Biological agents are widely used for various immune-mediated diseases, with remarkable effectiveness in the treatment of rheumatoid arthritis (RA), psoriasis, psoriatic arthritis, ankylosing spondylitis and Crohn's disease. However, attention needs to be drawn to the adverse effects of these therapies and the risk of reactivating underlying granulomatous infectious diseases such as tuberculosis, leprosy, syphilis, leishmaniasis, among others. The objective of this paper is to describe a case of leprosy in a patient with RA using anti-TNF alfa, demonstrating the need for systematic investigation of skin lesions suggestive of leprosy in patients who require rheumatoid arthritis therapeutic treatment, especially in endemic regions like Brazil.

TNF alpha antagonist-induced lupus-like syndrome is a rare condition which predominantly affects women (4:1). The average age of onset is 46-51 years. It occurs after exposure to TNF alpha antagonist and disappears after discontinuation of such agents. The pathogenic mechanism for development of the TNF alpha antagonist-induced lupus-like syndrome is not fully defined. It is believed that the medication induces apoptosis, leading to an accumulation of nucleosomal antigens of apoptotic cells. This would cause autoantibodies to be produced by susceptible individuals. The most common cutaneous manifestations include maculopapular exanthem, malar rash, alopecia, photosensitivity and, more rarely, vasculitis. Extracutaneous manifestations include: fever, weight loss, arthritis or arthralgia, myositis and hematological abnormalities. Antinuclear antibody may be positive in 80% of cases and anti-histone antibody is considered a disease marker for TNF alpha antagonist-induced lupus-like syndrome. Treatment corresponds to drug discontinuation. We report a rare case of sub-acute cutaneous lupus erythematosus with leukocytoclastic vasculitis induced by adalimumab in a 42-year-old patient.

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Introduction Various therapeutic strategies have been used for controlling or at least slowing the degenerative cascade that leads to symptomatic disk degeneration. In this context, given its regenerative capability, stem cells (SC) therapy has shown promising results acting early on the degenerative cascade. This study aims to evaluate the influence of autologous adult mononuclear SC on the histological changes of experimentally induced disk degeneration. Materials and Methods After local Ethical Committee approval, 16 rabbits-New Zealand, male, 3.5 to 4.5 kg-underwent needle puncture of the three caudal lumbar intervertebral discs using a previously validated technique, and the remaining discs were used as controls. The animals received either autologous mesenchymal SC or saline solution after 2 weeks (group 1) or 2 months (group 2). Animals underwent euthanasia 8 weeks after the cell administration, and the discs were harvested for analysis. The slides were analyzed on hematoxylin-eosin stains for the presence of degeneration by a previously validated score, and by automated color morphometry, also previously validated by the authors, defining cellular size and cellular population within the nucleus pulposus (NP). Results Total 91 intervertebral discs (IVDs) were obtained for histological analysis, extracted from 16 animals-4 animals were excluded due to inadequate tissue preparation. The study group was divided as follows: 55 control-not punctured-IVDs and 36 experimental IVDs; were 21 have received SC and 15, isotonic saline solution. The microscopically characteristic alterations of the experimental disk degeneration have been observed in all punctured IVDs; however, some slides suggested a less intensive degeneration process and normal areas inside de nucleus pulposus, meaning recovery areas in the IVDs which have received mononuclear stem cells. Through color morphometry, significant differences favoring the SC group regarding number of cells and especially nuclear size (p = 0.03) give indirect evidence that the injected cells survived within the NP. There was also a trend favoring the group receiving SC earlier (2 weeks). Conclusion Injection of SC was not able to interrupt the degenerative process triggered by disk puncture. However, the histological changes were less severe in the groups receiving cell therapy. Color morphometry showed clusters of cells within the NP, not seen in the control groups. I confirm having declared any potential conflict of interest for all authors listed on this abstract Yes Disclosure of Interest None declared

Contact dermatitis is a frequent, pruritic/itchy inflammatory dermatosis, caused by external agents in contact with the skin. It represents 4 to 7% of all dermatological appointments, besides being one of the main occupational diseases. The lymphomatoid contact dermatitis (LCD), described by Gomés Orbaneja in 1976, is defined as a particular form of allergic, persistent and chronic contact dermatitis, with clinical and/or histopathological characteristics similar to cutaneous lymphoma. The purpose of this article is to describe a case of LCD showing the necessity to be attentive to its diagnosis and prescribe the therapeutics to control its dermatological lesions efficiently.