Abstract We report the case of a 23-year-old immunocompetent patient who presented at the emergency department of a Brazilian hospital with epigastric pain and fever. After an investigation that included a computed tomography scan and upper gastrointestinal endoscopy with biopsy, a diagnosis of mucormycosis was established. The patient exhibited favorable progress after surgery and antifungal therapy. Mucormycosis is a rare condition that usually affects immunocompromised patients, with a high mortality rate of up to 85%. Correct diagnosis and fast initiation of therapy are required to ensure improved patient prognosis.

Abstract We present a case of disseminated cutaneous histoplasmosis in a male patient, rural worker, HIV positive for 20 years, with a history of irregular use of antiretroviral therapy, T cell counts below 50 cells/mm3 and with good response to treatment with Itraconazole. We highlight importance of skin lesions in clarifying early diagnosis, since this co-infection often leads patients to death.

Homem, 25 anos, com manchas acastanhadas, assintomáticas, nas regiões cervicais, axilares, inguinais e poplíteas há nove meses. Anatomopatológico com degeneração hidrópica da basal, incontinência pigmentar e infiltrado inflamatório linfocitário moderado na derme. O líquen plano pigmentoso invertido é um subtipo raro de líquen plano, caracterizado por máculas hipercrômicas, assintomáticas ou discretamente pruriginosas, de milímetros a centímetros de diâmetro, com limites nítidos, nas áreas intertriginosas, sendo mais comum nas flexuras axilares e inguinais de indivíduos de pele clara. Apresenta histologia liquenóide peculiar. Relata-se um caso com clínica, histologia e evolução típicas.

Twenty-five year old male patient presenting with asymptomatic brown spots, on cervical, axillary, inguinal and popliteal regions, for the last nine months. Pathological examination showed hydropic degeneration of the basal layer, pigmentary incontinence and moderate inflammatory lymphocytic infiltrate in the dermis. Lichen planus pigmentosus inversus is a rare subtype of lichen planus characterized by hyperchromic, asymptomatic or mildly pruritic macules, measuring from millimeters to centimeters in diameter, with defined borders, affecting intertriginous areas, most commonly in the axillae and groin of Caucasian patients. It presents unique lichenoid histology. We report a case with typical clinical features, histology and evolution.

PURPOSE: To investigate the effect of chronic experimental diabetes on skin allografts in rats as a simple model that could clarify some basic aspects and mechanisms involved in transplant rejection in diabetes compared to normal animals. METHODS: Skin grafting was performed with fragments of tail skin from sex matched non diabetic Wistar rats engrafted onto the thoracic area of diabetic and non diabetic recipients. Grafts were scored for rejection every other day and were removed on day 14. Skin grafts were graded according to the following itens: no rejection; or rejection including: acute, chronic and humoral and/or cellular rejection. Statistical analysis was performed using JMP 5.1 software with ANOVA test. Diabetes was induced with IV injection of alloxan 40 mg/kg. RESULTS: Inflammatory vascular infiltrate compromising the endothelium with areas of fibrinoid necrosis and thrombosis characteristics of acute humoral rejection and subendothelial lymphocyte infiltrate typical of acute cellular rejection were significantly (p<0.003) higher in diabetic than in non diabetic recipients as the inflammatory infiltrate in the epidermis (p<0.002). CONCLUSION: Skin transplant acute rejection from chronic alloxan diabetic rats to normal tissue was significantly more intense than the acute rejection between normal rats.

Kikuchi-Fujimoto disease, also known as histiocytic necrotizing lymphadenitis of unknown etiopathogenesis, is a self-limited disease which frequently appears as feverish lymphadenomegaly, thus creating the need for differential diagnosis with lymphoma, systemic lupus erythematosus (SLE), infectious mononucleosis, cat-scratch disease, and toxoplasmosis with lymphonodal impairment. However, there are cases in which it may evolve with complications such as aseptic meningitis, cerebellar ataxia, and aseptic myocarditis. We are presenting a case of a 24-year-old man who had an initial picture of arthralgia, evening fever and adenomegaly. Kikuchi disease was diagnosed through lymph node biopsy with immunohistochemistry and evolves with severe systemic manifestations, such as pericarditis with cardiac tamponade, pneumonitis, hepatitis, and acute kidney failure - the latter has not been reported in literature yet. There was significant improvement of the clinical picture with prednisone

O transplante renal alcançou expressivos e crescentes índices de sucesso desde sua implantação, constituindo atualmente uma terapia substitutiva de larga escala. É cada vez mais freqüente o encontro de biópsias de enxerto renal na rotina dos laboratórios de patologia, cujos achados são os mais variados. Este artigo resulta da experiência dos membros do Clube do Rim (da Sociedade Brasileira de Patologia) e apresenta um panorama geral da patologia do transplante renal, enfatizando a atual classificação de Banff, com suas principais categorias e entidades de diagnóstico problemático.

Renal transplant has reached remarkable and growing rates of success since its introduction; nowadays it is a widely used replacement therapy. Renal allograft biopsies are increasingly more frequent in the routine of pathology laboratories, whose histological findings are varied. This paper results from the expertise of the members of the Kidney Club of Sociedade Brasileira de Patologia, and presents a general overview of renal allograft pathology, focusing on the current Banff classification, its main categories and cases of difficult diagnosis.

