ABSTRACT Paracoccidioidomycosis is a deep systemic mycosis, endemic in some Latin American countries, with an acute/subacute clinical presentation. In our country, it is the main differential diagnosis of pulmonary tuberculosis. We describe the clinical case of a 48-year-old man from a rural area, immunocompetent, who presented clinically with respiratory distress, progressive weight loss and lesions in the oral mucosa; as radiological findings, he presented bilateral reticular infiltrates. From a mycological point of view, the presence of the microorganism was evidenced in various biological samples: biopsies of oropharyngeal lesions and mycological study of sputum. Targeted treatment with intravenous antifungals was performed, presenting a good response to it with clinical improvement.

RESUMEN La paracoccidioidomicosis es una micosis profunda sistémica, endémica en algunos países de Latinoamérica, de presentación clínica es de evolución aguda/subaguda, en nuestro país es el principal diagnostico diferencial de la tuberculosis pulmonar. Se describe el caso clínico de un hombre de 48 años, procedente de zona rural, inmunocompetente, que se presentó clínicamente por dificultad respiratoria, pérdida de peso de forma progresiva y lesiones en mucosas oral; como hallazgos radiológicos presentó infiltrados reticulares bilaterales. Desde el punto de vista micológico se evidenció la presencia del microorganismo en diversas muestras biológicas: biopsias de lesiones orofaríngeas y estudio micológico del esputo. Se realizó tratamiento dirigido con antimicótico intravenoso presentando buena respuesta al mismo con mejoría clínica.

Resumen Objetivo La histoplasmosis es una infección fúngica sistémica prevalente en la región del Río de la Plata. Puede exhibir manifestaciones orales, cutáneas y/o sistémicas. Las lesiones bucales significan un desafío diagnóstico debido a su semejanza clínica con el carcinoma oral de células escamosas (COCE). El objetivo de este trabajo fue presentar una serie de casos de histoplasmosis oral enfatizando la importancia del diagnóstico diferencial clínico con el COCE. Casos clínicos Se describen casos de histoplasmosis oral diagnosticados en los últimos 5 años en la Cátedra de Estomatología “A” de la Facultad de Odontología de la Universidad Nacional de Córdoba, Córdoba, Argentina. En forma paralela, se realizó una revisión de la literatura de los últimos 10 años. Los casos corresponden a 9 pacientes, 6 varones y 3 mujeres, cuya edad promedio fue de 58,6 años. 4 pacientes eran VIH positivos. Se planteó la sospecha de COCE en 5 pacientes, cuya presentación clínica intraoral consistía en úlceras o lesiones ulcerovegetantes, mayormente únicas, ubicadas en la encía. La revisión bibliográfica arrojó un resultado de 48 artículos que incluyeron 60 casos de histoplasmosis oral, con una prevalencia mayor en hombres y similitudes clínicas con COCE en el 80% de los casos. La lesión más predominante fue la úlcera en el 85% de los casos, ubicada en lengua, seguido por el paladar. El diagnóstico de histoplasmosis oral es desafiante y requiere un amplio diferencial, ya que se asemeja a múltiples patologías, debiendo ser considerada ante lesiones ulcerativas orales. Un diagnóstico preciso, de manera interdisciplinaria, es esencial para un tratamiento efectivo.

Abstract Aim Histoplasmosis is a systemic fungal infection prevalent in the Río de la Plata region. It could present oral, cutaneous and/or systemic manifestations. Oral lesions represent a diagnostic challenge due to their clinical similarity to oral squamous cell carcinoma (OSCC). The objective of this work is to present a case series of oral histoplasmosis emphasizing the importance of clinical differential diagnosis with OSCC. Clinical cases Cases of oral histoplasmosis diagnosed in the last 5 years in the Oral Medicine Department “A” of the Facultad de Odontología of the Universidad Nacional de Córdoba, Córdoba, Argentina are discribed. Alongside, a literature review of the last 10 years was carried out. 9 patients are described, 6 men and 3 women, whose average age was 58.6 years. 4 patients were HIV positive. The suspicion of OSCC was raised in 5 patients, whose intraoral clinical presentation consisted of single ulcers or vegetating ulcers, mostly single, located in the gingiva. The literature review included a total of 48 articles with 60 cases of oral histoplasmosis, with a higher prevalence in men and clinical similarities with OSCC in 80% of cases. The most predominant lesion was the ulcer in 85% of the cases, mostly located on the tongue, followed by the palate. The diagnosis of oral histoplasmosis is challenging and requires a wide differential, since it can mimic multiple pathologies, and should be considered in oral ulcerative lesions. An accurate diagnosis, in an interdisciplinary framework, is essential for effective treatment.

