES OF CUTANEOUS HORNS THAT WERE CLASSIFIED AS SUCH BY ANATOMICAL-PATHOLOGICAL REPORTS OF THE UNIVERSITY HOSPITAL (HOSPITAL DE CLÍNICAS DE UBERLÂNDIA) FROM 1990 TO 2006. RESULTS: The average age of patients was 67,42. The female sex was more affected (64,86%). The average time of clinical evolution was 16,92 months. Lesions were mostly frequent located on the head (35,14%) and upper limbs (31,08%). Histopathological analysis considered 41,44 % of the lesions as benign and 58,56% as pre-malignant or malignant among the 222 cases of cutaneous horns studied. Within the group of pre-malignant lesions, actinic keratosis was found in 83,84% of the cases; within the group of malignant lesions, squamous cell carcinoma was found in 93,75% of the cases. CONCLUSIONS: This study showed that the majority of cutaneosus horns occured in areas of the body that are exposed to the sun, predominantly head and upper limbs. Considering the high frequency of pre-malignant lesions and also the presence of malignant lesions it is suggested surgical exeresis followed by histopathological study of the cutaneous horns for confirmation of specific diagnosis.