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Necrobiontophage myiasis
P6809
P6471
Necrobiontophage myiasis Fred Bernardes Filho, MD, Instituto de Dermatologia Prof. Rubem David Azulay da Santa Casa da Miseric ordia do Rio de Janeiro (IDPRDA/SCMRJ), Rio de Janeiro, Brazil; Andreia Oliveira Alves, Universidade Metropolitana de Santos (UNIMES), Santos, Brazil; Jos e Sales Pereira Filho, MD, Instituto de Dermatologia Prof. Rubem David Azulay da Santa Casa da Miseric ordia do Rio de Janeiro (IDPRDA/SCMRJ), Rio de Janeiro, Brazil; Lorena Branco de Azevedo Cariello, Instituto de Dermatologia Prof. Rubem David Azulay da Santa Casa da Miseric ordia do Rio de Janeiro (IDPRDA/SCMRJ), Rio de Janeiro, Brazil; Maria Vict oria Quaresma, MD, Instituto de Dermatologia Prof. Rubem David Azulay da Santa Casa da Miseric ordia do Rio de Janeiro (IDPRDA/SCMRJ), Rio de Janeiro, Brazil; Yana Dias Almeidinha, Universidade de Ribeir~ao Preto (UNAERP), Ribeir~ao Preto, Brazil; Ystannyslau Bernardes da Silva, MD, Hospital Benefic^encia Portuguesa de Ribeir~ao Preto, Ribeir~ao Preto, Brazil Background: Necrobiontophage or secondary myiasis is caused by infestation of a nonobligate parasite fly larvae which possess affinity for tissues with lack of an epithelial barrier. Its gravity depends on location and the degree of tissue destruction. This kind of tropical disease is more frequently caused by flies from the genus Callitroga, Lucilia, and Musca. Clinically, a large number of visible moving larvae, intense itching and local pain can be described. Therefore, the welfare of the patient is of utmost importance when under treatment. Case report: Case 1: A 68-year-old woman who is a retired widow and lives in Rio de Janeiro, was guided to the outpatient clinic of our institute. During the visit she complained about the presence of worms she had for 3 days in her right leg. The worms appeared in a wound she have had for nearly 8 months. Under the dermatologic examination, a large number of fly larvae could be observed inside an ulcer located in her right perimaleolar region. Thus, we eliminated the larvae, cleaned and dressed the wound with a mixture made of sucrose, fructose, fatty acid, powder albumin, and propolis. The patient is following treatment in the outpatient clinic and has showed improvement of healing in ulcers. Case 2: A 31-year-old single woman who is a biologist and lives in Rio de Janeiro came to our outpatient clinic because of painful sores on her head that appeared after intense sun exposure for 5 days. She reported she had observed worms inside the wound for the past 2 days. She had seborrheic dermatitis on her entire head and also had penicillin, cephalosporins, and quinolones allergy. During the dermatologic examination, we observed 6 ulcers. The largest one measured 1.5 cm in the parietal region with exsudate and numerous larvae in all lesions. Removal of the larvae, cleaning and dressing of the wound were performed apart from the medication prescribed.
Nodular leprosy in children Flavia Schueler, Policlınica Geral do Rio de Janeiro, Rio de Janeiro, Brazil; Jose Nery, Policlınica Geral do Rio de Janeiro, rio de janeiro, Brazil; Julyana Pinto, Policlınica Geral do Rio de Janeiro, Rio de janeiro, Brazil; Luciana Klein, Policlınica Geral do Rio de Janeiro, Rio de Janeiro, Brazil; Marcio Jose Schueler, Policlınica Geral do Rio de Janeiro, Rio de Janeiro, Brazil; Vitor Perez, Policlinica Geral do Rio de Janeiro, Rio De Janeiro, Brazil We report a typical case of nodular leprosy in a child, and the importance of early diagnosis. A 12-year-old male born in and a resident of Rio de Janeiro, presented with hypochromic tuberonodular lesions on the face and erythematous plaque with a hypochromic halo on the right leg, sizing 3 cm 3 3 cm that appeared 3 months ago. No symptons related. His father has the lepromatous form and is in treatment for 10 months. Nodular leprosy of childhood is a benign variant of tuberculoid leprosy that usually affects children of 2 to 4 years of age who remain in prolonged contact with bacillary pacients. The early clinical diagnosis of leprosy in children is essential to the cure, interrupt the chain of transmission of the disease and strategically control the endemic and eliminate leprosy as a public health problem. The variety of nodular leprosy in children represents a clinical manifestation of tuberculoid leprosy that, according to some authors, is characterized by tuberonodular and brownish erythematous lesions located on the face or limbs. A smear is negative and generally affects child whose parents are with the lepromatous form of Hansen disease. No clinical evidence of nerve involvement, and the histopathologic is characterized by tuberculoid granuloma.The Mitsuda test is negative. The disease can espontaneously involute, and an atrofic scar can occur. The diagnosis was based on the clinical aspects of the lesions and by histopathologic results. The early diagnosis and epidemiologic investigation is important because it aims to break the chain of the disease transmission, by identifying the source of infection, and detecting new cases in the same household, to prevent new infections. Commercial support: None identified.