Resumo A esporotricose é uma micose subaguda a crônica causada por espécies do gênero Sporothrix. A forma linfocutânea predomina na maioria dos casos, porém indivíduos imunocomprometidos podem apresentar variantes disseminadas. Embora mais prevalente em adultos, sua ocorrência em lactentes é um fenômeno raro, com fatores de risco e aspectos epidemiológicos pouco estudados. Descrevemos um caso de infecção por esporotricose em criança de 9 meses, que se manifestou por dois nódulos de crescimento progressivo, de consistência mole, localizados nas regiões cervical direita e pré-auricular, associados a uma deterioração na condição geral e febre ao longo de um mês. Apesar de múltiplos tratamentos com antibióticos, não houve melhora das lesões. A cultura do material aspirado de um dos nódulos revelou Sporothrix. O paciente foi então tratado com itraconazol oral, levando à regressão das lesões em 2 meses. A identificação do agente de transmissão neste caso não foi possível. Este relato visa ampliar a compreensão da manifestação da esporotricose em lactentes e fornecer informações valiosas para o aprimoramento de estratégias específicas de prevenção, diagnóstico e tratamento para esse grupo particular de pacientes dermatológicos.

Abstract Sporotrichosis is a subacute to chronic mycosis caused by species of the genus Sporothrix. While the lymphocutaneous form predominates in most cases, immunocompromised individuals may present with disseminated variants. It is more prevalent in adults and rare in infants, with poorly studied risk factors and epidemiological aspects in this age group. We describe a case of sporotrichosis infection in a 9-month-old child, presenting with two progressively growing nodules, soft in consistency, located in the right cervical and pre-auricular regions, associated with a decline in general condition and fever over a month’s duration. Despite multiple oral antibiotics, there was no lesional improvement. Aspiration of one of the nodules, and culture of the secretion revealed Sporothrix. The patient was then treated with oral itraconazole, leading to regression of the lesions within 2 months. The identification of the transmission agent in this case was not possible. This report aims to broaden the understanding of sporotrichosis manifestation in infants and to provide valuable insights for the enhancement of specific preventive, diagnostic, and therapeutic strategies for this age group of dermatological patients.

Abstract Introduction: Baclofen is an agonist of GABA receptors in the central nervous system (CNS) whose effect is to reduce spasticity. The dose used in intrathecal baclofen pump therapy is up to 100 times lower than oral. There are reports of withdrawal syndrome in neonates exposed to baclofen in utero. Case presentation: The case of a 31-year-old patient with a history of spasticity secondary to neonatal hypoxia being managed with an intrathecal baclofen pump since 2012 is presented, who in 2023 had a pregnancy, cesarean section at 37+2 weeks of gestation under general anesthesia with no complications with favorable maternal-fetal outcomes. Discussion: It is necessary to evaluate the safety of the use of technologies such as intrathecal pumps in pregnancy, in this case with the use of baclofen with which we found multiple questions given the absence of randomized studies such as its possible teratogenic effect on the fetus and the possible syndrome of abstinence on the neonate, the present clinical case reports the use of this technology with favorable maternal-fetal outcomes and compares it with the cases reported in the literature, also finding possible related side effects. Conclusions: The information to date seems to demonstrate that the use of baclofen intrathecally during pregnancy is completely safe given its low plasma concentrations.

