Antonio Macedo D'ACri

The year 2022 was marked by a worldwide increase in the number of cases of infections by the monkeypox virus, being considered the greatest spread of this virus outside the African continent at all times. Full understanding of the significant increase in the number of monkeypox cases is still challenging, as it encompasses several clinical manifestations and particularities that make the correct diagnosis and adequate treatment difficult, increasing the potential for transmission of the virus between human beings. Just as public politics are being adopted in order to reduce the transmission of the virus, an alarm also occurs among health professionals who seek to understand the context of the significant increase in the number of cases worldwide, especially in young men. This work seeks to elucidate some knowledge gaps that still exist on the subject, such as the transmission routes of the disease, the epidemiological context, the particularities of the clinical management of dermatological lesions and the advent of new drugs for treatment. For this, PubMed, Lilacs and SciELO databases were used, searching for articles published from 1980 to 2022, in Portuguese, English and Spanish, respecting the inclusion and exclusion criteria adopted. Although the monkeypox virus was described for the first time in 1958, the literature on the subject is still limited and its bibliographic search proved to be a challenge for the author. According to the PRISMA stratification model, 40 articles that contributed to the result of the study were considered eligible, in which the sexual route was identified as a potential for transmission of the disease, with a prevalence of cases in males. It was also possible to identify morphological characteristics of the virus that allow it to survive longer on inert surfaces, as well as the contribution of the interruption of smallpox vaccination to the significant growth in the number of cases. Thus, this study proved to be efficient in establishing the causal relationships that culminated in the increase in the incidence of human infection by monkeypox worldwide, as well as contributing to the elucidation of diagnostic and treatment protocols in order to help medical procedures involving the disease.

Considering the increased utilization of anti-TNF medications in the treatment of inflammatory and autoimmune diseases, dermatologists should be aware of the possible adverse skin reactions. We describe a case of inverted psoriasis due to the use of infliximab used in the treatment of inflammatory bowel disease.

Importância do problema: Paracoccidioidomicose (PCM) é a micose sistêmica mais prevalente em indivíduos imunocompetentes no Brasil, sendo causado pelo fungo dimórfico Paracoccidioides spp. O fungo vive no solo e geralmente sua porta de entrada no paciente ocorre pelos pulmões por inalação de propágulos presentes no ar. Em áreas de maior endemicidade, como no Brasil, a incidência chega a três casos por 100 mil habitantes. As lesões cutâneas na PCM são frequentes. Lesões ulceradas ou ulcerovegetantes são os tipos morfológicos mais comuns, sendo o padrão infiltrativo o segundo mais descrito. A histologia demonstra inflamação granulomatosa na derme. A PCM infiltrativa pode ser facilmente confundida com sarcoidose, visto que ambas possuem similaridades clínicas e histopatológicas. Comentários: Nós descrevemos um caso de PCM cutânea com diagnóstico inicial incorreto de sarcoidose, tanto pelo quadro morfológico, como pelo exame histopatológico semelhante. Exames posteriores revelaram a presença de Paracoccidioides sp na coloração pelo Grocott e na cultura do material para fungos. Os autores acreditam que esse caso possa ajudar médicos a suspeitarem e considerarem PCM no diagnóstico diferencial de lesões cutâneas infiltrativas, especialmente se houver história epidemioló- gica de viagem a área endêmica ou resposta insatisfatória ao tratamento para sarcoidose.

Perforating dermatoses are a group of skin diseases characterized by transepidermal elimination of dermal material. The disease is divided into two groups: the primary group and the secondary group. The classical or primary perforating dermatoses are subdivided into four types according to the eliminated dermal materials: Kyrle disease, perforating reactive collagenosis, elastosis perforans serpiginosa, and perforating folliculitis. The secondary form is known as acquired perforating dermatosis. The term was proposed in 1989 by Rapini to designate the perforating dermatoses affecting adult patients with systemic disease, regardless of the dermal materials eliminated. This report describes a case of the disease with elimination of collagen and elastic fibers in a patient with chronic renal failure.

Gastric syphilis is an uncommon extracutaneous manifestation of syphilis, occurring in less than 1% of patients, presenting nonspecific clinical manifestations. In general, it occurs on secondary stage. The critical point is the recognition of the syphilitic gastric involvement, without which there may be incorrect diagnosis of malignancy of the digestive tract. In this report, a case of secondary syphilis with gastric involvement that had complete remission with benzathine penicillin will be described.