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Revista do Instituto de Medicina Tropical de São Paulo

Print version ISSN 0036-4665

Rev. Inst. Med. trop. S. Paulo vol.54 no.2 São Paulo Mar./Apr. 2012

http://dx.doi.org/10.1590/S0036-46652012000200013 

LETTER TO THE EDITOR

 

Analogies in medicine: little thief in the skin

 

 

José de Souza Andrade-Filho

Faculdade de Ciências Médicas de Minas Gerais Belo Horizonte, Minas Gerais, Brasil E-mail: labjsouzandrade@terra.com.br

 

 

February 23, 2012

Dear Sir,

Little thief in the skin. Furuncle is a cutaneous infection circunscribed to a pilosebaceous follicle caused by Staphylococcus aureus, a gram-positive coccus that grows in clusters and is one of the most common bacterial pathogens. Furuncle is more common in young adults and affects the skin of the neck, face, axillae, thighs and buttocks. The S.aureus infection produces suppuration and abscess formation. The abscesses range from microscopic foci to lesions of several centimeters in diameter that are filled with pus and bacteria. Clinically, the furuncle appears as an erythematous, hot, painful nodule. This is the classical aspect of the acute inflammation described in the first century by the roman Aurelius Cornelius Celsus, a writer and physician with the famous formula "notae vero inflammationis sunt quattuor: rubor et tumor, cum calore et dolore", which means redness and swelling, with heat and pain3.

In Houaiss - Dicionário da Língua Portuguesa (Dictionary of the Portuguese Language) - there is a clear explanation about furuncle: Etym. Lat. Furunculus,i precisely "a sucker or shoot harmful to the plant", a secondary bud of the vine that develops at the expenses of the main branches, stealing the sap. When it germinates, this new vine sprout arises and presents a small red node that, by analogy, receives the same name as an "infectious node" of the skin (furunculus: literally meaning little thief, diminutive form of fur, furis: thief)2,4.

In relation to the furuncle there is a rare hyper-IgE syndrome (HIES) (hyperimmunoglobulinemia IgE), in which recurrent infections occur, including lesions in the upper respiratory tract and other sites and abscesses in the skin caused by infective Staphylococcus aureus. DAVIS et al.1 in a scientific report about patients with hyper-IgE, coined the term Job's syndrome, inspired on Job, the biblical Old Testament personage1. Job was punished by God (or by the Devil?) with many kinds of misfortune and by a large number of abscesses (furuncles). He suffered with patience and courage and resisted a severe "chronic and relapsing furunculosis from head to foot". The mortality rate in Job's syndrome is high due to systemic infections leading to the gradual death of the patients. But Job, the man of the Bible, survived 140 years because the Lord blessed him twofold of all that he had lost, certainly including his army of immunoglobulins.

 

REFERENCES

1. Davis SD, Schaller J, Wedgwood RJ. Job's syndrome: recurrent "cold" staphylococcal abscesses. Lancet. 1966;1(7445):1013-15.         [ Links ]

2. Houaiss, A. Dicionário da língua portuguesa. Rio de Janeiro: Editora Objetiva; 2001.         [ Links ]

3. Pena GP, Andrade-Filho JS. Analogies in medicine: valuable for learning, reasoning, remembering and naming. Adv Health Sci Educ Theory Pract. 2010;15(4):609-19.         [ Links ]

4. Skinner HA. The origin of medical terms. 2nd ed. Baltimore: Williams & Wilkins; 1961.         [ Links ]