Resumen Introducción: El baclofeno es un agonista de los receptores GABA en el sistema nervioso central (SNC), cuyo efecto es la disminución de la espasticidad. La dosis utilizada en la terapia por bomba intratecal de baclofeno es de hasta 100 veces menor que por vía oral. Existen reportes de síndrome de abstinencia en neonatos expuestos a baclofeno en el útero. Presentación del caso: Se presenta el caso de una paciente de 31 años con antecedente de espasticidad secundaria a hipoxia neonatal en manejo con bomba intratecal de baclofeno desde el año 2012, quien en el 2023 cursó con embarazo. La paciente presentó cesárea a las 37+2 semanas de gestación, bajo anestesia general y sin complicaciones con desenlaces materno-fetales favorables. Discusión: Es necesario evaluar la seguridad del uso de tecnologías como bombas intratecales en el embarazo, ya que en este caso y con el uso de baclofeno se encontraron múltiples interrogantes dada la ausencia de estudios aleatorizados, así como su posible efecto teratogénico en el feto y el posible síndrome de abstinencia sobre el neonato. El presente caso clínico reporta el uso de esta tecnología con desenlace materno-fetales favorables y lo compara con los casos hallados en la literatura, encontrando además posibles efectos secundarios relacionados. Conclusiones: La información hasta la fecha parece demostrar que el uso de baclofeno vía intratecal durante el embarazo es completamente seguro, dadas sus bajas concentraciones en plasma.

RESUMEN El síndrome de Wells es una afección dérmica que presenta un gran polimorfismo clínico. Es una patología autolimitada, recurrente y su origen es incierto. Reportamos el caso de una paciente de 29 años, procedente del área Central de Paraguay, comerciante, sin patología de base que consultó por edema de manos y piel. El tratamiento indicado fue corticoide vía oral y desparasitación con buena evolución y sin recidivas.

ABSTRACT Wells syndrome is a dermal condition with a high clinical polymorphism. It is a self-limited, recurrent pathology and its origin is uncertain. We report the case of a 29-year-old female patient from the central area of Paraguay, a shopkeeper, with no underlying pathology, who consulted for hand and skin edema. The indicated treatment was oral corticosteroid and deworming with good evolution and no recurrences.

The resurgence of monkeypox, subsequent to its designation as a Public Health Emergency of International Concern by the World Health Organization in 2022, underscores the critical need for rigorous infection control protocols within dental settings. Due to the inherent nature of dental procedures, that involve working in close proximity to patients and potential exposure to infectious bodily fluids, the dental profession faces significant challenges in mitigating the transmission of mpox. This update provides a comprehensive review of the virological characteristics, transmission pathways, and clinical presentation of mpox, with particular emphasis on its oral manifestations and the implications for dental practitioners. It delineates both standard and enhanced infection control measures, including the application of personal protective equipment, stringent hand hygiene practices, meticulous environmental disinfection, and the prudent management of aerosol-generating procedures. Additionally, is addresses the importance of patient screening, isolation of suspected cases, and the education of both dental staff and patients regarding the transmission and prevention of mpox. The necessity for dental professionals to maintain vigilance, remain current with evolving guidelines, and implement comprehensive infection control strategies is emphasized, highlighting the pivotal role of dental practices in the early detection and control of mpox transmission during the ongoing outbreak.

Abstract Introduction. Superior mesenteric artery syndrome, also known as Wilkie syndrome, is a rare entity in which a reduction in the aorto-mesenteric angle or space determines extrinsic compression with obstruction of the distal third of the duodenum, demonstrating characteristic symptoms and signs of intestinal obstruction. The mainstay of treatment is conservative medical management with nutritional repletion, with the aim of increasing the thickness of the retroperitoneal fat and thereby resolving duodenal compression. Clinical case. A 16-year-old patient, with a chronic course marked by abdominal pain, constipation, bloating, heartburn and weight loss. Initially was treated as an acid-peptic disease, with poor improvement. Imaging studies were performed, which documented a decrease in the aorto-mesenteric angle. Conclusion. Based on the symptoms and findings on diagnostic images, the diagnosis of superior mesenteric artery syndrome was made, which is a cause of intestinal obstruction with a very low incidence. Its clinical presentation includes a wide variety of symptoms, among which abdominal pain and weight loss stand out. Confusion with other more common diseases is common, such as acid-peptic disease, gastrointestinal reflux and malabsorption. Its diagnosis requires a high index of suspicion, so it is important to know this entity and consider it in the study of patients with the aforementioned symptoms.

