Abstract:An 87-year-old patient presented with a 6-week history of an isolated progressive destructive nodular eyelid mass, secondary nodular and ulcerative lesions, and regional painful lymphadenopathy. After 4 weeks, fungal cultures demonstrated Sporothrix schenckii. S. schenckii is a rare dimorphic fungus that can occasionally involve the periocular skin. The authors' case demonstrates typical clinical features, emphasizes the delay in diagnosis, and shows effective treatment with oral itraconazole.
“…The conjunctival and lacrimal sac involvement is even more rarely described [6] and the delay in the diagnosis of this patient may have contributed to the lesion extension. Other authors have also reported periods of 1-3 months until a definitive diagnosis is obtained [8,10]. Overall, the clinical presentation of the disease is variable [6] and can be misdiagnosed with other diseases such as hordeolum, lacrimal sac tumor [26], bacterial abscesses, and basal cell or sebaceous carcinoma [10] until a final diagnosis is obtained.…”
Section: Discussionmentioning
confidence: 99%
“…The establishment of this mycosis in ocular adnexa is rare [1,6,7], and typically limited to the eyelids and eyebrows with accompanying regional lymphadenopathy following traumatic inoculation, or as fixed-cutaneous ulceration or conjunctivitis following exposure [6,8,9]. However, the number of reported ocular sporotrichosis cases has increased in recent years [6][7][8][10][11][12][13], especially in Rio de Janeiro State, Brazil, where sporotrichosis is endemic [14,15].…”
Sporotrichosis is a globally distributed subcutaneous fungal infection caused by dimorphic fungi belonging to the Sporothrix species complex that affects the skin of limbs predominantly, but not exclusively. A rare case of ocular sporotrichosis in an immunocompetent Brazilian patient from the countryside of Rio de Janeiro State is reported. A 68-year-old woman presented with a subconjunctival infiltrative lesion in the right eye with pre-auricular lymphadenopathy of onset 4 months ago that evolved to suppurative nodular lesions on the eyelids. Conjunctival secretion was evaluated by histopathological examination and inoculated on Sabouraud Dextrose Agar (SDA). Histopathology showed oval bodies within giant cells and other mononucleated histiocytes. Fungus grown on SDA was identified as Sporothrix sp. by morphological observations. The isolated strain was finally identified by Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry (MALDI-TOF MS) associated with an in-house database enriched with reference Sporothrix complex spectra. The strain presented a MALDI spectrum with the ion peaks of the molecular mass profile of S. brasiliensis. The patient was adequately treated with amphotericin B subsequently replaced by itraconazole. Due to scars left by the suppurative process, the patient presented poor final visual acuity. The present work presents an overview of ocular sporotrichosis and discusses the diagnostic difficulty that can lead to visual sequelae in these cases.
“…The conjunctival and lacrimal sac involvement is even more rarely described [6] and the delay in the diagnosis of this patient may have contributed to the lesion extension. Other authors have also reported periods of 1-3 months until a definitive diagnosis is obtained [8,10]. Overall, the clinical presentation of the disease is variable [6] and can be misdiagnosed with other diseases such as hordeolum, lacrimal sac tumor [26], bacterial abscesses, and basal cell or sebaceous carcinoma [10] until a final diagnosis is obtained.…”
Section: Discussionmentioning
confidence: 99%
“…The establishment of this mycosis in ocular adnexa is rare [1,6,7], and typically limited to the eyelids and eyebrows with accompanying regional lymphadenopathy following traumatic inoculation, or as fixed-cutaneous ulceration or conjunctivitis following exposure [6,8,9]. However, the number of reported ocular sporotrichosis cases has increased in recent years [6][7][8][10][11][12][13], especially in Rio de Janeiro State, Brazil, where sporotrichosis is endemic [14,15].…”
Sporotrichosis is a globally distributed subcutaneous fungal infection caused by dimorphic fungi belonging to the Sporothrix species complex that affects the skin of limbs predominantly, but not exclusively. A rare case of ocular sporotrichosis in an immunocompetent Brazilian patient from the countryside of Rio de Janeiro State is reported. A 68-year-old woman presented with a subconjunctival infiltrative lesion in the right eye with pre-auricular lymphadenopathy of onset 4 months ago that evolved to suppurative nodular lesions on the eyelids. Conjunctival secretion was evaluated by histopathological examination and inoculated on Sabouraud Dextrose Agar (SDA). Histopathology showed oval bodies within giant cells and other mononucleated histiocytes. Fungus grown on SDA was identified as Sporothrix sp. by morphological observations. The isolated strain was finally identified by Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry (MALDI-TOF MS) associated with an in-house database enriched with reference Sporothrix complex spectra. The strain presented a MALDI spectrum with the ion peaks of the molecular mass profile of S. brasiliensis. The patient was adequately treated with amphotericin B subsequently replaced by itraconazole. Due to scars left by the suppurative process, the patient presented poor final visual acuity. The present work presents an overview of ocular sporotrichosis and discusses the diagnostic difficulty that can lead to visual sequelae in these cases.
“…Subcutaneous mycosis such as micetoma, chromoblastomycosis, and sporotrichosis ( Fig. 6 ) are rare in this location but have been reported, such as a case of sporotrichosis with eyelid involvement after a traumatic injury with a subsequent development of nodular subcutaneous lesions with lymphangitis dissemination ( Iyengar et al, 2010 ). Fig.…”
The periocular area may be affected by infectious or noninfectious diseases such as inflammatory dermatoses, systemic disease, drug reactions, benign and malignant lesions, traumatic lesions, and esthetic complications. We present a review of the most common periocular dermatoses.
“…In general, the face, hands, forearms and feet are involved in patients with sporotrichosis. To date, sporotrichosis infection on the eyelids has been rarely reported . Moreover, sporotrichosis on the eyelids is typically misdiagnosed as hordeolum or lacrimal sac tumour because its clinical presentation is atypical.…”
Sporotrichosis on the eyelids is uncommon and has been rarely reported. As the largest series of 72 adults and children with eyelid sporotrichosis from Jilin ̀P̀̀rovince in China, this study provides useful information for the improved diagnosis and treatment of sporotrichosis.
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