Discussion: The main purpose of the treatment is to instruct the patient and to institutionalize care. We can conclude that antibiotics must be used in cases of bacterial infection, just as immunoprophylaxis to tetanus must be updated, when necessary. We propose the clinical use of sucrose, associated to flavorous, fructose, fatty acids and albumin for infected wounds treatment and other superficial lesions for presenting an antiseptic, antimicrobial and healing property. Commercial support: None identified.
P6786 Neuropathy in patients with leprosy and diabetes: The importance of clinical signs Maria Vict oria Quaresma, MD, IDPRDA - Instituto de Dermatologia Professor Rubem David Azulay, Rio de Janeiro, Brazil; Camila Sanches Bussad, IDPRDA Instituto de Dermatologia Professor Rubem David Azulay, Rio de Janeiro, Brazil; Eloisa Borges Parreira, IDPRDA - Instituto de Dermatologia Professor Rubem David Azulay, Rio de Janeiro, Brazil; Fred Bernardes Filho, MD, IDPRDA - Instituto de Dermatologia Professor Rubem David Azulay, Rio de Janeiro, Brazil; Mariana de Campos Raz e, IDPRDA - Instituto de Dermatologia Professor Rubem David Azulay, Rio de Janeiro, Brazil; Mariana Pelli Seabra, IDPRDA - Instituto de Dermatologia Professor Rubem David Azulay, Rio de Janeiro, Brazil; Marina de Campos Raze, IDPRDA - Instituto de Dermatologia Professor Rubem David Azulay, Rio de Janeiro, Brazil Background: Leprosy is an infectious disease caused by Mycobaterium leprae, with tropism for skin and peripheral nerves. By introducting multidrug therapy to the treatment, we obtained a significant reduction in the numbers of reported cases, but it is still difficult to adhere to treatment, abandonment is very common. Therefore, it is necessary that after the diagnosis, the patient receives health team guidance as to the time of treatment and possible side effects. It is noteworthy that the association with other comorbid disorders may lead to the need to increase the daily amount of medication administered, making it worst the diagnosis of leprosy. Case report: An 88-year-old woman who was born in Rio de Janeiro was sent to our Dermatology Clinic of our service, presenting paresthesia on distal lower limbs. Reports that has numbness in both feet for about 12 months and that in about 8 months the patient developed erythematous macules on elbows. In the story reported pathologic hypertension, diabetes, and Alzheimer disease. Dermatologic examination revealed erythematous macules observed with thermal hypoesthesia in elbows and back. On neurologic examination simplified, we find pain and thickening of the posterior tibial nerve. Performed biopsy of suspicious lesion and scraping smear intradermal with the results: leprosy and IB: 3+. She was diagnosed with borderline leprosy and was instituted multibacillary multidrug therapy with the estimate of 12 doses.
P6780
Discussion: In the case presented, we urge the importance of investigation of leprosy as a possible cause of neuropathy, even in patients with comorbidities, especially in endemic countries like ours. Although diabetic neuropathy clinically resemble the leprosy, the presence of other commemorative leprosy has allowed us the correct diagnosis and the immediate requirement of MDT. We emphasize the positive impact of training in infectious diseases in terms of resolution.
