Maurício de Quadros

Revista Online - Surgical & Cosmetic Dermatology | Publicação oficial da Sociedade Brasileira de Dermatologia, a segunda maior sociedade dermatológica do mundo com mais de 5.000 associados, o periódico Surgical & Cosmetic Dermatology, editada em 2009, constitui publicação médica destinada a difundir a experiência brasileira nas áreas de Cirurgia Dermatológica e Cosmiatria. É uma publicação trimestral das Sociedades Brasileiras de Dermatologia e de Cirurgia Dermatológica.

Zoon vulvitis or vulvitis chronica plasmacellularis is a rare, chronic benign inflammation of the vulvar mucosa, diagnosed histologically, with variable therapeutic responses. It is important to be diagnosed because it mimics the presentation of other genital conditions, such as lichen planus and squamous cell carcinoma, which require specific treatment. We report a case of a female patient with three asymptomatic shallow ulcers on the labia minora. Laboratory tests ruled out infectious diseases and the biopsy was consistent with Zoon Vulvitis.

Revista Online - Surgical & Cosmetic Dermatology | Publicação oficial da Sociedade Brasileira de Dermatologia, a segunda maior sociedade dermatológica do mundo com mais de 5.000 associados, o periódico Surgical & Cosmetic Dermatology, editada em 2009, constitui publicação médica destinada a difundir a experiência brasileira nas áreas de Cirurgia Dermatológica e Cosmiatria. É uma publicação trimestral das Sociedades Brasileiras de Dermatologia e de Cirurgia Dermatológica.

A 54-year-old male patient was admitted due to fever and cellulitis of the left leg (Figure 1). Three years before, he had undergone renal transplantation, and his immunosuppressive regimen was cyclosporine (75 mg b.i.d.) and prednisone (10 mg q.d.). His other significant medical history included previous deep venous thrombosis affecting the left leg, and type 2 diabetes, controlled with diet. At admission, he appeared healthy, with no complaints but fever and local inflammatory signs on the left leg. No abscess was perceived. He was treated with ciprofloxacin, but no improvement was seen after 96 h of antimicrobial therapy. Two out of three blood culture sets revealed the growth of yeast-like organisms (Cryptococcus neoformans var. grubii), and amphotericin B desoxycholate was started (1 mg/kg/day). Skin biopsies showed the presence of chronic panniculitis associated with round yeast forms (Figure 2), and culture of the fragments revealed C. neoformans var. grubii. The serum cryptococcal antigen titre was 1:32 768. Chest radiography and cerebrospinal fluid tests were negative, and there were no signs of intracranial hypertension. Renal function worsened after 20 days of amphotericin B deoxycholate treatment, and the antifungal therapy was changed to fluconazole (200 mg b.i.d.). During this period, a positive cytomegalovirus antigenemia (46 positive cells/100 000 leukocytes) was treated with a 14-day course of intravenous ganciclovir. The patient was discharged with secondary prophylaxis with fluconazole (200 mg q.d.). Skin lesions in patients with cryptococcosis are usually attributable to haematogenous dissemination (i.e., secondary cutaneous cryptococcosis), while primary cutaneous cryptococcosis is a rare condition. As this immunosuppressed patient had no evidence of pulmonary or central nervous system disease, it is possible that the chronic oedema caused by deep venous thrombosis had led to cellulitis and fungaemia.

The authors report a case of deficiency of the eighth component of complement in a young adult with a history of three episodes of meningitis; one of them proved to be meningococcal. The literature was reviewed and meningitis due to Neisseria meningitidis strains causing disease in complement-deficient and complement-sufficient patients was demonstrated. Meningococcal disease may be the first manifestation of complement deficiency; screening for complement function must be considered for those with invasive meningococcal disease, with posterior evaluation of the components of the terminal pathway of complement.