Brazilian Journal of Case Reports

Revisão narrativa baseada na experiência de um grupo de contracepção e prevenção de saúde sexual na atenção básica

Anna Luiza Lobo Trevisan — 2023-11-27

Infecções Sexualmente Transmissíveis (ISTs), apesar dos esforços de conscientização e prevenção, ainda representam um desafio para a saúde pública. Ademais, a ocorrência de gestações não planejadas permanece uma preocupação global em determinadas populações. Diante dos preocupantes dados destas causas em Ribeirão Preto, uma Unidade Básica de Saúde implementou o "Grupo de Anticoncepção e Prevenção de ISTs", estratégia que envolve a educação em saúde e busca melhorar a saúde comunitária local. Este artigo descreve detalhadamente essa estratégia, suas metas e impacto inicial observado na comunidade, bem como as evidências literárias que embasaram sua implementação. O grupo realiza rodas de conversa, desmistificando questões, esclarecendo dúvidas sobre contracepção, fornecendo orientações sobre gestação, planejamento familiar e prevenção de ISTs. O objetivo é aproximar as realidades das pacientes, encorajando sua participação ativa e compreensão desses assuntos. Posteriormente, as pacientes recebem orientações médicas individuais e escolhem o método contraceptivo desejado, mantendo uma relação horizontal para possíveis necessidades futuras. Como resultado, nota-se compreensão satisfatória dessas questões, embora haja uma preferência pela contracepção em detrimento de abordagem detalhada das ISTs. No entanto, são necessários estudos adicionais e exploração de outras abordagens para abranger efetivamente esses problemas e também prolongar o seguimento dessa estratégia educativa para resultados objetivos.

Botulinum Toxin A Delivery via MMP Technique: An Emerging Therapeutic Approach for Frontal Fibrosing Alopecia

Simone Ramos Nogueira Guerra Neri — 2023-06-29

Frontal Fibrosing Alopecia (FFA) is a disease of unknown etiology and pathogenesis whose prevalence has been increasing since its first description in 1994. With no cure, treatments only control the inflammatory process and disease progression, but do not reverse the changes induced by it. We report the case of a patient with early-stage FFA who underwent three monthly sessions of 30 units of Botulinum Toxin Type A administered by MMP® (Microinfusion of drugs through the skin) technique. The results showed a substantial improvement in the patient's clinical condition with inhibition of the inflammatory process and an evident increase in follicular density in the treated area.

Chronic meningitis by Cryptococcosis gatti in an immunocompetent patient: a case report

Bruno Pereira Conte — 2023-07-06

This paper aims to present an unusual case of neurocryptococcosis in an immunocompetent patient. As the previous literature proposes, the diagnosis is usually not evident and there is a delay in the cases resolution due to the symptoms being nonspecific, the tests being very sensitive, as well as the unusual neurological condition of fungal origin in a patient with no evidence of immunodeficiency. The history of alcoholism and the diagnosis of long-term type 2 diabetes raises the hypothesis that the patient had immunosuppression events. The diagnosis was made through hospital support in conjunction with a multidisciplinary team. Discussing the present case helps to elucidate the possible diagnoses involved in chronic meningitis, especially in fungal meningitis.

Frontoparietal cavernous malformation in a 39-year-old woman: a case report

Camilla Costa Sallem — 2023-07-06

Cerebral cavernous malformation (CCMs) is an angiographically occult, low-flow neurovascular disease resulting from capillary dilatation of cerebral blood vessels that may also occur in the spinal cord, causing extravasation of blood cells from the affected vessel that leads to multiple repercussions in the patient’s life. This condition’s clinical characteristics include recurrent bleeding, seizures, persistent neurological deficits, epilepsy, and death. In this study, we describe the clinical course of a patient with a Cavernous Malformation and its prognosis regarding the association between clinical progression and therapeutic perspectives. It's relevant to elucidate possible lack of studies that may urge further research on this theme and new learning pathways should be opted for to increase awareness of this condition in order to improve its prognosis.

Gastric pouch obstruction in a bariatric patient caused by the ingestion of cocaine packets: a case report

Matheus Vitoretti — 2023-07-12

The term "Body Packing" refers to individuals who carry intra-abdominal foreign objects containing illicit drugs that have been ingested to conceal them for smuggling purposes. With the increasing rates of international smuggling, drug transportation across borders has been constantly evolving among traffickers. Once introduced into the body, it becomes a matter of significant medical concern, as it can cause bowel obstruction, perforation, peritonitis, or intoxication. We present a case of a female, 44 years old, with a history of Fobi-Capella bariatric surgery, who was admitted to an Emergency Department for intractable vomiting, excessive drooling, and confirmed ingestion of 25 cocaine packages. The abdominal CT revealed multiple foreign bodies in the gastroenteroanastomosis topography, gastric pouch, and small bowel. Exploratory laparotomy with gastrostomy, enterotomy, and colotomy was performed. A second approach with intraoperative endoscopy was conducted to remove the remaining packages that were revealed by CT. This case report provides information about body packers' clinical condition, diagnosis, and treatment, to assist surgeons and clinicians with similar cases.

