SUMMARYThe Authors present a case of subcutaneous mucormycosis occurring in a patient with clinical and biochemical evidence of diabetic ketoacidosis. The clinical, mycological and histopathological features are described, emphasizing the relevance of a rapid diagnosis in order to stablish early treatment. The clinical forms of mucormycosis and the main associated conditions are briefly reviewed as well as the most probable conditions which may lead to the enhanced susceptibility to infection in the diabetic patient in ketoacidosis. The recovery of Rhizo¬ pus oryzae from the air of the room of the patient suggests a nosocomial infection acquired through contamination of venous puncture site by air borne spores. INTRODUCTIONThe human infections caused by fungi of the class Zygomycetes are cosmopolitan and have been reported in normal and immunocompromised hosts. The disease has been generically called Zygomycosis (Phycomycosis). GREER 12 suggested the terms Mucormycosis and Entomophtoromycosis to name the infections restrictly caused by Zygomycetes of the orders Mucorales and Entomophtorales, since they are different diseases 12 . The human mucormycosis is world-wide in distribution often as an opportunistic infection and rarely affecting immunologicaly normal individuals 18 . Frequently it is a disease of acute evolution, characterized by invasion and growth of Mucorales in the vascular wall and lumen, with subsequent mycotic thromboembolism, ischemia, tissue necrosis and eventually death depending on the effected site. The rhinocerebral variant is the most acute and fulminant of the known mycosis 21 .22. The entomophtoromycosis, also known as subcutaneous zygomycosis or basidiobolomycosis is restricted to tropical and subtropical regions, being reported the cases mainly from Africa and Asia, and occasionally from South America 5 . 13 . 18 . Generally it has a chronic evolution characterized by the development of eosinophilic granuloma in the subcutaneous fat, rhino-orbital cavities and other areas of the organism, with swelling of the affected regions. The patients are apparently healthy 6 . 18 . 19 .The agents of mucormycosis are ubiquitous in nature, where they live on decaying organic material as saprophytes. They may be isolated from the air, soil, fruits, clinical materials and human orifices 4 . They reproduce by sexual and asexual ways and in the anamorphic (asexual) state form a great amount of spores inside sacular structures called sporangia. The principal way of dissemination is the air. The primary or exogenous cutaneous and subcutaneous mucormycosis is a rare occurrence and the way of infection is related to the rupture of the skin barrier with subsequent development of necrotic lesions in the skin or subcutaneous iat i5 . 2i .Recently microepidemics of cutaneous mucormycosis were reported in hospitals and were related to the use of elasticized adhesive tape dressings on open wounds in immunocompromised patients 1U3 as well in patients with orthopedic problems and whithout apparent immunological c...
A case of intracranial chondrosarcoma is reported. Its diagnosis can be suspected through the findings of a paraselar avascular tumor, sometimes with in specific calcifications, visualized as a isodense and contrast-enhancing mass by computed tomography, as observed in the case. Differential diagnosis may be difficult with chondromas and meningiomas. Surgical resection is the treatment of choice, with good results.
A arterite temporal, descrita por Horton em 1932 10 , já foi motivo de numerosos registros na literatura mundial. Esta entidade, que atinge particularmente indivíduos acima de 50 anos, apresenta, como sintoma principal, cefaléia localizada. Usualmente é o clínico geral quem faz o primeiro atendimento e, em algumas ocasiões, o paciente é encaminhado a neurologista a > 3 . 4 .Seu diagnóstico não é puramente acadêmico, mas de real importância sob o ponto de vista prático, pois trata-se de processo generalizado cuja evolução pode resultar em danos irreparáveis, tais como amaurose, infarto do miocardio, trombose periférica e nefropatia difusa n > 12 > 13 > 14 .Tivemos oportunidade de observar um caso no qual a par de lesões arteriais características, existia comprometimento de glândulas salivares, fato que não é assinalado na literatura que tivemos a nosso alcance. Desde há alguns meses, o paciente vem apresentando apatia, desejo de morrer, desinteresse pelo trabalho, insônia, diminuição da libido e deficiên-cias de memória em relação a fatos recentes. Trinta dias antes da consulta surgiram dores nas regiões fronto-temporais, pulsáteis, que permaneciam por várias horas. Quinze dias antes da consulta, notou dilatacão dos vasos temporais superficiais, que se tornaram dolorosos ao toque e à palpacão. Ha 7 dias notou aumento de volume das parótidas sentindo dores nas articulações temporo-mandibulares quando abria a boca ou mastigava. Negava episódios de artrite mas referia dores musculares difusas ocasionais. Exame físico -Pressão arterial 120x80mm Hg; freqüência cardíaca lOObpm; temperatura 36.4.°C. Presença de nodulos nas regiões frontotemporais. A palpação das artérias temporais superficiais desencandeava dor; estas artérias estavam espessadas e tortuosas, com pulso presente. As glándulas parótidas
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