165 IMAGENS MÉDICASantibodies and the serum cryoglobulins was normal. No evidence of neoplasm was found. CVI was confirmed on Doppler ultrasonography and the histological examination of the ulcer showed dysmorphic calcification. CVI promotes the deposition of calcium phosphate in the tissues. 1,2 Calcium deposits cause persistent inflammatory reaction and lead to leg ulcer recurrences which increase the risk of further calcium salt deposition. 3,4 Our patient underwent analgesic treatment and started hyperbaric oxygen therapy with clinical improvement.A 76-year old women was referred to the internal medicine department for subcutaneous calcifications on her legs (Fig. 1). She had a history of chronic venous insufficiency (CVI) of the lower extremities with chronic ulcerative lesions. The physical examination showed induration of the legs and subcutaneous white calcifications (Fig. 2). The patient had no other associated illnesses and had normal levels of parathyroid hormone, calcium, phosphorus, serum creatinine and 25-hydroxycholecalciferol. The immunological study for scleroderma, antiphospholipid

No abstract

DESCRIPTIONPolyarteritis nodosa is a systemic necrotising vasculitis involving the small and medium arteries. Men aged between 40 and 60 years are more frequently affected and histological evidence of vasculitis in the involved organs is necessary for diagnosis. 2A 55-year-old woman presented with a history of fever and painful skin lesions in the right leg, associated with progressive weakness and sensory loss in the affected limb.Physical examination revealed multiple hypochromic spots over the face and limbs (figure 1), a rounded lesion with a necrotic centre and inflammatory broadsides on the right knee (figure 2), and two haemorrhagic bullous lesions on the right foot (figure 3). These lesions were associated with swelling, redness and warmth of the right limb. A distal paresis of the right limb, absence of right ankle reflex, decreased vibratory sensation and hypoesthesia below the right knee were observed during neurological examination.Because of weakness in the dorsiflexors of her feet and toes, the patient had a high-stepping gait, lifting her knees to avoid dragging her toes on the floor.Haematological investigations showed normocytic and normochromic anaemia, leucocytosis with neutrophilia, and elevated C reactive protein and erythrocyte sedimentation rate. Electromyography showed a common sciatic mononeuropathy. A skin biopsy of the knee lesion was performed and the

A linfangioleiomiomatose é uma doença rara multissitémica (1/1 000 000), apresentado-se tipicamente com doença pulmonar cística. Relatos de linfangioleiomiomatose ganglionar isolada são muito raros. Existe pouca informação relativamente ao tratamento e prognóstico. Descrevemos o caso de uma mulher de 48 anos com compressão uretérica por uma massa retroperitoneal. A biópsia mostrou linfangioleiomiomatose ganglionar. Foi submetida a ressecção parcial e mantém-se sob vigilância imagiológica há 3 anos, sem evidência de envolvimento pulmonar ou aumento das lesões abdominais. A doente evoluiu para menopausa 6 meses após o diagnóstico. Séries de casos sugerem que a linfangioleiomiomatose ganglionar pode preceder o envolvimento pulmonar em 1-2 anos, sendo as dimensões (>10 mm) da lesão um fator de risco. Está descrita estabilização da doença em mulheres pós-menopausa. Este caso evidencia uma apresentação e evolução atípicas, com uma lesão com >10 mm, com 3 anos de follow-up sem atingimento pulmonar, renal ou outras formas de atingimento linfático mais frequentes.

Herpes simplex virus type-1 pneumonia is unusual and rarely described without any degree of immunosuppression. We share a case of herpes simplex virus type-1 pneumonia in an immunocompetent patient, not only by its rarity, but to call attention to the importance of thinking about this entity when respiratory symptoms persist despite various antibiotic schemes, especially in the presence of ground glass or multifocal pulmonary infiltrates, regardless of patients' immune status.