Resumen Introducción. El síndrome de la arteria mesentérica superior, también conocido como síndrome de Wilkie, es una entidad infrecuente en la que una reducción del ángulo o espacio aorto-mesentérico determina una compresión extrínseca con obstrucción del tercio distal del duodeno, demostrando síntomas y signos característicos de obstrucción intestinal. El pilar del tratamiento es el manejo médico conservador con repleción nutricional, con el objetivo de aumentar el grosor de la grasa retroperitoneal y con esto resolver la compresión duodenal. Caso clínico. Paciente de 16 años, con un curso crónico marcado por dolor abdominal, estreñimiento, distensión, pirosis y pérdida de peso. Inicialmente se trató como una enfermedad ácido-péptica, con pobre mejoría, por lo que se realizaron estudios imagenológicos con lo que se documentó una disminución del ángulo aortomesentérico. Resultado. Se instauró un manejo médico con un protocolo de repleción nutricional por vía oral, para lograr ganancia de peso y evitar la cirugía. Conclusión. Con base a los síntomas y hallazgos en imágenes diagnósticas se hizo el diagnóstico de síndrome de la arteria mesentérica superior, que es una causa de obstrucción intestinal con muy baja incidencia. Su presentación clínica incluye gran variedad de síntomas, entre los que destaca el dolor abdominal y la pérdida de peso. Es frecuente la confusión con otras enfermedades más frecuentes, como enfermedad ácido-péptica, reflujo gastrointestinal y malabsorción. Su diagnóstico requiere un alto índice de sospecha, por lo que es importante conocer esta entidad y considerarla en el estudio de pacientes con los síntomas mencionados.

INTRODUCTION: Iron deficiency anaemia may be responsible for diverse oral mucosa changes due to the reduced oxygen-carrying capacity of red blood cells, but also due to changes in the oral mucosal structure and defence mechanisms AIMS AND OBJECTIVES: This study aims to report on three patients with iron deficiency anaemia who presented with distinct oral mucosal clinical features DESIGN/METHODS: The oral mucosal features of three patients who presented at the University of Pretoria Oral Health Centre with iron deficiency anaemia, of variable causes, were recorded. Special investigations were performed and reflected their degree of iron deflciency. The patients were managed collaboratively with their respective physicians to address the underlying cause of anaemia RESULTS: These cases demonstrate that dentists should explore the presence of anaemia to explain oral mucosal changes. Anaemia may present with wide-ranging clinical features, from recurrent to persistent oral ulcers, mucosal pallor, and Candida infection. Collaboration with attending physicians may help establish the cause of anaemia as a nutritional deflciency, gastric ulceration, or infective and inflammatory disease CONCLUSIONS: Dentists are pivotal in diagnosing haematological diseases such as iron deflciency anaemia. The oral features of ulceration, glossitis, Candida infection and mucosal pallor are important diagnostic indicators of iron deflciency anaemia

Abstract: The aim of this contribution is to present a corpus of data for the study of the current Spanish of Equatorial Guinea that was collected during a research stay on the island of Bioko and the mainland region of Rio Muni in February and March 2022. This corpus contains oral and written data from men and women who belong to different ethnic and age groups, live in different parts of the country, and have varying levels of education. After providing an overview of the geography, ethnic composition, history and sociolinguistic landscape of Equatorial Guinea, the article delves into the data collection process and the analysis tools used. It then describes the properties of the sample, the programs used in the data analysis, as well as the planned studies.

Resumen: El objetivo de esta contribución es presentar un corpus de datos para el estudio del español actual de Guinea Ecuatorial que fue recogido durante una estancia de investigación en la isla de Bioko y la región continental de Río Muni en febrero y marzo de 2022. Este corpus contiene datos orales y escritos de hombres y mujeres que pertenecen a diferentes etnias y grupos etarios, viven en distintas partes del país y poseen niveles de instrucción variados. Después de ofrecer una visión de conjunto de la geografía, la composición étnica, la historia y el panorama sociolingüístico de Guinea Ecuatorial, el artículo ahonda en el proceso de recogida de datos y los instrumentos de análisis empleados. A continuación, se describen las propiedades de la muestra, los programas empleados en el análisis de los datos, así como los estudios previstos.

