Cutaneous manifestations of deep mycosis: An experience in a tropical pathology laboratory

Abstract

Background:Cutaneous manifestations of deep mycotic infection are fraught with delayed or misdiagnosis from mainly cutaneous neoplastic lesions.Aim:This study is designed to present our experience of these mycoses in a pathology laboratory in the tropics.Materials and Methods:A clinicopathologic analysis of deep mycotic infections was conducted over a 15 years period Formalin fixed and paraffin wax processed biopsies were stained with hematoxylin and eosin, periodic acid Schiff (PAS), and Grocott's methenamine silver (GMS) for the identification of fungus specie. Patients’ bio-data and clinical information were obtained from records.Results:Twenty males and seven females presented with 6 months to 6 years histories of varying symptoms of slow growing facial swellings, nodules, subcutaneous frontal skull swelling, proptosis, nasal blockage, epistaxis, discharging leg sinuses, flank mass, convulsion and pain. Of the 27 patients, four gave antecedent history of trauma, two had recurrent lesions which necessitated maxilectomy, two presented with convulsion without motor dysfunction while one had associated erosion of the small bones of the foot. None of the patients had debilitating illnesses such as diabetes mellitus, tuberculosis, and HIV infection. Tissue histology revealed histoplasmosis (10), mycetoma (9), subcutaneous phycomycosis (6), and phaeohyphomycosis (2).Conclusion:Deep mycoses may present primarily as cutaneous lesions in immunocompetent persons and often elicit distinct histologic inflammatory response characterized by granuloma formation. Diagnosis in resource constraint setting can be achieved with tissue stained with PAS and GMS which identifies implicated fungus. Clinical recognition and adequate knowledge of the pathology of these mycoses may reduce attendant patient morbidity.

Atypical mycobacterial cutaneous infections in Egyptians: A clinicopathological study

“…Histologically, the granulomatous infiltrate of deep mycosis usually showed deep suppurative granuloma with neutrophilic abscess formation that usually surround the fungal hyphae in the deep dermis or subcutis. 36 The epidermis is usually normal or shows minimal changes while follicular involvement is much less than that observed with AMCI.…”

“…However, some clinical clues that help in differentiating both conditions include sinus formation with discharge, large subcutaneous mass formation, mucosal or bone involvement, pulmonary affection and presence of associated systemic symptoms. Histologically, the granulomatous infiltrate of deep mycosis usually showed deep suppurative granuloma with neutrophilic abscess formation that usually surround the fungal hyphae in the deep dermis or subcutis . The epidermis is usually normal or shows minimal changes while follicular involvement is much less than that observed with AMCI.…”

Cutaneous Manifestation of Underlying Disseminated Histoplasmosis in an Immunocompetent Host of Nonendemic Area with Reversible CD4 Cell Depletion and its Recovery on Antifungal Therapy

“…Cutaneous deep mycosis in immunocompetent hosts will Mycopathologia often elicit distinct histologic inflammatory response characterized by granuloma formation, and diagnosis can be achieved with tissue or fluid culture, tissue histology stained with H&E, PAS and GMS, immunohistochemistry and serology [25]. Histoplasmosis accounted for 37 % of these cases with a higher frequency in males [22]. Idiopathic CD4 lymphopenia (ICL) is a rare syndrome characterised by depleted CD4T lymphocytes to a level less than 300 cells/ml or \20 % of total lymphocytes over a period of minimum 6 weeks in patients without evidence of HIV infection, history of primary immunodeficiency or therapy-induced immunosuppression [26].…”

“…Cutaneous manifestation of deep mycosis is uncommon and fairly limited to few fungi species [22]. However, a number of dimorphic fungi are known in the causation of deep mycoses in immunocompromised persons [23].…”

PAS and GMS utility in dermatopathology: Review of the current medical literature

“…PAS and GMS were reported to be positive in most cases and concluded to be a helpful ancillary test 28. However, exact numbers or percentages of positive cases were not provided, particular staining characteristics of the fungi detected were not described, and the sensitivity and specificity of PAS vs GMS stains were not discussed.…”