CONTEXTO: A microscopia eletrônica tem sido usada há mais de três décadas para o diagnóstico morfológico das doenças glomerulares e seu valor tem sido amplamente enfatizado. Entretanto, relatos recentes têm analisado criticamente o uso rotineiro da microscopia eletrônica. O seu uso em outras áreas de diagnóstico como doenças tumorais tem declinado consideravelmente. Além disso, em virtude da inevitável pressão financeira para redução dos custos da investigação na rotina diagnóstica, a seleção dos casos para microscopia eletrônica tem sido rigorosa. OBJETIVO: Com o intuito de se identificarem as doenças glomerulares que dependem da microscopia eletrônica para o diagnóstico final, foram revisadas biópsias renais recebidas no período de 12 anos. TIPO DE ESTUDO: Prospectivo LOCAL: Hospital Ana Costa, Hospital Guilherme Álvaro e Serviço de Anatomia Patológica de Santos, São Paulo, Brasil. PARTICIPANTES: 200 biópsias renais consecutivas, obtidas de hospital privado e hospital-escola de 1979 a 1991. PRINCIPAIS VARIÁVEIS: Todos os casos foram analisados por microscopia óptica, imunofluorescência e microscopia eletrônica. O diagnóstico foi inicialmente feito por microscopia óptica e de imunofluorescência, e posteriormente pela microscopia eletrônica. RESULTADOS: A microscopia eletrônica foi diagnóstica ou essencial para o diagnóstico em 10,0% dos casos, correspondendo a 3,4% de glomerulopatias primárias e 100% das glomerulopatias hereditárias. A microscopia eletrônica foi contributiva para o diagnóstico em 5,5% dos casos, confirmando os diagnósticos formulados com base em dados clínicos e laboratoriais, e achados de microscopia óptica e de imunofluorescência. Obtivemos 7,5% de imunofluorescências discordantes, assim consideradas quando os achados de imunofluorescência não foram confirmados pela microscopia eletrônica. Em 77,0% dos casos, o diagnóstico final pôde ser estabelecido exclusivamente com base nos achados de microscopia óptica e de imunofluorescência. CONCLUSÕES: Foi possível diagnosticar com exatidão grande porcentagem (82,5 - 90,0%) dos casos com base nos achados isolados de microscopia óptica e de imunofluorescência. A microscopia eletrônica foi essencial para o diagnóstico das nefropatias hereditárias.

CONTEXT: Electron microscopy has been used for the morphological diagnosis of glomerular diseases for more than three decades and its value has been widely emphasized. However, recent reports have analyzed the routine use of electron microscopy critically. Its use in other areas of diagnosis such as tumor diseases has declined considerably; in addition, in view of the unavoidable financial pressure for the reduction of costs due to investigations and diagnostic routines, the selection of cases for electron microscopy has been quite rigorous. OBJECTIVE: To identify the glomerular diseases that depend on electron microscopy for a final diagnosis, by means of reviewing renal biopsies performed over a 12-year period. DESIGN: Prospective SETTING: Hospital Ana Costa, Hospital Guilherme Álvaro and Serviço de Anatomia Patológica de Santos, Santos, São Paulo, Brazil. PARTICIPANTS: 200 consecutive renal biopsies obtained from private hospitals and the teaching hospital from 1979 to 1991 were studied. MAIN MEASUREMENTS: All cases were analyzed via light microscopy, immunofluorescence and electron microscopy. The diagnosis was first made via light microscopy plus immunofluorescence and then via electron microscopy. RESULTS: Electron microscopy was diagnostic or essential for diagnosis in 10.0% of the cases, corresponding to 3.4% of primary glomerulopathies and 100% of hereditary glomerulopathies. Electron microscopy was contributory (useful) to the diagnosis in 5.5% of the cases, confirming the preliminary diagnosis formulated on the basis of clinical and laboratory data and light microscopy plus immunofluorescence findings. We obtained a 7.5% rate of discordant immunofluorescence, which was considered as such when negative immunofluorescence findings were not confirmed by electron microscopy. The final diagnosis with the use of light microscopy plus immunofluorescence alone was 77.0%. CONCLUSIONS: It was possible to diagnose with certainty a great percentage of glomerulopathies (82.5-90% of the cases) based on the light microscopy and immunofluorescence findings alone. Electron microscopy was essential for the diagnosis of hereditary nephropathies.

Os autores relatam caso de lúpus eritematoso cutâneo subagudo (LECSA) manifestado clinicamente como eritema anular centrífugo. Ressaltam a diferenciação clínica e laboratorial entre LECSA e lúpus eritematoso sistêmico. Também discutem a conduta terapêutica.

The authors describe a case of subacute cutaneous lupus erythematosus (SCLE) manifested clinically as a case of annular erythema centrifugum. The clinical and laboratorial differentiation of SCLE from systemic lupus erythematosus is emphasized, and the best therapeutic conduct is indicated.