BACKGROUND: To document the lip as an unusual site of clinical presentation of spindle cell carcinoma and to conduct a review of the literature. METHODS: A 66-year-old male patient presented with an ulcerated lesion of the lower lip. Morphological examination and immunohistochemical profiling of the lesion were performed. RESULTS: Histopathological examination showed a high-grade spindle cell neoplasm. Pleomorphic fusiform cells with cytological and nuclear atypia were predominant together with conspicuous perineural infiltration. A small focus of overlying stratified squamous parakeratinising epithelium was identified in a section of the lesion. Co-expression of cytokeratin and mesenchymal markers confirms the epithelial-mesenchymal transition which is inherent to this lesion. CONCLUSION: Spindle cell carcinoma (sarcomatoid carcinoma) is a rare variant of squamous cell carcinoma with an infrequent occurrence on the lower lip. The objective in reporting this case is to raise the clinicopathological awareness of this unconventional variant of squamous cell carcinoma to expedite diagnostic and therapeutic intervention. STATEMENT OF CLINICAL RELEVANCE: The documentation of a rare form of oral squamous cell carcinoma at an unusual site allows for expeditious diagnostic and therapeutic intervention.

INTRODUCTION: The bone marrow is responsible for haemopoiesis, but when it fails, oral mucosal lesions may be seen due to reduced platelets, white blood cells, or red blood cells. AIMS AND OBJECTIVES: This study aims to report on three patients who presented with leukaemia, aplastic anaemia and neutropenia, respectively, with spontaneous bleeding, ulceration and mucosal pallor. DESIGN/METHODS: The oral mucosal features of three patients who presented at the University of Pretoria Oral Health Centre, with varying degrees of bone marrow failure, were recorded. Special investigations were performed to check their bone marrow function. The patients were managed collaboratively with their respective physicians. RESULTS: These cases demonstrate that dentists should be cognisant of disorders of bone marrow failure so that patients are a) diagnosed timely and appropriately, b) referred back to their treating clinician due to relapse of a known disease, or c) managed in collaboration with their treating clinician to confirm a suspected diagnosis. CONCLUSIONS: Dentists play a pivotal role in diagnosing haematological disease that results from bone marrow failure. Bleeding, ulceration and mucosal pallor are important diagnostic indicators of reduced platelet, neutrophil and red blood cell counts.

Abstract White sponge nevus (WSN) is a rare autosomal-dominant disorder of the non-keratinized mucosa, characterized by a thickened white edematous mucosa whose surface appears irregular, wrinkly, or spongy. It affects mainly the oral mucosa. The histopathological examination demonstrates hyperparakeratosis, acanthosis with intracellular edema and vacuolization over the prickle cell layer, and eosinophilic perinuclear condensation. The currently accepted etiology is a mutation of the keratin 4 and/or keratin 13 genes. We present a case of WSN diagnosed in a 30-year-old white male patient with white corrugated bilateral lesions on the buccal mucosa that extended beyond the occlusal plane. A biopsy was obtained, and the histological presentation included superficial parakeratosis, prominent acanthosis of the squamous epithelium, and areas with prominent intracellular edema, which confirmed the diagnosis. No treatment was necessary other than patient counseling and initial 6-month follow-up consultation. His attending dentist was informed of the diagnosis, and further follow-ups were recommended.

Resumo O nevo branco esponjoso (NBE) é uma doença rara, autossómica dominante, da mucosa não queratinizada, que se caracteriza pela presença de uma mucosa espessada e esbranquiçada cuja superfície é irregular, rugosa ou esponjosa. A mucosa oral é a mais afetada. Na avaliação histopatológica apresenta hiper-paraqueratose, acantose com edema e vacuolização intracelulares na camada espinhosa, e condensação eosinofílica perinuclear. Atualmente pensa-se que a etiologia resulta da mutação dos genes da queratina 4 e/ou 13. Apresentamos um caso de um homem, leucodérmico, de 30 anos, com lesões brancas enrugadas bilaterais na mucosa bucal, cuja extensão ultrapassa o plano oclusal. Foi realizada uma biopsia, e a aparência histológica traduziu-se em paraqueratose superficial, com proeminente acantose do epitélio pavimentoso e áreas de proeminente edema intracelular, o que confirmou o diagnóstico. Não foi necessário tratamento, para além do aconselhamento do doente e follow-up inicial de 6 meses. O seu médico dentista foi informado do diagnóstico e recomendou-se manutenção de controlos

