Lesões molusco-símiles em paciente com esporotricose

Abstract

Sporotrichosis is a subcutaneous fungal infection caused by Sporothrix schenckii and acquired by direct inoculation. Although the majority of cases consist of the classic lymphocutaneous presentation, the frequency of atypical and severe clinical forms of the disease has increased progressively. Systemic and disseminated cutaneous sporotrichosis constitute rare variants and such cases are generally associated with cellular immunodeficiency or debilitated states. The present paper describes the first published case of molluscum-like lesions in disseminated mucocutaneous sporotrichosis. Direct mycological examination and histopathology revealed numerous yeast cells. Keywords: Itraconazole; Mycoses; Molluscum contagiosum; Sporotrichosis Resumo: Esporotricose é uma infecção fúngica subcutânea, adquirida por inoculação direta, causada pelo Sporothrix schenckii. Embora a apresentação clássica linfocutânea represente a maioria dos casos, as formas clínicas atípicas e graves têm aumentado em ocorrência. Esporotricose sistêmica e esporotricose cutânea disseminada são variantes raras, usualmente associadas à imunodeficiência celular ou a estados debilitantes. Relatamos o primeiro caso na literatura de lesões molusco-símiles em esporotricose cutaneomucosa múltipla. Os exames micológico direto e histopatológico apresentavam-se ricos em células leveduriformes. ©2011 by Anais Brasileiros de Dermatologia ▲ The increased incidence of sporotrichosis in Brazil has led to a rise in the number of cases involving unusual sites, lesions that are morphologically different from the classic types, and to generalization and systematization of the involvement of Sporothrix schenckii. [1][2][3][4] This report describes a 52-year old male patient with a history of alcoholic hepatopathy. He reported myalgia, nighttime fever and sweating over the previous three months, as well as a weight loss of 23 kilos. Thirty days previously, he noted an erythematous papule on his left thigh that subsequently ulcerated, with rapid dissemination of lesions to the rest of his body. Dermatological examination revealed papules, nodules and ulcerations with honey-colored crusts and raised borders over his entire body ( Figure 1). Molluscum-like lesions were found on his face and cervical region, sialorrhea and ulcerations on the tonsillar pillars and nasal mucosa (Figure 2). Direct mycological examination showed numerous yeast cells. Histopathology showed chronic granulomatous der-

Atypical Manifestation of Disseminated Sporotrichosis in an AIDS Patient

“…Despite these recommendations, Paixão et al [ 12 ], in a report from 2015, describe the difficulty of the therapeutic handling of disseminated sporotrichosis, especially in patients with acquired immunodeficiency syndrome. This fact had also been observed before by Schechtman et al [ 13 ] in 2011, whose patient with disseminated cutaneous sporotrichosis did not show a good therapeutic response even with the use of amphotericin B associated to itraconazole. There are also reports of limited response with association of terbinafine 250 mg/day, itraconazole 200 mg/day, and amphotericin B in liposomal formulation 3–5 mg/kg daily [ 12 , 14 ].…”

“…After onset of the sporotrichosis epidemic in Rio de Janeiro, several atypical clinical forms of sporotrichosis have been observed [ 1 ]. The first reported case of sporotrichosis manifesting as a molluscum-like lesion was demonstrated by Schechtman et al in 2011 [ 13 ].…”

Sporotrichosis in an unusual location - Case report

“…The increased incidence of sporotrichosis in Brazil has led to an increase in the number of cases in unusual locations, with lesions morphologically different from the traditional forms, as well as to the generalization and systematization of the disease. 5 …”

“…Although the traditional cutaneous-lymphatic form represents most cases of sporotrichosis, the increased incidence of the disease in Brazil has led to an increase in the incidence of atypical and severe clinical forms. 5 …”

Fixed cutaneous sporotrichosis in a patient with numerous fungal elements

“…In most sporotrichosis, histopathological detection of the etiologic agent is difficult due to a low fungal load, abundant cells being found in tissue only occasionally [ 6 ]. Sporotrichosis with numerous fungal elements is usually related to decreased immunity or underlying disorders, such as human immunodeficiency virus (HIV) infection, diabetes mellitus, alcoholism, or prolonged medication [ [7] , [8] , [9] ]. Corticosteroid therapy is one of the principal causes for this unusual histological feature.…”