Oral lesions as the only manifestation of secondary syphilis Patricia Makino Rezende, MD, Instituto de Dermatologia Professor Rubem David Azulay, Rio de Janeiro, Brazil; Ana Libia Cardozo Pereira, MD, Instituto de Dermatologia Professor Rubem David Azulay, Rio de Janeiro, Brazil; Andreia Munck de Almeida, MD, Instituto de Dermatologia Professor Rubem David Azulay, Rio de Janeiro, Brazil; Camila Makino Rezende, MD, Pontifıcia Universidade Cat olica Do Parana - PUCPR, Curitiba, Brazil; Janine Pichler de Oliveira, MD, Instituto de Dermatologia Professor Rubem David Azulay, Rio de Janeiro, Brazil Syphilis is a sexually transmitted disease caused by the bacterium Treponema pallidum. The incubation period can range from 10 to 90 days depending on the number and Treponemas virulence and immune response. The symptoms and signs are different according to the stage of disease. The oral manifestations of syphilis are, in many cases, the first signs of the disease and may guide the correct and early diagnosis. Syphilis ‘‘primary’’ recently, the expression is the intraoral chancre, which is a single lesion, ulcerated, asymptomatic and hardened edge which may involve the oral cavity in any area, however, the lip represents the most common site of involvement, followed by the tongue and tonsils. An important feature of syphilitic lesion ‘‘primary’’ of the oral cavity is the absence of painful symptoms. Signs and symptoms of syphilis ‘‘secondary’’ are characterized by headache, watery eyes, runny nose, sore throat, generalized arthralgia and myalgia. Cutaneous involvement is characterized diffuse maculopapular rash, which may affect the region including palmoplantar and oral. Clinically, oral cavity, there are red oval macules or papules eruptions. You can also submit the form of flat condyloma or condyloma latum, in the labial, characterized by nodular lesions or plaques slightly elevated and may be eroded or superficially ulcerated. In the tongue there is atrophy of the papillae, soft palate and the lesions can be represented by small ulcers. The authors report a case of a female patient, 31 years reporting lesions on the tongue, then evolved to bilateral buccal mucosa, which had started two months. On intraoral examination, erythematous lesions were observed bilaterally in the buccal mucosa and tongue is associated with absence of papillae in the distal third. He presented also with condylomatous lesions in the labial commissures, associated with erosions. The VDRL test confirmed the clinical hyphotesis. The patient was submitted to therapy with benzathine penicillin G 2.4 million IU per week for 2 weeks with an interval of 7 days with improvement of the clinical findings. The objective is to report a case of secondary syphilis diagnosed only with oral lesions and emphasize the importance of knowledge of oral manifestations in all stages of the disease.
Commercial support: None identified.
Commercial support: None identified.
AB122
J AM ACAD DERMATOL
APRIL 2013
P6471
Necrobiontophage myiasis Fred Bernardes Filho, MD, Instituto de Dermatologia Prof. Rubem David Azulay da Santa Casa da Miseric ordia do Rio de Janeiro (IDPRDA/SCMRJ), Rio de Janeiro, Brazil; Andreia Oliveira Alves, Universidade Metropolitana de Santos (UNIMES), Santos, Brazil; Jos e Sales Pereira Filho, MD, Instituto de Dermatologia Prof. Rubem David Azulay da Santa Casa da Miseric ordia do Rio de Janeiro (IDPRDA/SCMRJ), Rio de Janeiro, Brazil; Lorena Branco de Azevedo Cariello, Instituto de Dermatologia Prof. Rubem David Azulay da Santa Casa da Miseric ordia do Rio de Janeiro (IDPRDA/SCMRJ), Rio de Janeiro, Brazil; Maria Vict oria Quaresma, MD, Instituto de Dermatologia Prof. Rubem David Azulay da Santa Casa da Miseric ordia do Rio de Janeiro (IDPRDA/SCMRJ), Rio de Janeiro, Brazil; Yana Dias Almeidinha, Universidade de Ribeir~ao Preto (UNAERP), Ribeir~ao Preto, Brazil; Ystannyslau Bernardes da Silva, MD, Hospital Benefic^encia Portuguesa de Ribeir~ao Preto, Ribeir~ao Preto, Brazil Background: Necrobiontophage or secondary myiasis is caused by infestation of a nonobligate parasite fly larvae which possess affinity for tissues with lack of an epithelial barrier. Its gravity depends on location and the degree of tissue destruction. This kind of tropical disease is more frequently caused by flies from the genus Callitroga, Lucilia, and Musca. Clinically, a large number of visible moving larvae, intense itching and local pain can be described. Therefore, the welfare of the patient is of utmost importance when under treatment. Case report: Case 1: A 68-year-old woman who is a retired widow and lives in Rio de Janeiro, was guided to the outpatient clinic of our institute. During the visit she complained about the presence of worms she had for 3 days in her right leg. The worms appeared in a wound she have had for nearly 8 months. Under the dermatologic examination, a large number of fly larvae could be observed inside an ulcer located in her right perimaleolar region. Thus, we eliminated the larvae, cleaned and dressed the wound with a mixture made of sucrose, fructose, fatty acid, powder albumin, and propolis. The patient is following treatment in the outpatient clinic and has showed improvement of healing in ulcers. Case 2: A 31-year-old single woman who is a biologist and lives in Rio de Janeiro came to our outpatient clinic because of painful sores on her head that appeared after intense sun exposure for 5 days. She reported she had observed worms inside the wound for the past 2 days. She had seborrheic dermatitis on her entire head and also had penicillin, cephalosporins, and quinolones allergy. During the dermatologic examination, we observed 6 ulcers. The largest one measured 1.5 cm in the parietal region with exsudate and numerous larvae in all lesions. Removal of the larvae, cleaning and dressing of the wound were performed apart from the medication prescribed.