Abstract Introduction: Erythema nodosum is a rare disease whose pathophysiology is based on a type 4 delayed hypersensitivity response and its most common form of presentation is in the form of bilateral and symmetrical nodules and cutaneous plaques, predominantly affecting the pre-tibial region. Although the idiopathic etiology is still quite frequent, close to half of the cases are of secondary etiology, with oral contraceptives being amongst the most associated drugs with this entity, and this causal relationship being described for a greater number of estroprogestative associations. A rare case of erythema nodosum secondary to the association of ethinyl estradiol 0.03 mg + levonorgestrel 0.15 mg is described. Case description: We report a case of a 20-year-old woman who developed painful unilateral nodules in the pre-tibial region, related to the initiation of the combination of ethinyl estradiol 0.03 mg, and levonorgestrel 0.15 mg. The user describes the injuries as being longstanding, although she has never sought medical care in the past. After further investigation of the clinical history and suspicion of the causal relationship between the combined oral contraceptive and the appearance of lesions compatible with erythema nodosum, it was decided to suspend the same and start prednisolone 20 mg/day, with the user having a very favorable evolution. After discussing the existing therapeutic options, the user chose to switch to Implanon®. Conclusion: The literature is increasingly reporting the causal relationship between oral contraceptives, not only the combined type but also the isolated type, and the appearance of erythema nodosum. This is a rare and complex relationship. When a patient starts with painful nodules, a case of erythema nodosum must be considered, being aware of potential triggers - as combined oral contraceptives. In these cases, options must be explained to the user; therapeutic suspension is not the only way.

Resumo Introdução: O eritema nodoso é uma doença rara cuja fisiopatologia assenta numa resposta de hipersensibilidade tardia do tipo 4 e o seu modo de apresentação mais comum é sob a forma de nódulos e placas cutâneas bilaterais e simétricas, afetando predominantemente a região pré-tibial. Apesar da etiologia idiopática ainda ser bastante frequente, perto de metade dos casos são de etiologia secundária, estando os anticoncecionais orais entre os fármacos mais associados a esta entidade e sendo descrita esta relação causal para um número crescente de associações estroprogestativas. Descreve-se um caso raro de eritema nodoso secundário à associação de etinilestradiol 0,03 mg + levonorgestrel 0,15 mg. Descrição do caso: Relata-se o caso de uma mulher de 20 anos, que desenvolveu nódulos dolorosos na região pré-tibial do membro inferior direito, relacionando com o início da toma da associação de etinilestradiol 0,03 mg e levonorgestrel 0,15 mg. A utente descreve as lesões como sendo já crónicas, embora nunca tenha procurado cuidados médicos no passado. Após investigação mais aprofundada da história clínica e suspeição da relação causal entre o fármaco e o aparecimento das lesões compatíveis com um eritema nodoso optou-se por suspender o mesmo e iniciar prednisolona 20 mg/dia, tendo a utente evoluído no sentido da resolução clínica. Após discussão das opções terapêuticas existentes, a utente optou pela colocação de Implanon®. Conclusão: Na literatura é cada vez mais relatada a relação causal entre a toma de contracetivos orais, não só do tipo combinado como também do tipo isolado, e o aparecimento de eritema nodoso. Esta relação é rara e complexa. Perante um quadro de nódulos dolorosos dever-se-á considerar a hipótese de se tratar de um caso de eritema nodoso, estando atentos a potenciais triggers - caso dos contracetivos orais combinados. Nestes casos dever-se-á explicar à utente quais as suas opções, não sendo a suspensão terapêutica o único caminho a seguir.

