Cutaneous schistosomiasis is a rare clinical manifestation of schistosomiasis, an
infectious and parasitic disease, caused in Brazil by the trematode Schistosoma
mansoni. The lesions are due to the deposition of eggs or, rarely, adult worms,
usually involving the genital and groin areas. Extra-genital lesions occur
mainly on the torso as papules of zosteriform appearance. The case of a patient
with ectopic cutaneous schistosomiasis is reported in this article, due to the
rarity of its occurrence and its difficult clinical diagnosis.
We present a patient with Paracoccidioidomycosis/HIV coinfection which has been
investigated because of chronic monoarthritis and mucocutaneous lesions. A biopsy of
the synovial membrane and skin revealed structures consistent with Paracoccidioides
brasiliensis. At diagnosis, the count of CD4 + T cells was 44 cells/mm3.
We emphasize the importance of clinical suspicion of Paracoccidioidomycosis in
patients with HIV/AIDS who live in or are from risk areas.
HIV/syphilis co-infection is common because both conditions affect similar risk
groups. HIV interferes with the natural history of syphilis, which often has atypical
clinical features and nervous system involvement in the early stage of disease. We
report the case of an HIV-positive patient with secondary syphilis, scaling
palmoplantar keratoderma, scrotal eczema, balanitis and urethritis mimicking Reiter’s
syndrome. Immunohistochemistry using polyclonal antibodies against Treponema pallidum
revealed the presence of spirochetes, associated with the paretic form of parenchymal
neurosyphilis. The patient was given crystalline penicillin, with complete resolution
of dermatological and neurological symptoms, and no sequelae.
Synovial sarcomas are rare malignant tumors affecting mainly young adults, presenting
as a slow growth mass located in deep soft tissues of extremities, near the joints.
In this report a 34-year-old male patient, presented an ulcerovegetative lesion on
the right wrist which was completely excised. Histopathology and immunohistochemistry
confirmed synovial sarcomas with poorly differentiated cells. This patient presented
11 months later with ipsilateral axillary lymph node metastasis, which emphasizes the
unfavorable prognosis of this synovial sarcoma variant. The indolent growth pattern
of this sarcoma justifies the well circumscribed initial stages, which progressively
infiltrate adjacent structures with lung metastasis (80%) and lymph node involvement
(20%) and thus corroborates the importance of early diagnosis and proper
treatment.
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