The Intervention of Physiotherapy in the improvement of facial mimicry in a Peripheral Facial Palsy associated with a Pregnancy: A Case Report

João Carlos Martins Felício — 2023-07-14

Peripheral Facial Palsy is a peripheral paralysis of the facial nerve that results in muscle weakness on one side of the face. Patients develop unilateral facial paralysis within one to three days with involvement of the facial musculature associated or not with neurological alterations, the best-known being Bell's Palsy. Symptoms usually peak in the first week and then gradually subside over three weeks to three months. In this context, a female patient with the clinical Diagnosis of Peripheral Facial Paralysis, was subjected to an intervention plan in Physiotherapy lasting 4 months (sessions of 45 minutes at a frequency of 3 times a week), with the particularity of be 28 weeks pregnant at the start of the sessions. After the end of the sessions, there was a considerable improvement in facial movements, translating into considerable functional changes. The patient acquired greater motor recruitment in flaccid muscles, greater facial symmetry, and consequently greater autonomy in eating, chewing, containing liquids and intraoral sensibility.

Cytomegalovirus esophagitis associated with gastroesophageal reflux disease in an immunocompetent patient: case report

Cesar Romaro Pozzobon — 2023-07-19

Cytomegalovirus infection has a wide variability of clinical presentations depending on the patient's immunity, ranging from asymptomatic infections in immunocompetent individuals to infections with significant morbidity and mortality in immunocompromised patients. We originally described a clinical case of severe cytomegalovirus esophagitis, confirmed by blood polymerase chain reaction (PCR) test and esophageal biopsy, in a young immunocompetent patient with a long-standing diagnosis of gastroesophageal reflux disease. Clinical improvement occurred only after the initiation of specific treatment with ganciclovir, providing a negative viral load. This report reinforces the importance of ruling out the etiology of cytomegalovirus infection in severe ulcerative esophagitis, even in immunocompetent individuals.

A Clinical Odyssey: a case report on the diagnostic complexity and neurological management of Behçet's disease

Thaís Malta Romano — 2023-11-17

Behcet's Syndrome (BS) is a pathological condition that encompasses a diverse spectrum of clinical manifestations of a polysystemic nature. It is a chronically progressive inflammatory vasculitis, characterized mainly by recurrent episodes of oral and genital aphthous ulcers, ocular involvement, and other clinical expressions, including skin lesions and gastrointestinal disorders. The aim of this study is to present an atypical case of BS, as well as its correlation with the medical literature, to elucidate particularities of relevant significance for medical practice.

Cerebral Toxoplasmosis in a patient with Pneumocystis: a case report

João Vítor Moreira Nogueira — 2023-11-22

Acquired Immune Deficiency Syndrome, or AIDS, is characterized by a clinical condition in which the body's defenses suffer a gradual depletion, making it susceptible to a wide variety of infections. Among these, neurotoxoplasmosis is a characteristic opportunistic infection caused by Toxoplasma gondii. This infection generates numerous neurological deficits that can regress if early diagnosis and intervention are carried out. However, underdiagnosis of these cases due to incorrect management or inaccurate diagnosis leads to damaging and permanent results due to the expansive nature of the mass, which affects a wide range of organic functions. It is then associated with infection by Pneumocystis jirovecii, also characteristic of immunodeficient patients, demonstrating a synergism between the mechanisms that facilitate the infectious process. Because of the seriousness of these infections and their association, a clinical picture like this must be well visualized.

Bowen's disease with compact orthokeratosis at perianal region: a case report

Anna Luiza Lobo Trevisan — 2023-11-29

Bowen's Disease (BD) is an in situ squamous cell carcinoma (SCC) of epidermis, potentially malignant, which mainly affects sun-exposed areas. Nevertheless, the disease had an increased incidence in non-photo exposed areas, such as the anogenital region, correlating ambiental exposures, highlighting the Human Papillomavirus (HPV) infection as an important risk factor. BD has a positive prognosis according to its slow progress and prolonged time taken for full expression. In the anogenital region, presented in this case, the risk of invasive carcinoma is less than 6%. This case reports an unusual presentation of BD, describing a lesion with compact orthokeratosis in the anogenital region. The condition was diagnosed in a prevention routine of primary care attention, emphasizing the importance of premature diagnosis and satisfactory treatment, not just at BDs, but in a variety of conditions.

Pleomorphic Dermal Sarcoma: a case report

Carmen Déa Ribeiro de Paula — 2023-12-04

This case report brings a 79-year-old man, with a history of melanoma in situ on the extensor part of the left arm, who presented with an ulcerated nodule on the scalp, right parietal region, with rapid and progressive growth for 3 months. The lesion was clinically compatible with squamous cell carcinoma, Merkel carcinoma, amelanotic melanoma and pleomorphic dermal sarcoma. Exeresis was performed and the diagnosis of Pleomorphic Dermal Sarcoma (PDS) was confirmed by histological and immunohistochemical evaluation. Pleomorphic Dermal Sarcoma (PDS), formerly known as malignant fibrous histiocytoma or undifferentiated pleomorphic sarcoma of the skin, is a rare spindle cell mesenchymal tumor that may recur locally or metastasize. Our objective is to present this rare tumor to the reader, discussing the clinical, histological and immunohistochemical presentation, and to highlight the need for further studies on surgical management protocols and the development of guidelines for the standardization of management and safe follow-up of these patients.