ABSTRACT: Lymphangiomas are benign hamartomatous tumors of the lymphatic vessels, originating from a sequestration of the lymphatic sac and enlarged by inadequate drainage, lack of communication with the central lymphatic channels or excessive secretion of lining cells. The incidence of these tumors in the lymphatic system is low, with a frequency of 1.2 to 2.8/1000 in children, with no predilection for sex. Three types of lymphangioma can be distinguished in the maxillofacial territory: simple lymphangioma, cavernous lymphangioma, and cystic hygroma or cystic lymphangioma. Clinically, these lesions present as painless, slow-growing soft tissue masses. Their clinical appearance depends on the extent of the lesion. Various treatment methods for lymphangioma have been reported in the literature, with surgical excision being indicated mainly when vital structures are not involved in the lesion. This article presents a case of a 13-year-old female patient with an increase in volume in the vermilion of the upper lip, with a history of Koolen De Vries syndrome, in which the excision of the lesion was performed.

RESUMEN: Los linfangiomas son tumores benignos hamartomatosos de los vasos linfáticos, originadas de un secuestro del saco linfático y agrandados por un inadecuado drenaje a la falta de comunicación con los canales linfáticos centrales o a la secreción excesiva de células de revestimiento. La incidencia de estos tumores en el sistema linfático es baja con una frecuencia de 1,2 a 2,8/1.000 en niños, sin predilección por sexo. En el territorio maxilofacial se pueden distinguir tres tipos de linfangioma: linfangioma simple, linfangioma cavernoso e higroma quístico o linfangioma quístico. Clínicamente estas lesiones se presentan como masas de tejido blando indoloras y de crecimiento lento. Su aspecto clínico depende de la extensión de la lesión. Diversos métodos de tratamiento para el linfangioma han sido reportados en la literatura, siendo la escisión quirúrgica la indicada, principalmente cuando estructuras vitales no están involucradas en la lesión. En este artículo se presenta un caso de una paciente femenina de 13 años con un aumento de volumen en el bermellón del labio superior, con antecedente de síndrome Koolen De Vries, a la cual se le realizó la exéresis de la lesión.

RESUMEN La primera causa de muerte por enfermedad infecto-contagiosa a nivel mundial es atribuible a la infección por Mycobacterium tuberculosis. La tuberculosis extrapulmonar representa entre un 20 % y un 25 % de los casos de enfermedad tuberculosa. Frecuentemente, para arribar al diagnóstico de dichas localizaciones, se debe recurrir a pruebas diagnósticas invasivas Se presenta el caso de un paciente de 17 años de edad con compromiso extrapulmo nar de tuberculosis en médula ósea sin inmunocompromiso conocido, con síntomas de fiebre, astenia, pérdida de peso, tricitopenia y hepatoesplenomegalia, sin otros hallazgos clínicos significativos. Se arriba al diagnóstico por cultivo positivo para tuberculosis en material de punción/ biopsia de médula ósea. Luego de un mes de tratamiento con isoniacida, pirazinamida, etambutol y rifampicina evoluciona con registros febriles aún después de recibir antibióticos por infección urinaria por Klebsiella pneumoniae, por lo cual se inicia corticoterapia oral con buena respuesta. El paciente abandona el tratamiento luego de tres meses y medio por mala adherencia a este.

ABSTRACT The leading cause of death from a contagious infectious disease worldwide is attribut able to Mycobacterium tuberculosis infection. Extrapulmonary tuberculosis accounts for 20-25 % of cases of tuberculous disease. Frequently, in order to reach the diagnosis of these sites, invasive diagnostic tests have to be used. We present the case of a 17-year-old patient with extrapulmonary tuberculosis with bone marrow involvement. The patient wasn’t immunocompromised, and had the following symptoms: fever, asthenia, weight loss, tricytopenia and hepatosplenomegaly, without other significant clinical findings. The diagnosis was reached by positive culture for tuberculosis in bone marrow puncture aspiration/biopsy material After one month of treatment with isoniazid, pyrazinamide, ethambutol and rifampicin, the patient evolved with fever episodes, even after having received antibiotics for urinary tract infection caused by Klebsiella pneumoniae. Thus, oral corticosteroid therapy was started, with good response. The patient discontinued treatment after three and a half months due to poor adherence.