ABSTRACT Hyalohyphomycosis and phaeohyphomycosis are groups of mycoses caused by several agents and show different clinical manifestations. We report a case of an immunocompromised patient who presented rare manifestations of opportunistic mycoses: mycetoma-like hyalohyphomycosis on his right foot caused by Colletotrichum gloeosporioides, followed by cutaneous phaeohyphomycosis on his right forearm caused by Exophiala oligosperma. Further to the rarity of this case, the patient's lesion on the foot shows that the clinical aspects of mycetomas could falsely appear in other fungal infections similar to hyalohyphomycosis. We also show that the muriform cells that were seen in the direct and anatomopathological examination of the skin are not pathognomonic of chromoblastomycosis, as observed in the lesion of the patient's forearm. mycetomalike mycetoma like gloeosporioides oligosperma patients s chromoblastomycosis

Abstract Background The distinction between sensory neuronopathies (SN), which is by definition purely sensory, and sensory polyneuropathies (SP) and sensory multineuropathies (SM) is important for etiologic investigation and prognosis estimation. However, this task is often challenging in clinical practice. We hypothesize that F-wave assessment might be helpful, since it is able to detect subtle signs of motor involvement, which are found in SP and SM, but not in SN. Objective The aim of the present study was to determine whether F-waves are useful to distinguish SN from SP and SM. Methods We selected 21 patients with SP (12 diabetes mellitus, 4 transthyretin familial amyloid polyneuropathy, 4 others), 22 with SM (22 leprosy), and 26 with SN (13 immune-mediated, 10 idiopathic, 3 others) according to clinical-electrophysiological-etiological criteria. For every subject, we collected data on height and performed 20 supramaximal distal stimuli in median, ulnar, peroneal, and tibial nerves, bilaterally, to record F-waves. Latencies (minimum and mean) and persistences were compared across groups using the Kruskal-Wallis and Bonferroni tests. P-values < 0.05 were considered significant. Results All groups were age, gender, and height-matched. Overall, there were no significant between-group differences regarding F-wave latencies. In contrast, F-wave persistence was able to stratify the groups. Peroneal F-wave persistence was higher, bilaterally, in the SN group compared to SM and SP (p < 0.05). In addition, F-waves persistence of the ulnar and tibial nerves was also helpful to separate SN from SP (p < 0.05). Conclusion F-wave persistence of the peroneal nerves might be an additional and useful diagnostic tool to differentiate peripheral sensory syndromes. SN, , (SN) (SP (SM estimation However practice Fwave F wave involvement Fwaves waves 2 12 (1 mellitus polyneuropathy others, others (2 leprosy, leprosy leprosy) 13 immunemediated, immunemediated immune mediated, mediated immune-mediated 1 idiopathic clinicalelectrophysiologicaletiological electrophysiological etiological criteria subject median bilaterally Fwaves. waves. minimum mean KruskalWallis Kruskal Wallis tests Pvalues P values 005 0 05 0.0 age gender heightmatched. heightmatched matched. matched height-matched Overall betweengroup latencies contrast higher p 0.05. . 0.05) addition syndromes (SN ( 00 0.

