SUMMARY Leprosy is a chronic infectious disease caused by Mycobacterium leprae, which affects mainly the skin and peripherical nerves. Brasil has not yet achieved its goal of elimination of the number of cases of this disease, ranking second in terms of absolute numbers worldwide, with India occupying the first position. Primary Neural Leprosy is considered to be a challenge in diagnosis, since it affects the peripherical nerve system with the absence of skin lesions, thus mimicking rheumatological disorders, like in the case presented. A male, 31, with no previous comorbidities, five years ago, started feeling severe pain in the left ankle as well as morning hand pain and stiffness. After many years of being submitted to intense rheumatological disease investigation, they all proved to be negative. Upon physical examination, the patient presented no skin lesions, symmetric polyarthritis in metacarpophalangeal joints and thickness of the left sural nerve. Lab exams showed no alterations and bacilloscopy was negative. Ultrasonography was used to investigate the thickness of the left sural nerve. Biopsy showed a minimal amount of perineural lymphocytes and positive AFB testing. Based on the electroneuromyography, the conclusion was multiple mononeuropathy, and multibacillary polychemotherapy was started. Leprosy remains a public health problem in Brasil. Due to the high prevalence of the disease, our medical colleagues must be alert and trained to recognize this clinical presentation of leprosy. Correct referral to Reference Centers accelerates research, contributing to an accurate diagnosis, classification, and treatment, thus preventing irreversible sequelae with severe functional disability.

This is a case report about Porphyria cutanea tarda (PCT) and its relationship with the infection caused by the human immunodeficiency virus (HIV). Cutaneous porphyria is an illness caused by enzymatic modification that results in partial deficiency of uroporphyrinogen decarboxylase (Urod), which may be hereditary or acquired. Several studies suggest that HIV infection associated with cofactors might trigger the development of porphyria cutanea tarda. In this case report, we present a patient infected with HIV, who after the introduction of antiretroviral therapy (ART) enjoyed clinical improvement of porphyria cutanea tarda symptoms.

RESUMOIntrodução: O melanoma cutâneo (MC) é a terceira neoplasia mais frequente na pele, entretanto é a de pior prognóstico. Mesmo sendo pouco prevalente, representa uma séria ameaça de saúde pública em virtude de ocasionar altas taxas de morbimortalidade. Objetivo: O objetivo deste estudo é realizar uma triagem nos prontuários de pacientes diagnosticados com MC durante cinco anos em um serviço especializado em câncer de pele da cidade de Curitiba/PR, a fim de conhecer as características desta neoplasia nessa população. Métodos: Realizou-se uma análise restrospectiva através da verificação de prontuários de pacientes com MC, diagnosticados no período compreendido entre janeiro de 2007 e dezembro de 2011, em um serviço especializado em câncer de pele da cidade de Curitiba/PR. Resultados: A amostra consistiu em 23 casos de MC de sítio primário, sendo lentigo maligno (43,4%), extensivo superficial (26%), nodular (17,6%) e não especificado (13%). Dentre estes 3 com Breslow ≥4mm, todos em pacientes do sexo masculino. Em contrapartida, em 43,4% dos pacientes não foi possível aplicar o índice de Breslow, em virtude do lentigo maligno melanoma caracterizar-se por ser in situ. Identificou-se homens com diagnóstico mais tardio em relação às mulheres, já que 80% deles possuíam um Breslow >1mm. Conclusão: Sugere-se maior divulgação dos cuidados com a exposição solar e melhor formação para que o médico clínico geral seja um identificador de MC o mais precocemente possível, podendo, assim, encaminhar o paciente para uma abordagem com maior possibilidade de cura.Palavras-Chave: Epidemiologia; Diagnóstico; Melanoma.ABSTRACT Introduction: The cutaneous melanoma (CM) is the third most common skin cancer, however, has the worst prognosis. Even being little prevalent, is a serious worring due to high morbidity and mortality rates. Objective: To perform a screening in the medical records of MC diagnoses for five years in a skin cancer specialized center in Curitiba / PR, with the view to know the characteristics of this cancer in this population. Methods: A retrospective analysis was performed by checking records of patients with MC, diagnosed in the period between January 2007 and December 2011, in a skin cancer specialized center in Curitiba / PR. Results: 23 patients were selected, and lentigo malign (43.4%), superficial spreading (26%), nodular (17.6%) and unspecified (13%). Among these 3 with Breslow ≥4mm, all in male patients. However, in 43.4% of patients was not possible to apply the Breslow thickness, due to lentigo malign melanoma characterized by being in situ. Men were diagnosed later in relation to women, since 80% of them had a Breslow> 1mm. Conclusion: It is suggested wider disclosure of sun protection and better training for the primary care physician, and thus can route the patient to an approach with greater chances of cure.