Nodular leprosy in children Flavia Schueler, Policlınica Geral do Rio de Janeiro, Rio de Janeiro, Brazil; Jose Nery, Policlınica Geral do Rio de Janeiro, rio de janeiro, Brazil; Julyana Pinto, Policlınica Geral do Rio de Janeiro, Rio de janeiro, Brazil; Luciana Klein, Policlınica Geral do Rio de Janeiro, Rio de Janeiro, Brazil; Marcio Jose Schueler, Policlınica Geral do Rio de Janeiro, Rio de Janeiro, Brazil; Vitor Perez, Policlinica Geral do Rio de Janeiro, Rio De Janeiro, Brazil We report a typical case of nodular leprosy in a child, and the importance of early diagnosis. A 12-year-old male born in and a resident of Rio de Janeiro, presented with hypochromic tuberonodular lesions on the face and erythematous plaque with a hypochromic halo on the right leg, sizing 3 cm 3 3 cm that appeared 3 months ago. No symptons related. His father has the lepromatous form and is in treatment for 10 months. Nodular leprosy of childhood is a benign variant of tuberculoid leprosy that usually affects children of 2 to 4 years of age who remain in prolonged contact with bacillary pacients. The early clinical diagnosis of leprosy in children is essential to the cure, interrupt the chain of transmission of the disease and strategically control the endemic and eliminate leprosy as a public health problem. The variety of nodular leprosy in children represents a clinical manifestation of tuberculoid leprosy that, according to some authors, is characterized by tuberonodular and brownish erythematous lesions located on the face or limbs. A smear is negative and generally affects child whose parents are with the lepromatous form of Hansen disease. No clinical evidence of nerve involvement, and the histopathologic is characterized by tuberculoid granuloma.The Mitsuda test is negative. The disease can espontaneously involute, and an atrofic scar can occur. The diagnosis was based on the clinical aspects of the lesions and by histopathologic results. The early diagnosis and epidemiologic investigation is important because it aims to break the chain of the disease transmission, by identifying the source of infection, and detecting new cases in the same household, to prevent new infections. Commercial support: None identified.
Discussion: The main purpose of the treatment is to instruct the patient and to institutionalize care. We can conclude that antibiotics must be used in cases of bacterial infection, just as immunoprophylaxis to tetanus must be updated, when necessary. We propose the clinical use of sucrose, associated to flavorous, fructose, fatty acids and albumin for infected wounds treatment and other superficial lesions for presenting an antiseptic, antimicrobial and healing property. Commercial support: None identified.