Resumo Antecedentes A distinção entre neuronopatias sensitivas (SN) e polineuropatias sensitivas (SP) e multineuropatias sensitivas (SM) é importante para a investigação etiológica e para o prognóstico. Contudo, esta tarefa é desafiadora na prática clínica. Hipotetizou-se que a avaliação das ondas-F pode ser útil, por ser capaz de detectar envolvimento motor nas SP e SM, mas não nas SN. Objetivo Determinar se as ondas-F podem ajudar a distinguir entre SN, SP e SM. Métodos Selecionou-se 21 pacientes com SP (12 diabetes mellitus, 4 ATTR-FAP e 4 com outras neuropatias), 22 com SM (22 hanseníases) e 26 com SN (13 imunomediadas, 10 idiopáticas e 3 com outras neuronopatias), de acordo com critérios clínicos, etiológicos e eletrofisiológicos. Para cada indivíduo, foi aferida a altura e foram aplicados 20 estímulos distais supramáximos nos nervos mediano, ulnar, fibular e tibial, bilateralmente, para registrar as ondas-F. Uma comparação foi feita, por grupo, das latências (mínimas e médias) e persistências pelos testes Kruskal-Wallis e Bonferroni. Valores de p < 0.05 foram considerados estatisticamente significativos. Resultados Todos os grupos foram pareados por idade, sexo e altura. Não houve diferença estatística significativa entre os grupos quanto às latências das ondas-F. A persistência da onda-F foi capaz de estratificar os grupos, sendo as dos nervos fibulares bilateralmente maiores no grupo SN que nos grupos SM e SP (p < 0.05). Adicionalmente, a persistência das ondas-F dos nervos ulnares e tibiais também foi útil para distinguir SN de SP (p < 0.05). Conclusão A persistência das ondas-F dos nervos fibulares pode ser uma ferramenta adicional e útil para diferenciar síndromes sensitivas periféricas. (SN (SP (SM prognóstico Contudo clínica Hipotetizouse Hipotetizou ondasF ondas F Selecionouse Selecionou 2 12 (1 mellitus ATTRFAP ATTR FAP neuropatias, neuropatias , neuropatias) (2 hanseníases 13 imunomediadas 1 neuronopatias, neuronopatias) clínicos eletrofisiológicos indivíduo mediano ulnar tibial ondasF. F. feita mínimas médias KruskalWallis Kruskal Wallis Bonferroni 005 0 05 0.0 significativos idade ondaF onda 0.05. . 0.05) Adicionalmente periféricas ( 00 0.

Abstract Background: Livedoid vasculopathy (LV) manifests as ulcers and atrophic white scars on the lower extremities. The main known etiopathogenesis is hypercoagulability with thrombus formation, followed by inflammation. Thrombophilia, collagen and myeloproliferative diseases may induce LV, but the idiopathic (primary) form predominates. Bartonella spp. may cause intra-endothelial infection and skin manifestations caused by these bacteria may be diverse, including leukocytoclastic vasculitis and ulcers. Objective: The aim of this study was to investigate the presence of bacteremia by Bartonella spp. in patients with difficult-to-control chronic ulcers diagnosed as primary LV. Methods: Questionnaires and molecular tests (conventional PCR, nested PCR and real-time PCR) were applied and liquid and solid cultures were performed in the blood samples and blood clot of 16 LV patients and 32 healthy volunteers. Results: Bartonella henselae DNA was detected in 25% of LV patients and in 12.5% of control subjects but failed to reach statistically significant differences (p = 0.413). Study limitations: Due to the rarity of primary LV, the number of patients studied was small and there was greater exposure of the control group to risk factors for Bartonella spp. infection. Conclusion: Although there was no statistically significant difference between the groups, the DNA of B. henselae was detected in one of every four patients, which reinforces the need to investigate Bartonella spp. in patients with primary LV. Background (LV extremities formation inflammation Thrombophilia (primary predominates spp intraendothelial intra endothelial diverse Objective difficulttocontrol difficult Methods conventional realtime real time 1 3 volunteers Results 25 125 12 5 12.5 p 0.413. 0413 0.413 . 0 413 0.413) limitations Conclusion groups B 2 12. 041 0.41 41 04 0.4 4 0.

