Lacaziosis - unusual clinical presentation

Abstract

Lacaziosis or Jorge Lobo's disease is a fungal, granulomatous, chronic infectious disease caused by Lacazia loboi, which usually affects the skin and subcutaneous tissue. It is characterized by slow evolution and a variety of cutaneous manifestations with the most common clinical expression being nodular keloid lesions that predominate in exposed areas. We report the case of a patient who had an unusual clinical presentation, with a single-plated lesion on the back. Histopathological examination confirmed the diagnosis of Lacaziosis.

Onychomatricoma of the Nail Bed

“…Since its first description in 1992, some cases have been reported in the literature, describing its clinical, intraoperative, and histopathological characteristics in the nail matrix and plate [1, 2]. Recent data consider it the result of a cell differentiation disorder at the nail matrix, but with uncertain etiology [3, 4].…”

“…Fingers are more commonly affected than toes, with prevalence of 63 and 36%, respectively [5]. Although showing characteristic clinical and intraoperative signs, the lack of knowledge about this disease and its tendency to be asymptomatic contribute to a mistaken and/or late diagnosis [2, 5]. …”

“…Other findings that may be present include transverse hypercurvature, longitudinal hypercurvature, erythema and edema of the proximal nail fold, prominent longitudinal groove, longitudinal melanonychia, onychodystrophy, and dorsal pterygium [2, 5, 6]. …”

“…However, the gold standard diagnostic method is histopathological examination [2, 5]. The latter reveals a fibroepithelial tumor with biphasic growth that shows multiple digitiform projections coated by matrix papillomatous epithelium, which runs towards the nail plate and generates perforations [2, 5, 7]. …”

Lobomicose

“…6 Posteriormente surgiram diversas denominações tais como: doença de Jorge Lobo, blastomicose de Jorge Lobo, blastomicose pseudolepromatosa amazó-nica, 7 Lobomicose, e mais recentemente Lacaziose. 8 As lesões nodulares de aspecto queloidiforme são características dessa doença, sendo relatadas outras apresentações, nomeadamente placas eritemato-violáceas infiltradas, 8,9 como observado no presente caso. Por apresentar caráter polimorfo, foram propostas classificações que se baseiam essencialmente nos aspectos clínicos morfológicos, subdividindo os casos em infiltrativos, queloides, placas verruciformes e ulceradas.…”