NEUSA YURIKO SAKAI VALENTE
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/53 - Laboratório de Micologia, Hospital das Clínicas, Faculdade de Medicina
LIM/53 - Laboratório de Micologia, Hospital das Clínicas, Faculdade de Medicina
8 resultados
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- Leprosy in transplant recipients: report of a case after liver transplantation and review of the literature(2011) TRINDADE, M. A. B.; PALERMO, M. L.; PAGLIARI, C.; VALENTE, N.; NAAFS, B.; MASSAROLLO, P. C. B.; D'ALBUQUERQUE, L. A. C.; BENARD, G.P>Leprosy still is an important public health problem in several parts of the world including Brazil. Unlike the diseases caused by other mycobacteria, the incidence and clinical presentation of leprosy seems little affected in immunosuppressed patients. We report the first case, to our knowledge, of a liver transplant patient who developed multi-bacillary leprosy. The patient presented with papules and infiltrated plaques with loss of sensation suggestive of leprosy 3.5 years after living-related liver transplantation for autoimmune hepatitis. A skin biopsy showing non-caseating macrophagic granulomas, neuritis, and intact acid-fast bacilli on Fite-Faraco stain, confirmed the diagnosis of borderline lepromatous leprosy. The donor of the liver did not show any evidence of leprosy. During follow-up, the patient presented 2 episodes of upgrading leprosy type I reactions, 1 mild before leprosy treatment, and 1 moderate 3 months after receiving standard multi-drug treatment (rifampicin, clofazimine, and dapsone). These reactions were accompanied by increase in liver function tests, especially of canalicular enzymes. This reaction occurred despite the patient's triple immunosuppression regimen. The moderate reaction was successfully treated with further immunosuppression (prednisone, 0.5 mg/kg). Currently, the patient is asymptomatic, off leprosy medication, with routine liver transplant follow-up. The dilemmas in diagnosis and management of such a case are discussed and the literature on leprosy in transplant recipients is reviewed.
- Alopecia areata incognita(2011) MOLINA, Luciana; DONATI, Aline; VALENTE, Neusa S. Y.; ROMITI, Ricardo
- Extensive long-standing chromomycosis due to Fonsecaea pedrosoi: Three cases with relevant improvement under voriconazole therapy(2011) CRIADO, Paulo Ricardo; CARETA, Mariana Figueiroa; VALENTE, Neusa Y. S.; MARTINS, Jose Eduardo Costa; RIVITTI, Evandro A.; SPINA, Ricardo; BELDA JR., WalterObjective: To evaluate voriconazole in the treatment of extensive cases of chromomycosis. Chromomycosis is a chronic infection, which is extremely difficult to eradicate, and is caused by dematiaceous (dark-colored) fungi which affect the skin and subcutaneous tissues, with Fonsecaea pedrosoi being the major etiologic agent. Drugs such as itraconazole, terbinafine, posaconazole and amphotericin B have been employed with variable results. Methods: We treated three Caucasian male patients (ages 44, 57 and 77 years), two were farmers and one a trash collector, with long-standing (20, 10 and 21 years of disease, respectively) and extensive chromomycosis (one lower limb affected, at least) due to Fonsecaea pedrosoi. All patients had received previous therapy with the formerly indicated drugs itraconazole and terbinafine for several months either without or with incomplete response. After that, we started treatment with voriconazole per os 200 mg twice a day. Results: The patients were treated with voriconazole for 12 months until there was clinical and mycological improvement. Clinical response was evident after 30-50 days. One patient developed visual abnormalities and tremors, and the voriconazole was reduced to 200 mg/day without impairment of the clinical and mycological response. The same patient presented photosensitive dermatitis after 12 months of therapy and the voriconazole was stopped. All patients showed elevations of serum gamma-glutamyl transpeptidase (GGT) during the treatment without clinical relevance. Moreover, our three patients obtained partial response with this therapy. Conclusions: This is the first report with a case series of chromomycosis treated with voriconazole. Despite its high cost, voriconazole is a safe and possibly promising drug for use on extensive chromomycosis refractory to conventional treatment.
- Microvascular Lymphatic Density Analysis in Cutaneous Regressive and Nonregressive Superficial Spreading Melanomas Using the Lymphatic Marker D2-40(2011) COSTA, Helena Olegario da; SOTTO, Mirian N.; VALENTE, Neusa Yuriko Sakai; SILVA, Luiz Fernando Ferraz da; SANCHES JR., Jose Antonio; SILVA, Ana Maria Goncalves da; FESTA NETO, CyroBackground: The prognostic significance of spontaneous regression in melanoma, especially thin lesions, has been a controversial issue for the past 20 years, although recent studies suggest that extensive and late regression may be related to worse prognosis. Many data suggest that lymphangiogenesis predicts metastatic spread in melanoma. Methods: We have quantified lymphatic microvascular density (LMVD) in thin (<= 1.0 mm) superficial spreading melanomas comparing regressive and nonregressive melanomas, regressive and nonregressive areas from the same tumor, and early and late histological stages of regression in the same tumor. In addition, we tried to correlate lymphangiogenesis and tumor growth phase. We conducted histological examinations and immunohistochemical analyses using monoclonal antibody D2-40 with subsequent quantification by image analysis of 37 melanomas, 16 regressive and 21 nonregressive (controls). Results: We found higher LMVD in the late stage of regression compared with nonregressive area (internal control) of regressive melanomas. Conclusions: Our study suggest that the late stage of spontaneous regression in thin melanomas may be related to worse prognosis as it showed higher LMVD, and evidence shows that this is related with increased risk of metastatic spread. But this supposition must be confirmed by a longer follow-up for detection of lymph node metastases.
