ABSTRACT Mass vaccination campaigns are essential to control the ongoing novel severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) pandemic. The Covishield vaccine consists of the replication-deficient simian adenovirus vector ChAdOx1, which contains the full-length structural spike protein of SARS-CoV-2. Occasionally, it can lead to cutaneous reactions that contribute to fear of vaccination, hesitancy, and incomplete vaccination schedules. We report a case of facial angioedema following the first dose of Covishield in a 63-year-old woman with no previous history of allergies or hypersensitivity to drugs or vaccines. No rebound of angioedema was recorded after the second homologous and third heterologous doses.

Abstract The differential diagnosis of optic neuritis is broad and varied. We report the case of a 24-year-old Brazilian man who presented with five-week history of fever, malaise, myalgia, severe fatigue, tender right preauricular lymphadenopathy, and acute vision blurring associated with right optic disc swelling and exudates in a macular star pattern. His illness developed soon after an infestation of fleas broke out among his cats. Diagnosis of ocular bartonellosis was confirmed by serological and molecular analyses targeting amplification of Bartonella spp. htrA gene. Signs and symptoms only improved after initiation of antimicrobial therapy.

ABSTRACT It is essential for health care providers to be familiared with the full spectrum of clinical presentations of syphilis. We present herein a case of syphilide psoriasiforme, an uncommon but well recognized clinical presentation of secondary syphilis. A 46-year-old HIV-infected female patient was referred to our attention with a presumptive diagnosis of palmoplantar psoriasis. On examination, there were exuberant pinkish-red papules and plaques covered with a thick silvery scale in the palms, flexor surfaces of the wrists, and the medial longitudinal arches of the feet. Serological and histopathological analyses uncovered the diagnosis of syphilis. Clinical remission was obtained after treatment. A detailed review of the literature on syphilide psoriasiforme, including descriptions from older syphilology textsis provided. The present case report emphasizes the need for clinicians to have a heightened awareness of the varied and unusual clinical phenotypes of syphilis.

Resumo Objetivos: Identificar e descrever as alterações oculares em idosos com HIV ou aids através de exame oftalmológico. Avaliar a associação entre as alterações oculares encontradas e o nível de linfócitos T CD4, tempo da terapia antirretroviral, características demográficas e faixa etária. Métodos: Série de 40 casos de pacientes idosos com HIV examinados nos serviços de oftalmologia e imunologia do Hospital Universitário Gaffrée e Guinle (HUGG) de janeiro de 2017 a junho de 2018. Foi realizado o seguinte exame oftalmológico: anamnese, acuidade visual, motilidade ocular, reflexo pupilar, biomicroscopia, tonometria de aplanação e fundoscopia. As análises estatísticas foram realizadas pelo SPSS 20.0. Resultados: A média de idade dos 40 pacientes foi 64,7 anos (dp: 5,1) e o diagnóstico de infeção pelo HIV foi em média há 16.6 anos (dp:7). A maioria dos pacientes examinados possui visão normal (n=22; 55%) e pressão intraocular normal (entre 11 e 21 mmHg). As principais queixas dos pacientes durante a anamnese foram: embaçamento visual (50%), redução da acuidade visual (47.5%), prurido ocular (27.5%), lacrimejamento (25%) e ardência (25%). As alterações biomicroscópicas mais frequentes foram catarata (92.5%), seguida de olho seco (32.5%). Na fundoscopia encontrou-se 43,8 % de alterações da vascularização retiniana, 43.8 % de alterações relacionadas ao nervo óptico e 31,3% relacionadas ao pólo posterior da retina. Conclusão: Alterações oculares foram comuns e podem ser justificadas pela: senilidade, estado inflamatório gerado pela infecção crônica do HIV, efeitos adversos da Terapia antirretroviral prolongada e senescência biológica precoce associada a infecção do HIV.

Abstract Objectives: Identify and describe ocular changes in elderly with HIV or aids through ophthalmological examination. Evaluate the association between ocular alterations and the level of TCD4 lymphocytes, time of antiretroviral therapy, demographic characteristics and age range. Methods: Case series of 40 elderly patients with HIV infection. The study was carried out at the ophthalmology and immunology outpatient clinics of the Gaffrée and Guinle University Hospital (HUGG) from january 2017 to june 2018. The patients were attended at the ophthalmology clinic and underwent a ophthalmological exam including: anamnesis, visual acuity, ocular motility, pupillary reflex, biomicroscopy, aplanation tonometry and fundoscopy. Statistical analyses were performed using SPSS 20.0. Results: The average of the 40 patients was 64.7 years (sd: 5.1), aged between 60 and 78 years, and the average time of HIV infection was 16.6 years (sd: 7 years). Most of the patients examined had normal vision (55%) and normal intraocular pressure (between 11 and 21 mmHg). The main complaints of patients during anamnesis were visual blurring (50%), visual acuity reduction (47.5%), ocular itchiness (27.5%), tearing (25%) and burning (25%).The most frequent changes in biomicroscopy were: cataract (92.5%) and dry eye (32.5%). Funduscopy found 43.8% of retinal vascularization alterations, 43.8% of alterations related to the optic nerve and 31.3% related to retinal posterior pole. Conclusion: Ocular changes were common and can be explained by senility, inflamatory changes caused by chronic HIV infection, adverse effects of antiretroviral therapy and early biological ageing associated to HIV infection.

