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BACKGROUNDLeprosy, a chronic infectious disease caused by Mycobacterium leprae, affects the skin, peripheral nerves, upper respiratory tract, musculoskeletal system and eyes. As it presents a wide spectrum of clinical manifestations, it can be a diagnostic challenge, especially in early stages of disease. Some of these manifestations resemble pictures of rheumatic diseases that affect adults and children. Among the musculoskeletal manifestations of childhood leprosy are inflammatory chronic arthritis, mimicking juvenile idiopathic arthritis or spondyloarthritis, inflammatory swelling of the hands and feet, neuropathic arthritis, septic arthritis, arthralgias/ myalgias, soft tissue rheumatism and multisystem involvement similar to collagenases, including vasculitis and myositis. CASE REPORTWe report the case of a previously healthy 8-year-old boy admitted to the pediatric rheumatology unity due to the presence of puffy hands and fingers and hard and shiny edema of the lower limbs, suggesting systemic scleroderma diagnosis. He had an 11-month history of recurrent episodes of intermittent fever, plaque-like, erythematous, nonpruritic facial skin lesions and joint pain in the knees and ankles. On physical examination, he presented, in addition to the aforementioned findings, purpuric lesions on the toes, hepatosplenomegaly, arthralgias (wrist, small joints of the hands, knees and ankles) and erythematous plaques infiltrated in the bilateral malar region, nasal region and auricular pavilion. Complementary tests showed normocytic and normochromic anemia, leukocytosis, neutrophilia, thrombocytosis, elevation of inflammatory tests and negativity of ANA, RF, ANCA, anti-RNP and anti-Scl70. Due to the infiltrated skin lesions, lymph smear testing was performed, which was strongly positive, and a diagnosis of Virchowian leprosy associated with mixed leprosy reaction was made. There was clinical and laboratory improvement after initiation of multidrug therapy and systemic corticosteroid therapy. CONCLUSIONLeprosy is known as a great mimic of rheumatic diseases, often fulfilling diagnostic criteria for many of them. The multibacillary forms present greater musculoskeletal involvement. It should be considered in differential diagnosis of children with musculoskeletal symptoms, autoantibody positivity and cutaneous and/or neurological involvement.
BACKGROUNDCatastrophic antiphospholipid syndrome (APS) is a severe acquired thrombophilia characterized by rapid development of thromboses in several organs, in presence of antiphospholipid antibodies. For histopathologic confirmation, thrombosis should be present without significant evidence of vessel wall inflammation. APS is a known association of systemic lupus erythematosus (SLE) and, when present with lupus, has the worst outcome. Peripheral vascular disease leading to digital gangrene is a well-recognized complication of APS, particularly in patients with SLE. Digital gangrene in SLE is a rare form of vascular injury and generally leads to digital amputation. CASE REPORTA previously healthy 12-year-old girl is brought to the emergency department because of a 3-day history of purpuric lesions in the lower limbs and digital gangrene in all right toes and in the second, third and fourth fingers on the left hand. She had rapid progression to gangrene in all the aforementioned digits and ulceration and gangrene of purpuric lesions. Arterial Doppler ultrasound of the four limbs showed no changes. Brain magnetic resonance imaging (MRI) showed lacunar infarcts of probable microembolic etiology. Laboratory findings included triple positivity in high titers of antiphospholipid antibodies, ANA and anti-DNA and hypocomplementemia, suggesting SLE and probable catastrophic APS diagnosis. Biopsy of skin lesions showed nonleukocytoclastic cutaneous small vessel vasculitis, leading to the hypothesis of lupus vasculitis. Methylprednisolone pulse therapy, human immunoglobulin, vasodilators and anticoagulation were performed. Due to the presence of lupus vasculitis, it was chosen to use cyclophosphamide. There was a halt in the progression of the vascular condition, but the patient evolved with self-amputation of some of the affected distal phalanges of the right toes and the left hand. After six doses of cyclophosphamide in a biweekly schedule, azathioprine was started, and the patient is currently asymptomatic with a SLEDAI-2K score of zero. CONCLUSIONDigital gangrene may be secondary to thrombosis or small vessel vasculitis. This distinction can be difficult, especially in patients with lupus-associated antiphospholipid syndrome. Only 0.2% of patients with SLE presented initially as digital necrosis and less than 10% of pediatric APS patients present with small-vessel thrombosis. Despite the rarity of presentation and the difficulty in distinguishing the diagnosis, early recognition and treatment of both diseases are essential to prevent progression and reduce their morbidity and mortality.
Psidium guajava L. is widely cultivated in tropical and subtropical regions of the world. This research aimed to evaluate the effect of the use of biodegradable coating associated with different temperatures on the quality of 'Paluma' guava fruits infested by Ceratitis capitata Wiedemann on its control. The experiment was conducted in a completely randomized design in a 3 × 6 × 6 factorial scheme with three replicates. The factors under study were three temperatures 10 ºC, 15 ºC, and 23 ºC (room temperature) with six treatments each: Control - WoO WoC (without oviposition and without coating); WiO WoC (with oviposition and without coating); WiO+CCFO (without oviposition and coating containing fennel oil); WiO+CCFO (with oviposition and coating containing fennel oil); WoO+CCBO (without oviposition and coating containing basil oil); WoO+CCBO (with oviposition and coating containing basil oil). The treatments were evaluated in six periods according to the factors already mentioned. Physical, physical-chemical, biochemical and subjective evaluations were performed. Data were submitted to analysis of variance based on the significance of the F test and, in order to test the effect of storage days, the results were submitted to regression analysis. The use of biodegradable coating associated with low temperatures minimizes the loss of mass and promotes less loss of fruit firmness. The presence of C. capitata larvae depreciates the physical-chemical quality of guava fruits, but the coating process associated with low temperatures is lethal to eggs and larvae of C. capitata, reducing damage in fruits infested.
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