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A biopsy was performed in the dorsal region three days after the onset of the rash&#44; in order to corroborate to the clinical diagnosis&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Histopathologic findings</span><p id="par0015" class="elsevierStylePara elsevierViewall">The skin biopsy showed hyperkeratosis&#44; mild spongiosis&#44; dyskeratosis&#44; focal parakeratosis&#44; and apoptotic keratinocytes&#46; In follicular epithelia&#44; was observed dyskeratosis and multinucleated giant cells &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; The dyskeratotic alterations also compromised the acrosyringium &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Discussion</span><p id="par0020" class="elsevierStylePara elsevierViewall">Torres&#44; in 1952&#44;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> describes in a case study the histopathologic changes in a skin biopsy of measles according to the time of biopsy&#46; Ten hours after the eruption&#44; the changes restricted to the epidermis&#44; with spongiosis and karyolysis&#46; Hyaline necrosis of epidermal cells either singly or in clumps represents the primary change in the measles eruption&#46; In lesions biopsied after 12<span class="elsevierStyleHsp" style=""></span>h&#44; Torres described the formation of small vesicles with necrotic keratinocytes and a few polymorphonuclear cells&#46; At this time&#44; he observed multinucleate epithelial giant cells in the stratum spinosum&#46; Perivascular infiltration by mononuclear cells occurs 12<span class="elsevierStyleHsp" style=""></span>h after the eruption&#46; In the dermis&#44; it was described edema of the papillary layer and perivascular infiltrations in the reticular layer by large mononuclear cells some of them containing small irregular deeply stained granule&#44; 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such as hydropic vacuoles in the epidermis&#59; edema&#44; and an increase of large round cells of dermis&#59; edema&#44; and various degrees of degeneration of cells of the hair follicle&#46; The vesicle formations occur in connection with similar changes in the sebaceous glands and hair follicles&#44; being nearly always extensively affected&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Epithelial giant cells in the hair follicles were described&#44; in our knowledge&#44; only by Hall et al&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> in skin biopsies from Rhesus monkeys with measles rash&#44; without documentation in humans&#46; To the best of our knowledge&#44; this is the first report that describes the giant cells of measles in hair follicles and dyskeratotic alterations in the acrosyringium&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Financial support</span><p id="par0060" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Authors&#8217; contributions</span><p id="par0040" class="elsevierStylePara elsevierViewall">Monique Freire Santana&#58; Approval of the final version of the manuscript&#59; conception and planning of the study&#59; elaboration and writing of the manuscript&#59; obtaining&#44; analysis&#44; and interpretation of the data&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Luiz Carlos de Lima Ferreira&#58; Approval of the final version of the manuscript&#59; conception and planning of the study&#59; effective participation in research orientation&#59; critical review of the manuscript&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Jo&#227;o Gabriel Nogueira de Oliveira&#58; Elaboration and writing of the manuscript&#59; obtaining&#44; analysis&#44; and interpretation of the data&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">F&#225;bio Francesconi&#58; Effective participation in research orientation&#59; intellectual participation in the propaedeutic and&#47;or therapeutic conduct of the studied cases&#59; critical review of the manuscript&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conflicts of interest</span><p id="par0065" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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TROPICAL/INFECTOPARASITARY DERMATOLOGY
Histopathological changes in epithelium of hair follicles and acrosyringium caused by measles in child
Monique Freire Santanaa,
Corresponding author
monique.freire20@gmail.com

Corresponding author.
