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from the south of Brazil&#44; born through vaginal delivery&#44; with severe recurrent eczema since she was 18 months of age&#44; when she stopped being breastfed&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">On examination&#44; she had macerated&#44; exudative&#44; and foul-smelling eczematous lesions on the scalp and retroauricular&#44; cervical&#44; antecubital&#44; and intergluteal regions&#59; temporal alopecia&#59; crusts in the umbilical&#44; perioral and nasal regions &#40;<a class="elsevierStyleCrossRefs" href="#fig0005">Figs&#46; 1 and 2</a>&#41;&#46; Laboratory tests were normal&#44; except serology for HTLV-I&#47;II which was reactive&#44; confirming the diagnosis of IDH according to the criteria described in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> The other viral serologies were negative&#46; The neurological examination was normal&#46; Her mother also had positive serology for HTLV-I&#47;II&#46; Treatment with oral sulfamethoxazole&#160;and&#160;trimethoprim was started&#44; with significant clinical improvement&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">IDH usually starts in childhood and is considered an early clinical marker of HTLV-I infection&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4</span></a> The main route of transmission is through breastfeeding&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;5</span></a> Its pathogenesis involves individual susceptibility&#44; immune dysregulation&#44; bacterial superinfection&#44; environmental antigenic stimulation and persistent inflammation&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> The pro-inflammatory state may be related to the proliferation of T lymphocytes and high levels of IL-1&#44; IL-6&#44; TNF&#945; and IFN&#945;&#59; elevated IgE levels increase susceptibility to <span class="elsevierStyleItalic">S&#46; aureus</span> and <span class="elsevierStyleItalic">S&#46; beta-haemolyticus</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Patients should be screened for HTLV-I in cases of severe&#44; resistant&#44; recurrent eczema with secondary infection&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Atopic dermatitis &#40;AD&#41; and seborrheic dermatitis are the main differential diagnoses&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Histopathology is non-specific and CD8 T lymphocytes predominate in immunohistochemistry&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Approximately 10&#37; of those infected develop adult T-cell leukemia&#47;lymphoma and HTLV-I-associated myelopathy&#47;adult tropical spastic paraparesis&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#8211;4</span></a> Symptoms tend to show remission at puberty but persist if they start at the adult age&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;4</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">IDH does not have a specific treatment or vaccine&#59; however&#44; it usually responds to antibiotics such as sulfamethoxazole&#160;and&#160;trimethoprim&#44; and cephalexin&#44; for long periods&#44; with recurrence being common&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4</span></a> Infected individuals must be monitored due to the possibility of severe neurological and lymphoproliferative complications&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The interruption of the transmission involves screening blood donors&#44; using condoms&#44; family counseling&#44; avoiding breastfeeding&#44; and avoid sharing needles&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">IDH is relevant in the practices of dermatologists&#44; infectologists&#44; hematologists and neurologists and&#44; despite its absence from the lists of neglected diseases&#44; the perception is that it is very close to that situation&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> It is not compulsorily notified&#44; and there are not even policies for the prevention or care for the virus carriers&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">We emphasize the importance of this case&#44; as it occurred outside the endemic areas in Brazil &#8211; which are the northern and northeastern regions &#8210; and because it was managed as a recalcitrant AD for a long period&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0055" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors&#39; contributions</span><p id="par0060" class="elsevierStylePara elsevierViewall">Michele Caroline dos Santos Garcia&#58; Design and planning of the study&#59; drafting and editing of the manuscript&#59; collection&#44; analysis&#44; and interpretation of data&#59; intellectual participation in the propaedeutic and&#47;or therapeutic conduct of the studied cases&#59; critical review of the literature&#59; critical review of the manuscript&#59; approval of the final version of the manuscript&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Renata Heck&#58; Critical review of the manuscript&#59; intellectual participation in the propaedeutic and&#47;or therapeutic conduct of the studied cases&#59; effective participation in research orientation&#59; approval of the final version of the manuscript&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Renan Rangel Bonamigo&#58; Critical review of the manuscript&#59; intellectual participation in the propaedeutic and&#47;or therapeutic conduct of the studied cases&#59; effective participation in research orientation&#59; approval of the final version of the manuscript&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Cristiane Almeida Soares Cattani&#58; Design and planning of the study&#59; critical review of the manuscript&#59; intellectual participation in the propaedeutic and&#47;or therapeutic conduct of the studied cases&#59; effective participation in research orientation&#59; approval of the final version of the manuscript&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0080" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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