Resumo A Pasteurella multocida é um dos agentes mais comuns em infeções dos tecidos moles ocorrendo após mordedura de cães e (particularmente) gatos. A transmissão também pode ocorrer após arranhadelas desses animais. Os autores apresentam o caso de um homem de 78 anos, imunocomprometido, que recorre ao serviço de urgência por febre e sinais inflamatórios na mão direita após arranhadela de gato. Iniciou antibioterapia endovenosa empírica, dirigida após isolamento de Pasteurella spp. em zaragatoa. Após 3 semanas de antibioterapia o doente melhorou e teve alta. Dez dias após retorna ao hospital por choque séptico com ponto de partida em recorrência da celulite, havendo crescimento de Pasteurella multocida em hemoculturas. Após resultado do teste de suscetibilidade a antimicrobianos, completou 6 semanas de levofloxacina e penicilina. O doente recuperaria, não obstante ser imunocomprometido e as taxas de mortalidade serem consideráveis na bacterémia por Pasteurella spp.

Abstract Pasteurella multocida is the most common cause of soft tissue infection in humans following bites caused by dogs and (particularly) cats. Transmission may also occur after scratches inflicted by these animals. The authors present the case of a 78-year-old immunocompromised male who presented to the emergency department with fever and inflammatory signs on his right hand following a cat scratch. He was started on empirical intravenous antibiotics which, after isolation of Pasteurella spp. on a swab sample, was subsequently directed. A total of 3 weeks of antibiotics were administered, the patient improved and was discharged. Ten days after he returned to the hospital with septic shock secondary to recurrence of the cellulitis, and Pasteurella multocida was identified on blood cultures. After availability of the antibiotic sensitivity test, 6 weeks of levofloxacin and penicillin were administered. The patient recovered, despite being immunocompromised and Pasteurella spp. bacteremia having a relevant mortality rate.

Abstract: Background: Cancer is currently among the three leading causes of death after solid organ transplantation and its incidence is increasing. Non-melanoma skin cancer - squamous cell carcinoma and basal cell carcinoma - is the most common malignancy found in kidney transplant recipients (KTRs). The incidence of non-melanoma skin cancer in KTRs has not been extensively studied in Portugal. Objectives: To determine the incidence of non-melanoma skin cancer in KTRs from the largest Portuguese kidney transplant unit; and to study risk factors for non-melanoma skin cancer. Methods: Retrospective analysis of clinical records of KTRs referred for the first time for a dermatology consultation between 2004 and 2013. A case-control study was performed on KTRs with and without non-melanoma skin cancer. Results: We included 288 KTRs with a median age at transplantation of 47 years, a male gender predominance (66%) and a median transplant duration of 3.67 years. One fourth (n=71) of KTRs developed 131 non-melanoma skin cancers, including 69 (53%) squamous cell carcinomas and 62 (47%) basal cell carcinomas (ratio squamous cell carcinoma: basal cell carcinoma 1.11), with a mean of 1.85 neoplasms per patient. Forty percent of invasive squamous cell carcinomas involved at least two clinical or histological high-risk features. The following factors were associated with a higher risk of non-melanoma skin cancer: an older age at transplantation and at the first consultation, a longer transplant duration and the presence of actinic keratosis. KTRs treated with azathioprine were 2.85 times more likely to develop non-melanoma skin cancer (p=0.01). Conclusion: Non-melanoma skin cancer was a common reason for dermatology consultation in Portuguese KTRs. It is imperative for KTRs to have access to specialized dermatology consultation for early referral and treatment of skin malignancies.