We found an EH subpopulation with abnormally high values of UFF but evidence of only a minor mineralocorticoid action, which was not directly related to the BP elevation, suggesting that another alternative mechanism could be triggering the F-induced hypertension. The origin of hypercortisoluria was not elucidated; however, a subtle glucocorticoid resistance was found in some cases.

Acrokeratoelastoidosis (AKE) is a rare form of focal acral keratoderma of unknown cause that typically begins during childhood and manifests with multiple, small, hyperkeratotic papules located over the lateral margins of the hands and feet. The purpose of this article is to report a pediatric case of AKE with dermoscopic, sonographic, and histopathologic descriptions, contributing to the awareness of this clinical diagnosis. We describe a 7-year-old girl with nonpainful yellowish papules on the lateral and medial aspects of both feet. Dermoscopy showed yellowish, structureless, linear areas. The sonographic appearance was suggestive of benignancy and ruled out the presence of piezogenic pedal papules and granulomas. Histopathology was consistent with AKE, showing acral skin with hyperorthokeratosis, hypergranulosis, and elastorrhexis in the reticular dermis. Acrokeratoelastoidosis may be difficult to recognize clinically because of its resemblance to other focal acral keratodermas. Color Doppler ultrasound can be a useful noninvasive tool for diagnosis and can confirm its benign appearance, although histopathology confirms the definitive diagnosis. To date, the dermoscopic description and ultrasound morphology of AKE have not been reported.

30 kg/m²) and 30 normotensive adults (NT). In each patient, we measured serum levéis of E E, serum aldosterone (SA), plasma renin activity (PRA), adrenocorticotrophic hormone (ACTH), the urinary free cortisol/creatinine (UFF/Cr), F/ACTH and SA/PRA ratios. Each polymorphism was studied by PCR and 8% polyacrylamide gel electrophoresis. Statistical associations were evaluated by Pearson correlations and the genetic equilibñum by the Hardy-Weinberg (H-W) equation. Results: We found all three polymorphisms in the EH and the NT group, both in genetic equilibñum. In obese essential hypertensives, the CAI5polymorphism showed association with SA/PRA ratio (r =0.189, p =0.012) and F/ACTH (r =0.301, p 0.048); CA19 also showed correlation with F/ACTH in obese EH (r = 0.220, p 0.009). The InsA83557polymorphism correlated with UFF/Cr in both EH (r =0.206; p =0.03), and in obese EH (r =0.354; p =0.05). Conclusions: The CAI5 and CAI9 polymorphism correlated with changes in biochemical parameters in HPA and RAA axis of obese essential hypertensives. These changes mayresult of modifications in the expression of 11ßHSD1, leading to increased cortisol and aldosterone levéis independent of ACTH and renin control, respectively]]>

Introduction: Drug reaction with eosinophilia and systemic symptoms (DRESS) is a potentially lifethreatening, drug-induced hypersensitivity reaction that includes skin eruptions, fever, lymphadenopathy, hematological abnormalities, and internal organ involvement. Objective: To present a rare condition in children; to facilitate a rapid diagnostic suspicion and recognition by doctors. Case report: A 9 months old infant admitted due to a severe viral pneumonia, treated with non-invasive ventilation and ceftriaxone, among other medications. Five days after stopping antibiotics, a violetcolored maculopapular rash appeared, confluent predominantly in the trunk, face and upper extremities, combined with a fever, eosinophilia, and elevated transaminases. She was treated with oral prednisone and topical corticosteroids for 6 weeks, with good results at 3 months follow-up. Conclusions: The diagnosis of DRESS syndrome is made using clinical criteria and laboratory examinations, as well as a skin biopsy in the case of any doubt in the diagnostics. Although it is most frequently caused by anticonvulsants, many other drugs have been implicated. Management consists of discontinuing the suspected drug associated with the reactions and a prolonged treatment of corticosteroids.

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