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FIG 2: Histology of a splenic hamartoma, showing the exclusive presence of red pulp tissue on the left hand side, without associated white pulp follicles, as can be seen on the right hand side, which shows normal adjacent splenic tissue. Haematoxylin and eosin. x 100 FIG 1: Splenic hamartomas, identified during laparotomy as several discoloured nodules protruding above the capsular surface of the slightly enlarged spleen FIG 3: Immunohistochemistry of a splenic hamartoma, showing positive staining for antibody CD31 in the endothelial cells of the vessels. Avidin-biotin complex method. x 100

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Background Due to coronavirus disease 2019 (COVID-19) pandemic response measures, the administration of botulinum toxin (BTX) was delayed for many patients during the first lockdown period in Portugal. Objectives To review the impact of postponing BTX treatment on migraine control. Methods This was a retrospective, single-center study. Patients with chronic migraine who had done at least three previous BTX cycles and were considered responders were included. The patients were divided into two groups, one that has had their treatment delayed (group P), and one that has not (controls). The Phase III Research Evaluating Migraine Prophylaxis Therapy (PREEMPT) protocol was used. Migraine-related data were obtained at baseline and at three subsequent visits. Results The present study included two groups, group P (n = 30; 47.0 ± 14.5 years; 27 females, interval baseline -1st visit: 5.5 [4.1–5.8] months) and the control group (n = 6; 57.7 ± 13.2 years; 6 females; interval baseline–1st visit 3.0 [3.0–3.2] months). No difference between the groups was present at baseline. When compared to baseline, the number of days/month with migraine (5 [3–6.2] vs. 8 [6–15] p < 0.001), days using triptans/month (2.5 [0–6] vs. 3 [0–8], p = 0.027) and intensity of pain (7 [5.8–10] vs. 9 [7–10], p = 0.012) were greater in the first visit for group P, while controls did not present a significant variation. The worsening of migraine-related indicators decreased in the following visits; however, even in the third visit, it had not returned to baseline. Correlations were significant between the delayed time to treatment and the increase in days/month with migraines at the first visit after lockdown (r = 0.507; p = 0.004). Conclusions There was a deterioration of migraine control after postponed treatments, with a direct correlation between the worsening of symptoms and the number of months that the treatment was delayed.

Allergic contact dermatitis (ACD) is a type IV, delayed‐type reaction caused by skin contact with low‐molecular‐weight organic chemicals and metal ions that activate antigen‐specific T cells, primarily T‐helper 1 (Th1), in a sensitized individual, leading to skin eczema.First‐line treatments are based on avoidance of causal agents and topical corticosteroids/immunomodulators. In recalcitrant cases, chronic oral immunosuppressive agents may be used, but they may have serious adverse effects and do not address the immunological disfunction. We report a case of severe ACD, unresponsive to topical or oral immunosuppressive therapy, which resolved itself after treatment with teriflunomide (TF) 14 mg/daily used for multiple sclerosis. TF is a once‐daily, oral selective and reversible dihydroorotate dehydrogenase inhibitor, revealing a new treatment option for ACD.

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A 26-year-old patient was admitted with a 6-month history of fever,fatigue,and unintentional weight loss.Abdominal CT described an heterogeneous hepatosplenomegaly.Laboratory studies revealed leucopenia,anemia and elevated CRP.Bone marrow aspirate revealed amastigotes compatible with Leishmania spp.Was treated with liposomal amphotericin B with favourable outcome.Authors intend to raise awareness of VL in immunocompetentpatients.

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