article 6 Citação(ões) na Scopus Nevo da epidermólise bolhosa: aspectos clínicos, dermatoscópicos e histológicos em um caso de portador da forma distrófica recessiva(2011) MELO, Juliana Nakano de; TERUYA, Priscila Yoshie; MACHADO, Maria Cecilia Rivitti; VALENTE, Neusa Sakai; SOTTO, Mirian Nacagami; OLIVEIRA, Zilda Najjar Prado deAcquired melanocytic lesions may present unusual clinical features in all forms of hereditary epidermolysis bullosa. These lesions are known as ""EB nevi"", and often pose a diagnostic challenge for dermatologists given their resemblance - clinically, dermoscopically and histologically - to melanoma. The lesions have been reported in all types of hereditary EB, most of them in childhood. We report the case of a 6-month-old boy suffering from recessive dystrophic epidermolysis bullosa (RDEB) that presented as a large pigmented lesion on his left thigh. We decided to monitor the lesion closely since we considered that the clinical and pathological aspects of the lesion were compatible with the description of other previously reported cases of EB nevi.- Case Report: A Patient with Erythema Nodosus Leprosum and Chagas Cardiopathy: Challenges in Patient Management and Review of the Literature(2011) TRINDADE, Maria Angela B.; CARVALHO, Noemia B.; BELFORT, Elaini C.; PAGLIARI, Carla; GAKIYA, Erika; SAKAI-VALENTE, Neusa Y.; BENARD, Gil; SHIKANAI-YASUDA, Maria A.We report a patient with severe multi-bacillary leprosy complicated by recurrent episodes of erythema nodosum necrotisans that required thalidomide and/or corticosteroids during follow-up. Although the patient was from an area to which Chagas disease is endemic, this diagnosis was initially missed and was only investigated when heart failure developed in the patient. The difficulties of managing erythema nodosum necrotisans and heart failure concomitantly and those involved in excluding the diagnosis of acute myocarditis caused by reactivation of Chagas disease secondary to the immunosuppressive regimen are discussed. Other potential causes for the heart failure and possible interactions between the two diseases and their treatments are discussed. We also reviewed the literature for the association between leprosy and Chagas disease, both of which are highly endemic in Brazil. This case emphasizes the importance of searching for subclinical co-infections in leprosy patients because reactions frequently develop during specific. treatment in these patients, and these reactions require prolonged therapy with immunosuppressive drugs.
article 113 Citação(ões) na Scopus Facial Papules in Frontal Fibrosing Alopecia Evidence of Vellus Follicle Involvement(2011) DONATI, Aline; MOLINA, Luciana; DOCHE, Isabella; VALENTE, Neusa S.; ROMITI, RicardoBackground: Frontal fibrosing alopecia is considered a particular clinical form of lichen planopilaris that primarily involves the scalp hair over the frontal hairline. Concomitant involvement of vellus at different body sites has recently been reported. To our knowledge, this is the first report on the involvement of facial vellus by effects of the inflammatory process. Unlike the usual noninflammatory clinical presentation of vellus involvement over other body areas, facial vellus involvement can lead to surface changes that may be recognized both by patients and dermatologists. Observations: Four patients with typical clinical features of frontal fibrosing alopecia presented with noninflammatory follicular papules over the face, most of-ten inside the temporal area, and described as ""roughness"" by the patients. Histologic samples showed lichen planopilaris features involving the facial vellus. Conclusions: The new concept of frontal fibrosing alopecia as a generalized disease is important for treatment planning and research. Dermatologists must learn to recognize facial surface changes and discuss these with the patients, who may attribute this roughness to aging or hormonal changes associated with menopause. Further studies are needed to determine the prevalence of this involvement in patients with frontal fibrosing alopecia.article 45 Citação(ões) na Scopus Livedoid vasculopathy: an intringuing cutaneous disease(2011) CRIADO, Paulo Ricardo; RIVITTI, Evandro Ararigboia; SOTTO, Mirian Nacagami; VALENTE, Neusa Yuriko Sakai; AOKI, Valeria; CARVALHO, Jozelio Freire de; VASCONCELLOS, CidiaLivedoid vasculopathy is a skin disease that occludes the blood vessels of the dermis. It has a pauciinflammatory or non-inflammatory nature. It is characterized by the presence of macular or papular, erythematous-purpuric lesions affecting the legs, especially the ankles and feet, and producing intensely painful ulcerations, which cause white atrophic scars called ""atrophie blanche"". This review includes studies and case reports found in the medical literature regarding the etiopathogenic associations of the disease, particularly those related to thrombophilia, their histopathological findings and the therapeutic approaches used in the difficult clinical management of these cases.