ABSTRACT Purpose: To compare ocular surface parameters in rosacea patients with those of controls. Methods: Ninety-three participants took part in this cross-sectional, observational, non-interventional study. These consisted of a rosacea group (n=40) and a control group (n=53). We compared objective parameters of the ocular surface, including conjunctival hyperemia, tear film stability and volume, meibomian gland dysfunction, dry eye disease, and ocular surface staining, between the two groups. Results: In the rosacea group, 69.23% were female. The mean age was 47.34 ± 12.62 years old. No statistically significant differences between groups were found in visual acuity (p=0.987), tear film parameters (tear meniscus height (p=0.338), noninvasive tear film rupture time (p=0.228), invasive rupture time (p=0.471), Schirmer’s test scores (p=0.244), conjunctival hyperemia (p=0.106), and fluorescein staining (p=0.489). Significant differences were found in meibography evaluations (p=0.026), mucous layer integrity (p=0.015), and ocular surface symptoms (p<0.0001). Rosacea patients also showed important eyelid differences in glandular expressibility (p<0.001), glandular secretion pattern (p<0.001), and telangiectasia (p<0.001) compared to controls. Conclusion: Meibomian gland dysfunction is frequently associated with dermatological conditions. It can be observed in morphological findings from meibography as well as lipid secretion impairment, leading to evaporative dry eye, ocular surface dysfunction, and inflammation. Purpose controls Methods Ninetythree Ninety three crosssectional, crosssectional cross sectional, sectional cross-sectional observational noninterventional non interventional study n=40 n40 n 40 (n=40 n=53. n53 n=53 . 53 (n=53) volume disease Results 6923 69 23 69.23 female 4734 47 34 47.3 1262 12 62 12.6 old p=0.987, p0987 p p=0.987 , 0 987 (p=0.987) p=0.338, p0338 p=0.338 338 (p=0.338) p=0.228, p0228 p=0.228 228 (p=0.228) p=0.471, p0471 p=0.471 471 (p=0.471) Schirmers Schirmer s p=0.244, p0244 p=0.244 244 (p=0.244) p=0.106, p0106 p=0.106 106 (p=0.106) p=0.489. p0489 p=0.489 489 (p=0.489) p=0.026, p0026 p=0.026 026 (p=0.026) p=0.015, p0015 p=0.015 015 (p=0.015) p<0.0001. p00001 p<0.0001 0001 (p<0.0001) p<0.001, p0001 p<0.001 001 (p<0.001 Conclusion conditions impairment inflammation n=4 n4 4 (n=4 n5 n=5 5 (n=53 692 6 2 69.2 473 3 47. 126 1 12. p098 p=0.98 98 (p=0.987 p033 p=0.33 33 (p=0.338 p022 p=0.22 22 (p=0.228 p047 p=0.47 (p=0.471 p024 p=0.24 24 (p=0.244 p010 p=0.10 10 (p=0.106 p048 p=0.48 48 (p=0.489 p002 p=0.02 02 (p=0.026 p001 p=0.01 01 (p=0.015 p0000 p<0.000 000 (p<0.0001 p000 p<0.00 00 (p<0.00 n= (n= (n=5 69. p09 p=0.9 9 (p=0.98 p03 p=0.3 (p=0.33 p02 p=0.2 (p=0.22 p04 p=0.4 (p=0.47 (p=0.24 p01 p=0.1 (p=0.10 (p=0.48 p00 p=0.0 (p=0.02 (p=0.01 (p<0.000 p<0.0 (p<0.0 (n p0 p=0. (p=0.9 (p=0.3 (p=0.2 (p=0.4 (p=0.1 (p=0.0 p<0. (p<0. p=0 (p=0. p<0 (p<0 p= (p=0 p< (p< (p= (p

