A 58-year-old woman with myasthenia gravis on chronic high-dose prednisone and a history of azathioprine, mycophenolate, and cyclophosphamide had multiple hospitalizations for myasthenic crises and opportunistic diseases such as cytomegalovirus uveitis and oroesophageal candidiasis. In 2024, she developed a cutaneous condition on the left upper limb, with extensive necrotic crusts and subcutaneous nodules with surrounding hyperemia. On 11/22/2024, biopsy of the lesions showed Penicillium spp. in culture, establishing chronic penicilliosis. She started liposomal amphotericin B followed by itraconazole, with unsatisfactory clinical response, requiring adjustment to voriconazole with serum level monitoring until reaching an adequate therapeutic dose. Invasive Penicillium spp. infections are rare in immunodeficient patients but are associated with high morbidity and mortality. Treatment guidelines for Talaromyces (Penicillium) marneffei, the best-studied pathogenic species in the genus, recommend induction with amphotericin B and maintenance with itraconazole, reserving voriconazole for refractory cases. Studies in HIV-positive patients show efficacy above 95% with this regimen; however, other species have a worse prognosis, lower cure rates, and greater need for combination therapy. In this case, persistence of infection despite antifungal management reinforces the chronic and refractory nature of penicilliosis in the setting of sustained immunosuppression. After attempts to taper prednisone, she developed a myasthenic crisis requiring noninvasive ventilation in intensive care. Prolonged antifungal therapy follows international recommendations, but immunologic stabilization is essential for definitive control. This case illustrates the complexity of treating rare mycoses in non-HIV immunosuppressed patients, requiring mycological surveillance, precise pathogen identification, and a multidisciplinary approach. Limited clinical response underscores the need for integrated strategies using second-line antifungals, immunomodulation, and ongoing clinical support. Penicilliosis is an emerging opportunistic infection, of low prevalence and difficult to control, with clinical presentations often underestimated and adverse outcomes, especially in contexts of immune fragility.
Resumo Não existe padronização de tratamento para as fraturas multifragmentares da tuberosidade anterior da tíbia (TAT) nos pacientes adultos, com ou sem associação com fraturas metafisárias da tíbia proximal. O objetivo desta nota técnica é demonstrar os resultados da utilização da placa de minifragmentos colocada segundo o princípio da banda de tensão, de forma horizontal, em dois pacientes portadores de fratura multifragmentar da TAT.
Cystic craniopharyngiomas (CPs) are benign tumors and due to the anatomic position next to critical neurological structures remains a therapeutic challenge. In order to prevent bigger complications, the intracavitary irradiation with phosphorus-32 (³²P) emerged as a minimally invasive strategy to control cystic components and delay or avoid external-beam radiotherapy. A systematic search of publications was conducted in databases including PubMed, Embase, and the Cochrane Library, covering studies published up to July 2025. The risk of bias was assessed using the ROBINS-I tool, as recommended by Cochrane. Data analysis was performed using RStudio (version 2025.05.0). Eight studies comprising 285 patients were included. The pooled complete cyst reduction rate was 25.62
There is no standardized treatment for multifragmentary fractures of the anterior tibial tuberosity (ATT) in adult patients, with or without concomitant metaphyseal fractures of the proximal tibia. This technical note aims to demonstrate the results of using a minifragment plate positioned horizontally according to the tension band principle in two patients with multifragmentary fractures of ATT.
Os padrões de hemorragia identificados na Ressonância Magnética (RM) constituem marcadores fundamentais no diagnóstico de diversas patologias neurológicas e sistêmicas. O presente trabalho tem como objetivo revisar as características imagiológicas de quatro condições distintas: a embolia gordurosa cerebral, a coagulação intravascular disseminada, a angiopatia amiloide cerebral e a lesão axonal difusa. Destaca-se a superioridade técnica das sequências de suscetibilidade magnética, especificamente a Imagem Ponderada por Susceptibilidade (SWI) e o T2*, na detecção de micro-hemorragias e depósitos de hemossiderina, muitas vezes invisíveis à tomografia computadorizada. Através de uma revisão bibliográfica, discutem-se os padrões de distribuição espacial, ressaltando a importância do diagnóstico diferencial radiológico para a definição do prognóstico e o manejo clínico adequado de pacientes críticos e neurológicos.
