No abstract

Pyoderma gangrenosum associated to the use of cocaine/levamisole is a rare condition associated to their consumption. Cocaine use is frequent in Colombia, and the substance is contaminated with levamisole, an anthelmintic that increases the psychotropic effects and enhances its side effects. We present three clinical cases of patients with ulcerated lesions, in which the diagnosis was pyoderma gangrenosum secondary to the use of cocaine contaminated with levamisole. This called the attention of the health staff to investigate the abuse of substances in gangrenous pyoderma and also evidence that the interruption of consumption was the basis of management.

Introduction In the GLADEL cohort, the bullous lupus (BSLE) prevalence was 0.41%. However, literature on pediatric BSLE is scarce. This study described the clinical, histological, and immunological characteristics and the treatment response in a series of children with BSLE as the first clinical manifestation of pediatric SLE. Methods The clinical, histological, and immunological characteristics of a series of 5 cases of BSLE between 2010-2019 from two reference centers in Colombia were analyzed. Results All cases had bullous lesions that resolved with residual hypopigmentation. One had a focal seizure, and another arthritis with thrombocytopenia. Two had transient proteinuria with normal urinalysis. Anti-nuclear antibody titers ranged from 1:160 to 1:2560, and four were anti-dsDNA (+). Five patients had anti-RNP antibodies, and four anti-Sm antibodies. All had low C3, and 80% low C4 counts; 80% had erythrocyte sedimentation rate (ESR) ≥20 mm/hour and 60% had C-reactive protein (CRP) ≥0.5 mg/dL. All patients responded to glucocorticoids and dapsone. Histology reports and direct immunofluorescence (DIF) test showed subepidermal blisters with neutrophils in the papillary dermis and linear deposits of Igs/complement proteins in 80% of the skin biopsies. IgG/IgM was present in 5 samples. IgA was positive in 60% and C3 in 80%. Conclusions In this pediatric series, BSLE tends to have a monophasic behavior associated with neuropsychiatric, skeletal, and hematological involvement in 40% of the patients, and with good prognosis.

Introducción: la feohifomicosis es una infección micótica que ocurre especialmente en pacientes inmunosupri­midos y que provoca lesiones cutáneas y, ocasionalmente, en otros órganos. La histopatología, el cultivo y la bio­logía molecular son parte del estudio diagnóstico. El tratamiento incluye la combinación de terapia antimicótica sistémica e intervenciones quirúrgicas. Presentación del caso: hombre de 61 años, diabético y trasplantado renal, con historia de 1 año de lesión ulce­rada en rodilla derecha, no dolorosa y secretante. Histopatológicamente se observaron hifas dematiáceas, con diagnóstico presuntivo de feohifomicosis. Ante la mala evolución clínica a pesar del uso de itraconazol, requirió inicio de anfotericina B y manejo quirúrgico, de donde se aisló en cultivo Cladophialophora spp., confirmando así el diagnóstico. Actualmente está recibiendo voriconazol, con mejoría satisfactoria. Conclusiones: se presenta un caso de feohifomicosis tumoral en un paciente inmunosuprimido, con poca me­joría al uso de terapia sistémica, que requirió combinación con manejo quirúrgico para obtener mejores resul­tados.