RESUMO Objetivo: Avaliar as alterações da superfície ocular em pacientes com Rosácea, e comparar com grupo controle. Métodos: Noventa e três indivíduos foram selecionados para este estudo transversal, observacional e não intervencionista, dividido em dois grupos: rosácea (n=40) e controles (n=53). Foram avaliados parâmetros objetivos da superfície ocular (hiperemia conjuntival, estabilidade e volume do filme lacrimal, disfunção da glândula meibomiana, doença do olho seco, coloração da superfície ocular) e comparado indivíduos saudáveis com pacientes com rosácea. Resultados: 69,23% dos indivíduos com rosácea eram mulheres, com média de idade de 47,34 ± 12,62 anos. Em comparação com controles pareados, não foram evidenciadas diferenças estatisticamente significativas em relação à acuidade visual (p=0,987) e parâmetros do filme lacrimal (altura do menisco lacrimal (p=0,338), tempo de ruptura do filme lacrimal não invasivo (p=0,228), tempo invasivo de ruptura (p=0,471) e teste de Schirmer (p=0,244), bem como hiperemia conjuntival (p=0,106) e coloração com fluoresceína (p=0,489). Associação significativa foi encontrada na avaliação da meibografia (p=0,026), integridade da camada mucosa (p=0,015) e sintomas de superfície ocular (p<0,0001). Pacientes com rosácea também apresentaram alterações importantes na borda palpebral: expressibilidade glandular (p<0,001), padrão de secreção glandular (p<0,001) e telangiectasia (p<0,001). Conclusão: A disfunção da glândula de Meibômio está frequentemente associada a condições dermatológicas e é caracterizada por achados morfológicos na meibografia, bem como comprometimento da secreção lipídica que leva ao olho seco evaporativo e alterações da superfície ocular e inflamação. Objetivo Rosácea controle Métodos transversal intervencionista grupos n=40 n40 n 40 (n=40 n=53. n53 n=53 . 53 (n=53) meibomiana Resultados 6923 69 23 69,23 mulheres 4734 47 34 47,3 1262 12 62 12,6 anos pareados p=0,987 p0987 p 0 987 (p=0,987 altura p=0,338, p0338 p=0,338 , 338 (p=0,338) p=0,228, p0228 p=0,228 228 (p=0,228) p=0,471 p0471 471 (p=0,471 p=0,244, p0244 p=0,244 244 (p=0,244) p=0,106 p0106 106 (p=0,106 p=0,489. p0489 p=0,489 489 (p=0,489) p=0,026, p0026 p=0,026 026 (p=0,026) p=0,015 p0015 015 (p=0,015 p<0,0001. p00001 p<0,0001 0001 (p<0,0001) palpebral p<0,001, p0001 p<0,001 001 (p<0,001 p<0,001. Conclusão inflamação n=4 n4 4 (n=4 n5 n=5 5 (n=53 692 6 2 69,2 473 3 47, 126 1 12, p=0,98 p098 98 (p=0,98 p033 p=0,33 33 (p=0,338 p022 p=0,22 22 (p=0,228 p=0,47 p047 (p=0,47 p024 p=0,24 24 (p=0,244 p=0,10 p010 10 (p=0,10 p048 p=0,48 48 (p=0,489 p002 p=0,02 02 (p=0,026 p=0,01 p001 01 (p=0,01 p0000 p<0,000 000 (p<0,0001 p000 p<0,00 00 (p<0,00 n= (n= (n=5 69, p=0,9 p09 9 (p=0,9 p03 p=0,3 (p=0,33 p02 p=0,2 (p=0,22 p=0,4 p04 (p=0,4 (p=0,24 p=0,1 p01 (p=0,1 (p=0,48 p00 p=0,0 (p=0,02 (p=0,0 (p<0,000 p<0,0 (p<0,0 (n p=0, p0 (p=0, (p=0,3 (p=0,2 p<0, (p<0, p=0 (p=0 p<0 (p<0 p= (p= p< (p< (p

Abstract Leprosy reactions are an acute inflammatory phenomenon that can arise before diagnosis, during treatment, or after cure of leprosy. These reactions are considered one of the main diseases that cause physical disabilities. Immunosuppressive treatment for these immune responses makes these patients susceptible to coinfections, which can trigger new leprosy reactions. The main objective of this study was to evaluate the occurrence of infection by Bartonella sp. in blood samples from 47 patients who had untreatable episodes of type 2 leprosy reactions for more than six months, comparing them with a control group. Cultures and molecular methods (PCR) were used. Amplicons from species-specific reactions and sequencing showed a higher prevalence of Bartonella henselae infection in patients, 19/47 (40.4 %), compared to control, 9/50 (18.0 %), p= 0.0149. Five patients accepted treatment for coinfection, and all showed improvement in leprosy reactions with treatment for B. henselae infection. We conclude that these bacteria can trigger chronic reactions of type 2 leprosy and should be investigated in these patients. Summary line Patients who have chronic type 2 leprosy reactions are more susceptible to Bartonella henselae infection than controls: 19/47 (40.4 %) compared 9/50 (18.0 %), p= 0.0149. diagnosis disabilities coinfections sp 4 months group PCR (PCR used speciesspecific species specific 1947 19 19/4 40.4 404 40 (40. %, % , 950 9 50 9/5 18.0 180 18 0 (18. p 00149 0149 0.0149 coinfection B controls 194 1 19/ 40. (40 95 5 9/ 18. (18 0014 014 0.014 (4 (1 001 01 0.01 ( 00 0.0 0.

