Zigomicosis (mucormicosis) cutánea en paciente con leucemia

—Cutaneous zygomycosis (mucormycosis) is a rare disease caused by opportunist fungi classified as Zygomycetes; it associates in most of the cases to uncontrolled diabetes mellitus, and secondly with hematological diseases specially leukemia.We report the case of a 21 year-old female with type L2 acute lymphoblastic leukemia, who presented on her nose an indurated, black-purple, necrotic lesion, which extended to the hard palate and paranasal sinuses. She was treated with usual doses of amphotericin B, with poor response at all she died.We discussed if this case was a primary cutaneous case or secondary to a rhinocerebral form of presentation.     

Fusariosis diseminada en paciente con leucemia mieloblástica aguda

Members of the Fusarium genus are ubiquitous soil fungi and are common plant pathogens. More recently, they have become important as pathogens of immunocompromised human patients.A 62-year-old man with acute mielogenous leukemia due to mielodisplastic syndrome treated with chemotherapy, antibiotherapy and amphotericin B developed fever, malaise and red papular skin lesions, asymmetrically distributed over the face, trunk and extremities. Central necrosis appeared in some of them. Laboratory test only revealed anemia, trombopenia and leukopenia. A radiological examination revealed lung inolvement. Skin biopsy showed numerous septate hyphae in mid and deep dermis. A sparse inflammatory infiltrate was present. Culture from skin lesions showed a Fusarium species. Antifungal treatment with a combination of amphotericin B was given without improvement. The skin lesions disappeared with granulocyte colony-stimulating factor therapy and neutropenia recovery.     

Mucormicosis diseminada en una paciente con leucemia mieloblástica aguda

—A 63-year-old woman diagnosed of acute myelogenous leukemia presented, five days after suffering respiratory tract infection, an ulceronecrotic lesion on the right side of the nose followed by a satellite lesion on his right leg. Mucor spp. was found in the culture of one of two biopsy specimens. Both of them yielded thrombi formed by nonseptate hyphae. She worsened quickly. Despite treatment with amphotericin B and surgical debridement the patient died.Mucormycosis is an opportunistic fungal infections of the class zygomycetes that affects immunosuppressed patients. Cutaneous involvement in disseminated mucormycosis is a rare manifestation; skin lesions have been described as nodules with ecchymotic center, erythematous plaques with a purple center or ecthyma gangrenosum-like lesions. Since these organisms are ubiquitous, histopathologic and microbiologic rigorous criteria must be observed. Treatment of choice consists of parenteral amphotericin B and surgical debridement wich are not able to avoid a high mortality rate.     

Leucemia cutánea aleucémica: presentación de un caso

—The term aleukemic leukemia cutis describes the invasion of the skin by leukemic cells in the absence of peripheral blood and/or bone marrow involvement. Although the pathogenic mechanisms of this disease are still unknown, it is widely recognized its poor prognosis. Most of the reported patients completely developed the hematologic disease (the majority acute granulocytic or monocytic leukemias) in 10-14 months after diagnosis of aleukemic leukemia cutis, and they had a median survival of 22 months.We report on a case of a 77-year-old man with aleukemic leukemia cutis who presented with numerous erythematous to violaceous papulonodular lesions, mainly located on the trunk and head, lack of peripheal blood involvement and very early alterations in the bone marrow aspirate. Inmunohistochemical stains of skin and bone marrow biopsies revealed the infiltration of both tissues by blast cells of monocyte-histiocytic lineage. Our patient presented spontaneous resolution of skin lesions and his hematological disease showed no progression during 9 months after diagnosis, although he did not undergo any treatment.We emphasize the low incidence of association between myelodysplastic syndromes and aleukemic leukemia cutis as well as the surprising spontaneous remission of cutaneous lesions in our patient.     

Vasculitis cutánea,neutropenia y fiebre,en una paciente con artritis reumatoide grave

—Rheumatoid vasculitis is an uncommon and life-threatening complication of rheumatoid arthritis, with an associated high mortality rate due to systemic vasculitis and infections. We report the case of a 70-years-old woman with a severe rheumatoid arthritis who presented with an intense outbreak of rheumatoid vasculitis involving the skin, neutropenia and fever. In this case, autoinmune neutropenia increases the susceptibility to bacterial infections and is a limiting factor on therapy with cytostatic agents.We think this is an interesting patient since the combination of vasculitis, neutropenia and fever represents a critical situation in dermatology, and these situations are unfrequent in our daily practice.