Caso para diagnóstico

Abstract

HISTORY OF THE DISEASEA thirteen-year-old black boy, native of Sao Paulo, complained of recurring pruritic lesions on his forearms associated with edema of the lower lip, photophobia, and red eyes that had developed two years before. Physical examination revealed conjunctival enanthema associated with pterygium ( Figure 1). The lower lip was everted, swollen, exulcerated with vegetant lesions all over its extension (Figure 2). Erythematous, scaly, crusted lesions in the nose ( Figure 1); excoriated papules and nodules in the forearms were observed in association with residual hyperchromic maculae ( Figure 3). The patient presented low cognitive development without previous diseases. He denied similar cases of the disease in his family. An Bras Dermatol. 2010;85(5):733-5.Skin biopsy of the lower lip showed acanthosis and spongiosis with dermal perivascular mononuclear cell infiltration composed by lymphocytes, plasma cells, and eosinophils (Figure 4). Eye examination revealed enanthema, Trantas dots, and pterygium. After three months of thalidomide use (100mg/day), remission of lesions was observed, including that of cheilitis. The patient suspended the medication and symptoms recrudesced. Treatment with thalidomide 100mg/day for six months was reestablished with rapid improvement; the dose was then reduced to 50mg/day and lesions were controlled for two more years. The patient's low cognitive development prevented the progressive reduction of medication.