RESUMO Objetivo: Avaliar as alterações da superfície ocular em pacientes com Rosácea, e comparar com grupo controle. Métodos: Noventa e três indivíduos foram selecionados para este estudo transversal, observacional e não intervencionista, dividido em dois grupos: rosácea (n=40) e controles (n=53). Foram avaliados parâmetros objetivos da superfície ocular (hiperemia conjuntival, estabilidade e volume do filme lacrimal, disfunção da glândula meibomiana, doença do olho seco, coloração da superfície ocular) e comparado indivíduos saudáveis com pacientes com rosácea. Resultados: 69,23% dos indivíduos com rosácea eram mulheres, com média de idade de 47,34 ± 12,62 anos. Em comparação com controles pareados, não foram evidenciadas diferenças estatisticamente significativas em relação à acuidade visual (p=0,987) e parâmetros do filme lacrimal (altura do menisco lacrimal (p=0,338), tempo de ruptura do filme lacrimal não invasivo (p=0,228), tempo invasivo de ruptura (p=0,471) e teste de Schirmer (p=0,244), bem como hiperemia conjuntival (p=0,106) e coloração com fluoresceína (p=0,489). Associação significativa foi encontrada na avaliação da meibografia (p=0,026), integridade da camada mucosa (p=0,015) e sintomas de superfície ocular (p<0,0001). Pacientes com rosácea também apresentaram alterações importantes na borda palpebral: expressibilidade glandular (p<0,001), padrão de secreção glandular (p<0,001) e telangiectasia (p<0,001). Conclusão: A disfunção da glândula de Meibômio está frequentemente associada a condições dermatológicas e é caracterizada por achados morfológicos na meibografia, bem como comprometimento da secreção lipídica que leva ao olho seco evaporativo e alterações da superfície ocular e inflamação.

ABSTRACT Purpose: To compare ocular surface parameters in rosacea patients with those of controls. Methods: Ninety-three participants took part in this cross-sectional, observational, non-interventional study. These consisted of a rosacea group (n=40) and a control group (n=53). We compared objective parameters of the ocular surface, including conjunctival hyperemia, tear film stability and volume, meibomian gland dysfunction, dry eye disease, and ocular surface staining, between the two groups. Results: In the rosacea group, 69.23% were female. The mean age was 47.34 ± 12.62 years old. No statistically significant differences between groups were found in visual acuity (p=0.987), tear film parameters (tear meniscus height (p=0.338), noninvasive tear film rupture time (p=0.228), invasive rupture time (p=0.471), Schirmer’s test scores (p=0.244), conjunctival hyperemia (p=0.106), and fluorescein staining (p=0.489). Significant differences were found in meibography evaluations (p=0.026), mucous layer integrity (p=0.015), and ocular surface symptoms (p<0.0001). Rosacea patients also showed important eyelid differences in glandular expressibility (p<0.001), glandular secretion pattern (p<0.001), and telangiectasia (p<0.001) compared to controls. Conclusion: Meibomian gland dysfunction is frequently associated with dermatological conditions. It can be observed in morphological findings from meibography as well as lipid secretion impairment, leading to evaporative dry eye, ocular surface dysfunction, and inflammation.

ABSTRACT As leprosy and leprosy reactions are the most prevalent infectious cause of physical disability, it is important to commit efforts to better understand these chronic reactions. Infections, even when asymptomatic, can trigger leprosy reactions and Bartonella spp. in turn, can cause chronic infections. We presented a case of a 51-year-old man who was admitted presenting with chronic type 2 leprosy reactions. He had a lepromatous form of leprosy that was histologically diagnosed six months after the onset of signs and symptoms compatible with a chronic type 2 reaction. He reported a history of a previous hepatitis B diagnosis. During a 24-month multidrug therapy (MDT), chronic reactions were partially controlled with prednisone and thalidomide. Thirty-three months following the leprosy treatment, he still experienced chronic reactions, and whole bacilli as well as globi were found on a new skin biopsy. Since coinfections can trigger type 2 reactions and the patient had close contact with animals and ticks, we investigated the presence of a Bartonella sp. infection. Bartonella henselae DNA was detected in a skin fragment obtained before the beginning of the leprosy retreatment. However, even after six months of a second leprosy MDT, he continued to experience type 2 chronic reactions. He was admitted to the hospital to undergo an intravenous antibiotic therapy for 14 days and then complete the treatment per os for ten more weeks. Leprosy reactions improved following the treatment for B. henselae. After completing the MDT treatment, he has been accompanied for sixty months with no signs of leprosy or leprosy reactions. The asymptomatic infection by B. henselaein this patient was considered the putative trigger of chronic leprosy reactions and leprosy relapse.

Abstract: Periungual and paronychia-like skin lesions can mimic various diseases, setting up a diagnostic challenge that invariably requires correlation with complementary tests. We report a case of an ulcerated tumor of the nailfold diagnosed as leishmaniasis. Although paronychia-like cutaneous leishmaniasis is a rare variant, its epidemiological relevance in Brazil should prompt dermatologists to include it as a plausible diagnosis thus leading to correct work up and treatment.