, Luiz Carlos de Lima Ferreirab, Joao Gabriel Nogueira de Oliveirac, Fábio Francesconid
a Department of Teaching and Research, Fundação Centro de Controle de Oncologia do Amazonas, Manaus, AM, Brazil
b Pathological Anatomy Management, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brazil
c Dermatology Medical Residency Program, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brazil
d Universidade Federal do Amazonas, Manaus, AM, Brazil
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 9-year-old boy evolved with headache and fever&#46; Seven days after the onset of symptoms&#44; coughing&#44; an episode of hemoptysis&#44; coryza&#44; and conjunctivitis&#44; followed by a rash that started on the forehead with a cephalophaudal progression&#46; He had no comorbidities or family history&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The exanthema was distributed in a cephalocaudal direction&#44; with appearance of pruritic maculopapular lesions&#44; some confluent plaques&#44; more intense on the face and trunk&#46; The physical examination revealed a hypochromic macula&#44; with diffuse erythematosus halo&#44; before the appearance of a rash on the oral mucosa&#44; Koplik&#39;s sign &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#44; besides erythematous papules and conjunctival hyperemia&#46; The patient had not completed the measles vaccination scheme&#46; A biopsy was performed in the dorsal region three days after the onset of the rash&#44; in order to corroborate to the clinical diagnosis&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Histopathologic findings</span><p id="par0015" class="elsevierStylePara elsevierViewall">The skin biopsy showed hyperkeratosis&#44; mild spongiosis&#44; dyskeratosis&#44; focal parakeratosis&#44; and apoptotic keratinocytes&#46; In follicular epithelia&#44; was observed dyskeratosis and multinucleated giant cells &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; The dyskeratotic alterations also compromised the acrosyringium &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Discussion</span><p id="par0020" class="elsevierStylePara elsevierViewall">Torres&#44; in 1952&#44;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> describes in a case study the histopathologic changes in a skin biopsy of measles according to the time of biopsy&#46; Ten hours after the eruption&#44; the changes restricted to the epidermis&#44; with spongiosis and karyolysis&#46; Hyaline necrosis of epidermal cells either singly or in clumps represents the primary change in the measles eruption&#46; In lesions biopsied after 12<span class="elsevierStyleHsp" style=""></span>h&#44; Torres described the formation of small vesicles with necrotic keratinocytes and a few polymorphonuclear cells&#46; At this time&#44; he observed multinucleate epithelial giant cells in the stratum spinosum&#46; Perivascular infiltration by mononuclear cells occurs 12<span class="elsevierStyleHsp" style=""></span>h after the eruption&#46; In the dermis&#44; it was described edema of the papillary layer and perivascular infiltrations in the reticular layer by large mononuclear cells some of them containing small irregular deeply stained granule&#44; so-called Mallory-Medlar-Lipsch&#252;tz cells also described&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The most common findings are parakeratosis&#44; giant-cell formation&#44; intranuclear and cytoplasmic inclusions&#44; dyskeratosis&#44; spongiosis&#44; and intracellular edema&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1&#44;2</span></a> It can also be described as an inflammatory infiltrate of mononuclear cells with eosinophils and capillaries with fibrin thrombi&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> Electronic microscopy examination can show capsid particles&#44; within the endoplasmic reticulum and secretory vesicles measuring approximately 40&#8211;60<span class="elsevierStyleHsp" style=""></span>nm in diameter&#44;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> and aggregates of microtubules within the nuclei and the cytoplasm of syncytial giant cells in both epidermal and oral epithelial lesions&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Ewing<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> described some findings at the hair follicles in measles&#44; such as hydropic vacuoles in the epidermis&#59; edema&#44; and an increase of large round cells of dermis&#59; edema&#44; and various degrees of degeneration of cells of the hair follicle&#46; The vesicle formations occur in connection with similar changes in the sebaceous glands and hair follicles&#44; being nearly always extensively affected&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Epithelial giant cells in the hair follicles were described&#44; in our knowledge&#44; only by Hall et al&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> in skin biopsies from Rhesus monkeys with measles rash&#44; without documentation in humans&#46; To the best of our knowledge&#44; this is the first report that describes the giant cells of measles in hair follicles and dyskeratotic alterations in the acrosyringium&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Financial support</span><p id="par0060" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Authors&#8217; contributions</span><p id="par0040" class="elsevierStylePara elsevierViewall">Monique Freire Santana&#58; Approval of the final version of the manuscript&#59; conception and planning of the study&#59; elaboration and writing of the manuscript&#59; obtaining&#44; analysis&#44; and interpretation of the data&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Luiz Carlos de Lima Ferreira&#58; Approval of the final version of the manuscript&#59; conception and planning of the study&#59; effective participation in research orientation&#59; critical review of the manuscript&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Jo&#227;o Gabriel Nogueira de Oliveira&#58; Elaboration and writing of the manuscript&#59; obtaining&#44; analysis&#44; and interpretation of the data&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">F&#225;bio Francesconi&#58; Effective participation in research orientation&#59; intellectual participation in the propaedeutic and&#47;or therapeutic conduct of the studied cases&#59; critical review of the manuscript&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conflicts of interest</span><p id="par0065" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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Article information
ISSN: 03650596
Original language: English
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Idiomas
Anais Brasileiros de Dermatologia
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