ABSTRACT Mycobacterium haemophilum is a nontuberculous mycobacterium that causes localized or disseminated disease, mainly in immunocompromised hosts. We report the case of a 35-year-old HIV-infected woman who presented with several enlarging cutaneous lesions over the arms and legs. Histopathological examination revealed the diagnosis of a cutaneous mycobacterial disease. Mycobacterial analyses unveiled M. haemophilum infection. Six months after completion of a successful antimycobacterial treatment, she developed an immune reconstitution inflammatory syndrome (IRIS). This paradoxical relapse presented as tenderness, redness and swelling at the precise sites of the healed lesions and took place in the setting of significant recovery of the CD4 cell count (from 05 to 318 cells/mm 3 ). Microbiological analyses of these worsening lesions were negative, and they spontaneously remitted without the initiation of a novel antimycobacterial treatment cycle. M. haemophilum infection should always be considered as a cause of skin lesions in immunocompromised subjects. Physicians should be aware of the possibility of IRIS as a complication of successful antiretroviral therapy in HIV-infected patients with M. haemophilum infection.

ABSTRACT Objectives The increase in HIV transmissibility in non-ulcerative sexually transmitted infection is already well-established. It is estimated that symptomatic carriers of N. gonorrhoeae and C. trachomatis have a relative risk of 4.8-fold and 3.6-fold, respectively, for the sexual acquisition of HIV. This type of evaluation for asymptomatic urethritis is necessary to reinforce strategies to combat HIV transmission. This study aims to assess the prevalence of patients with asymptomatic urethritis among men diagnosed with HIV-1 and determine the risk factors associated with this infection. Methods We enrolled a total of 115 male patients aged 18 years or older who have been diagnosed with HIV infection and have no symptoms of urethritis or other sexually transmitted infections and who have been evaluated between May and August 2015 in a follow-up visit at the Immunology Outpatient Clinic of a Brazilian University Hospital. Results Four asymptomatic patients were positive for C. trachomatis and were considered asymptomatic carriers of urethritis. Prevalence was 3.47%. Patients who were positive for C. trachomatis urethritis had a lower mean age (p = 0.015). Conclusion The presence of asymptomatic sexually transmitted infection is a challenge in clinical practice. We recommend that, in outpatient practice, the habit of inquiring on previous sexual behavior to obtain more information about risks and associations with asymptomatic sexually transmitted infection, a routine physical examination and complementary tests to detect STI pathogens should be performed to discard these conditions. The development of rapid tests for this purpose should also be encouraged.

ABSTRACT It is essential that healthcare providers are familiar with the full spectrum of clinical presentations of syphilis. A rare manifestation of secondary syphilis is the corymbiform (or corymbose) arrangement, in which a central greater papule is surrounded by smaller satellite lesions. Very few reports of corymbiform syphilis are available in current biomedical databases. We present the case of a 28 year-old HIV-infected male patient on regular, successful antiretroviral therapy who developed an asymptomatic corymbiform maculopapular lesion in the medial aspect of the right thigh. There were also a few brownish macular lesions on the left sole. New serological tests for syphilis (which had been negative in the past) were reactive. The coymbiform lesion slowly regressed and the non-treponemal test reverted to negative after benzathine penicillin G treatment. A review of the literature is provided. This is the first report of corymbiform syphilis in an HIV-infected patient.

ABSTRACT A prevalence of 3.47% of asymptomatic Chlamydia trachomatis urethritis has been previously reported among males living with HIV infection in Brazil. This study aims to assess the recurrence of C. trachomatis urethritis three years later in the same cohort of patients and analyze associated risk factors. A total of 115 male patients diagnosed with HIV infection, with no symptoms of urethritis and observed since May of 2015 in followup visits were enrolled. They had urine samplers tested by PCR for C. trachomatis and N. gonorrhoeae between February and March 2018. Results: Three of the four patients who had asymptomatic C. trachomatis urethritis three years before were recurrently positive for C. trachomatis urethritis. Two new patients were diagnosed as positives, accounting for a total asymptomatic C. trachomatis urethritis prevalence of 4.34%. The prevalence during the whole study was 5.21%. The relative risk for a new urethritis episode among those previously diagnosed with urethritis is RR=41.62 (95% CI: 9.42-183.84), p < 0.01. Patients who presented asymptomatic urethritis anytime and who were recurrently positive for C. trachomatis had a lower mean age (p<0.01). Married individuals were protected regarding asymptomatic urethritis [p<0.01, OR = 0.04 (0.005-0.4)] and had lower risk to develop recurrence [p<0.01, RR = 0.86 (0.74-0.99)]. Illicit drugs users had risk associated to asymptomatic urethritis [p=0.02, OR= 5.9 (1.03-34)] and higher risk to develop recurrence [p<0.01, RR=1.1 (1-1.22)]. Conclusion: The recurrence of asymptomatic C. trachomatis urethritis after treatment among males living with HIV infection in Brazil can be considered high and should not be neglected.

Abstract Botryomycosis is an uncommon, chronic, suppurative, bacterial infection that primarily affects the skin and subcutaneous tissues. It has long been associated with defects of cellular immunity. We report a 28-year-old woman who presented with a chronic, ulcerated lesion with draining sinuses in the right malar region. Predisposing factors were HIV infection with poor immunological control, alcoholism, and a previous trauma to the right cheek. Several courses of antimicrobial therapy provided only partial and temporary remission. Complete clinical remission was only achieved 5 years later when a novel antiretroviral regimen composed of darunavir and raltegravir was initiated.