P6786 Neuropathy in patients with leprosy and diabetes: The importance of clinical signs Maria Vict oria Quaresma, MD, IDPRDA - Instituto de Dermatologia Professor Rubem David Azulay, Rio de Janeiro, Brazil; Camila Sanches Bussad, IDPRDA Instituto de Dermatologia Professor Rubem David Azulay, Rio de Janeiro, Brazil; Eloisa Borges Parreira, IDPRDA - Instituto de Dermatologia Professor Rubem David Azulay, Rio de Janeiro, Brazil; Fred Bernardes Filho, MD, IDPRDA - Instituto de Dermatologia Professor Rubem David Azulay, Rio de Janeiro, Brazil; Mariana de Campos Raz e, IDPRDA - Instituto de Dermatologia Professor Rubem David Azulay, Rio de Janeiro, Brazil; Mariana Pelli Seabra, IDPRDA - Instituto de Dermatologia Professor Rubem David Azulay, Rio de Janeiro, Brazil; Marina de Campos Raze, IDPRDA - Instituto de Dermatologia Professor Rubem David Azulay, Rio de Janeiro, Brazil Background: Leprosy is an infectious disease caused by Mycobaterium leprae, with tropism for skin and peripheral nerves. By introducting multidrug therapy to the treatment, we obtained a significant reduction in the numbers of reported cases, but it is still difficult to adhere to treatment, abandonment is very common. Therefore, it is necessary that after the diagnosis, the patient receives health team guidance as to the time of treatment and possible side effects. It is noteworthy that the association with other comorbid disorders may lead to the need to increase the daily amount of medication administered, making it worst the diagnosis of leprosy. Case report: An 88-year-old woman who was born in Rio de Janeiro was sent to our Dermatology Clinic of our service, presenting paresthesia on distal lower limbs. Reports that has numbness in both feet for about 12 months and that in about 8 months the patient developed erythematous macules on elbows. In the story reported pathologic hypertension, diabetes, and Alzheimer disease. Dermatologic examination revealed erythematous macules observed with thermal hypoesthesia in elbows and back. On neurologic examination simplified, we find pain and thickening of the posterior tibial nerve. Performed biopsy of suspicious lesion and scraping smear intradermal with the results: leprosy and IB: 3+. She was diagnosed with borderline leprosy and was instituted multibacillary multidrug therapy with the estimate of 12 doses.
P6780
Discussion: In the case presented, we urge the importance of investigation of leprosy as a possible cause of neuropathy, even in patients with comorbidities, especially in endemic countries like ours. Although diabetic neuropathy clinically resemble the leprosy, the presence of other commemorative leprosy has allowed us the correct diagnosis and the immediate requirement of MDT. We emphasize the positive impact of training in infectious diseases in terms of resolution.
Oral lesions as the only manifestation of secondary syphilis Patricia Makino Rezende, MD, Instituto de Dermatologia Professor Rubem David Azulay, Rio de Janeiro, Brazil; Ana Libia Cardozo Pereira, MD, Instituto de Dermatologia Professor Rubem David Azulay, Rio de Janeiro, Brazil; Andreia Munck de Almeida, MD, Instituto de Dermatologia Professor Rubem David Azulay, Rio de Janeiro, Brazil; Camila Makino Rezende, MD, Pontifıcia Universidade Cat olica Do Parana - PUCPR, Curitiba, Brazil; Janine Pichler de Oliveira, MD, Instituto de Dermatologia Professor Rubem David Azulay, Rio de Janeiro, Brazil Syphilis is a sexually transmitted disease caused by the bacterium Treponema pallidum. The incubation period can range from 10 to 90 days depending on the number and Treponemas virulence and immune response. The symptoms and signs are different according to the stage of disease. The oral manifestations of syphilis are, in many cases, the first signs of the disease and may guide the correct and early diagnosis. Syphilis ‘‘primary’’ recently, the expression is the intraoral chancre, which is a single lesion, ulcerated, asymptomatic and hardened edge which may involve the oral cavity in any area, however, the lip represents the most common site of involvement, followed by the tongue and tonsils. An important feature of syphilitic lesion ‘‘primary’’ of the oral cavity is the absence of painful symptoms. Signs and symptoms of syphilis ‘‘secondary’’ are characterized by headache, watery eyes, runny nose, sore throat, generalized arthralgia and myalgia. Cutaneous involvement is characterized diffuse maculopapular rash, which may affect the region including palmoplantar and oral. Clinically, oral cavity, there are red oval macules or papules eruptions. You can also submit the form of flat condyloma or condyloma latum, in the labial, characterized by nodular lesions or plaques slightly elevated and may be eroded or superficially ulcerated. In the tongue there is atrophy of the papillae, soft palate and the lesions can be represented by small ulcers. The authors report a case of a female patient, 31 years reporting lesions on the tongue, then evolved to bilateral buccal mucosa, which had started two months. On intraoral examination, erythematous lesions were observed bilaterally in the buccal mucosa and tongue is associated with absence of papillae in the distal third. He presented also with condylomatous lesions in the labial commissures, associated with erosions. The VDRL test confirmed the clinical hyphotesis. The patient was submitted to therapy with benzathine penicillin G 2.4 million IU per week for 2 weeks with an interval of 7 days with improvement of the clinical findings. The objective is to report a case of secondary syphilis diagnosed only with oral lesions and emphasize the importance of knowledge of oral manifestations in all stages of the disease.
Commercial support: None identified.
Commercial support: None identified.
AB122
J AM ACAD DERMATOL
APRIL 2013