Advanced stages of mycobacterial diseases such as leprosy and tuberculosis are characterized by a loss of T-cell function. The basis of this T-cell dysfunction is not well understood. The present report demonstrates major alterations in the expression of signal transduction molecules in T cells of leprosy patients. These alterations were most frequently observed in lepromatous leprosy (LL) patients. Of 29 LL patients, 69% had decreased T-cell receptor ζ-chain expression, 48% had decreased p56lck tyrosine kinase, and 63% had a loss of nuclear transcription factor NF-κB p65. An electrophoretic mobility shift assay with the gamma interferon core promoter region revealed a loss of the Th1 DNA-binding pattern in LL patients. In contrast, tuberculoid leprosy patients had only minor signal transduction alterations. These novel findings might improve our understanding of the T-cell dysfunction observed in leprosy and other infectious diseases and consequently might lead to better immunologic evaluation of patients.

The findings of this study suggest that patients with the two distinct forms of leprosy are capable of responding to a polyclonal T-lymphocyte stimulus such as anti-CD3 and provide evidence suggestive of alterations in the immune responses mediated by cytokines that may contribute to the spectrum of disease and response to treatment.

La necrólisis epidérmica tóxica y el síndrome de Stevens-Johnson son las reacciones cutáneas a medicamentos de mayor gravedad y constituyen un espectro de la misma enfermedad, compartiendo aspectos etiológicos, patogénicos, histológicos y terapéuticos. Objetivos. Describir los casos de necrólisis epidérmica tóxica y síndrome de Stevens-Johnson durante un periodo de nueve años en el Hospital Universitario del Valle, los tratamientos usados en el manejo de los pacientes y la mortalidad de los mismos.Metodología. Se hizo una revisión retrospectiva de las historias clínicas de los pacientes con Stevens-Johnson y necrólisis epidérmica tóxica, diagnosticados y manejados desde febrero de 2003 hasta abril de 2012 en el Hospital Universitario del Valle. Se analizaron las características clínicas, frecuencia, mortalidad, medicamentos relacionados como posibles desencadenantes, tratamientos utilizados y sus resultados.Resultados. Se analizaron los datos de 29 casos, 13 (44,8 %) tenían diagnóstico de necrólisis epidérmica tóxica, 13 (44,8 %) de síndrome de Stevens-Johnson y los tres restantes (10,3 %) síndrome de superposición de síndrome de StevensJohnson y necrólisis epidérmica tóxica. En el 55 % (n=16) se pudo establecer un solo medicamento como desencadenante. En 41 % (n=12) de los pacientes se encontraron dos o más medicamentos como posibles desencadenantes. Solo en uno no se identificó ningún medicamento. Los antibióticos, los anticonvulsivos, los AINE y el alopurinol fueron los más asociados. Todos los pacientes recibieron medidas de soporte. El 68 % (n=20) de los pacientes recibió tratamiento antibiótico debido a infección asociada. Veintitrés pacientes (79,3 %) recibieron pentoxifilina como parte de su tratamiento. Seis (20,6 %) recibieron gammaglobulina (dos de ellos asociada a pentoxifilina oral). La mortalidad fue del 3,4 % (n=1).Conclusiones. Las medidas de soporte son fundamentales en el manejo de los pacientes con necrólisis epidérmica tóxica y síndrome de Stevens-Johnson, independientemente del área corporal comprometida, así como el manejo oportuno de complicaciones como la infección sobreagregada. La pentoxifilina puede considerarse una alternativa en el tratamiento de estas enfermedades.

Background: Adult T-cell Leukemia/Lymphoma (ATLL) is classified as a peripheral CD4+ T-cell neoplasm caused by the human T-cell lymphotropic virus type 1 (HTLV-1). Typical symptoms are associated with leukemic infiltration; however, atypical and exaggerated manifestations of verrucous carcinoma have also been described. Case report: We present here the case of a patient with multiple skin lesions, ischemic necrosis in the hallux and lymphadenopathies. Biopsies were taken, which showed verrucous epidermal carcinoma and cutaneous lymphoma. Splenomegaly and adenopathy in mesentery, retro peritoneum and lymph node chains in the limbs were observed. Bone marrow examination showed findings compatible with T-cell leukemia/lymphoma; and it was ELISA positive for HTLV-1/2. Treatment and outcome: The patient had a good initial response to a CHOP scheme (cyclophosphamide, doxorubicin, vincristine and prednisone) with filgrastim. However, the patient had a relapse and died before the second cycle. Clinical relevance: Comorbidity could lead to the associated risk factors model. According to this model, secondary immunodeficiency caused by HTLV-1 may induce the development of verrucous carcinomas; alternatively, the disease could be due to a correlation between HTLV-1 and the human papillomavirus (HPV).

We present a 53-years old male with a 10 years history of vitiligo who further developed psoriatic lesions clearly representing a Koebner´s phenomenon. He is currently being treated with phototherapy and narrowband UVB with an interin satisfactory outcome especially in the psoriasis.