No abstract

Background: Caring for leprosy patients requires neurological assessment for prevention of potential physical disabilities. This study focused on the neurological impairment and degree of physical incapacity (DI) at the time of the diagnosis and at discharge of leprosy patients from Dermatology Department of the University of the State of Pará. Methods and findings: It was a cross-sectional, observational study based on the medical records, neurological assessment and DI of 14 patients assisted at a referral service between 2012 and 2016, applying descriptive statistical analysis. At diagnosis were observed patients with decreased abduction forces of the 5th finger (14.28%), extension of hallux and foot dorsiflexion (10.72%); loss of protective sensitivity in the ulnar nerve area (3.57%) and tibial nerve area (25%); 7.15% of thickened ulnar nerve; DI 0 (64.28%) and DI 1 (35.72%). At discharge, 10.72% of the patients showed decreased abduction of the 5th finger, extension of hallux and foot dorsiflexion (14.28%); loss of protective sensitivity just in the tibial nerve area (17.87%); 4.28% of thickened ulnar nerve; DI 0 (78.57%) and DI 1 (21.43%). Conclusions: Therefore, most of the patients had normal neurological assessment and DI 0 at both moments, with reduction of alterations in discharge, except for the fibular nerve. Thus, it is highlighted the primary role of the health team, which constitutes one of the main agents promoters of health education, especially when it comes to preventing disabilities in leprosy.

BACKGROUND: describes clinical aspects of patients with chromoblastomycosis treated at the dermatology department of the Para State University. The  present  study  aimed  to  describe  clinical  and therapeutic   aspects   of   patients   with   chromoblastomycosis   treated   at the   dermatology department  of  Para  State  University. METHODS: An  observational,  descriptive,  case  series  study  was performed,  comprising  12  patients  with  the  diagnosis  of  chromoblastomycosis.  A  clinical interview and a dermatological protocole were applied, classifing these patients in variables as gender, age, time of illness, type of lesion (size, shape, appearance,  location  and  evolution),  treatment and complications.  Those unable to attend the clinic in person or unable to be represented by someone legally, a Term of Consent for Data Use was applied. CONCLUSIONS: most of the patients were male, rural workers, with vegetative lesions according to the classification of Carrión, graduated as moderate, with less than 10 years of evolution.

No abstract

Background: Adrenal myelolipoma is a rare benign tumor formed by hematopoietic tissue and mature adipose tissue. Usually is insidious and found occasionally on image exams, therefore is also called incidentaloma. Image studies and anatomopathological exam are important to define the diagnosis of adrenal myelolipoma. This study's objective was to report the case of this rare adrenal tumor and its main diagnostic means.Case: It was report a case about a 72-year-old patient, whose initial symptom was diffuse abdominal pain, nausea and vomiting, diagnosed with adrenal myelolipoma after image studies even in the absence of laboratory abnormalities, and submitted at a private hospital at Belém-PA. Conclusions:The adrenal myelolipoma, due its usual asymptomatic characteristics or its no-specifics symptoms, requires a meticulous analysis concerning both diagnosis and treatment. Thus, our case report corroborates the importance of the image studies in front of an obscure and difficult diagnosis, especially the computed tomography, and anatomopathological evaluation, since they are essential to the best decision making and consequently a better prognosis of the patient.

BACKGROUNDGranulomatosis with polyangiitis (GPA) is an anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis with low prevalence and incidence. Approximately 25% of patients have mild manifestations such as nasal crusts, polyarthralgia, or other nonlife-threatening findings. Involvement of organs such as the lungs, gastrointestinal tract, and central nervous system (CNS) is rare, so alternative diagnoses should be considered. We report a case of a patient with GPA with disease activity in the lungs and liver, initially diagnosed with cancer. CASE REPORTA 65-year-old white woman was diagnosed in 2018 with localized GPA, ANCA positive, involving mucous membranes (hard palate perforation with oroantral communication), and was in follow-up with Dermatology, using methotrexate 20 mg/week and prednisone 10 mg/day until March 2022, when, due to mucosal signs of activity and weight loss, prednisone was modified to 60 mg/day. One month later, she presented with subacute behavioral changes, mental confusion, psychomotor agitation and persecutory delusions. The patient was hospitalized for investigation. In search of infection, chest tomography showed the presence of multiple solid pulmonary nodules, bilateral, with predominantly peripheral distribution, some minimally cavitated, that did not exist previously; sparse hypovascularized formations were also seen in the liver parenchyma, measuring up to 3 cm, suggestive of neoplastic involvement. CNS was investigated using magnetic resonance imaging, which showed only cavernomas (venous malformations); however, lumbar puncture detected cytomegalovirus infection with a viral load of 12,983 IU/mL, which was confirmed in peripheral blood (4,349,719 IU/mL). Amid treatment with ganciclovir, methotrexate was discontinued and prednisone 60 mg/day was maintained. After two weeks of hospitalization, a lung biopsy was requested, but was not performed because the nodules had disappeared. The liver was biopsied, showing extensive necrotic coagulative areas, associated histiocytic reaction (granulomatous outlines) with epithelioid cells and macrophages, in addition to peripheral inflammation and microthrombosis of the microvascular fiber, confirming disease activity. Methylprednisolone pulse therapy was not prescribed because of the infectious context, and, after treatment, mycophenolate mofetil was initiated considering methotrexate failure and lymphopenia as a contraindication for azathioprine. The patient was discharged with improvement in neurological symptoms, mucosal signs of activity, and inflammatory markers; liver imaging was repeated afterwards. CONCLUSIONPatients with GPA with nonsevere manifestations are often classified as having nonsevere or limited disease. However, this case report shows that cases initially diagnosed with limited GPA may develop severe organic involvement, requiring a detailed and systematic investigation.

No abstract