Jorge Lobo’s disease: a case of keloidal blastomycosis (lobomycosis) in a nonendemic area

Arju, Rezina; Kothadia, Jiten P.; Kaminski, Monica; Abraham, Sherly; Giashuddin, Shah

doi:10.1177/2049936114559919

Cited by 8 publications

(50 citation statements)

References 15 publications

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“…3,4 To our knowledge, this is the first report of lobomycosis in a European traveler. Only nine imported cases have been described in industrialized countries: the United Kingdom, 5 the United States, 7,8,11,14 the Netherlands, 9 France, 10 Germany, 12 and Canada. 13 Five were migrants from endemic countries whereas only four were travelers from the United States, 11,14 Canada, 13 and South Africa 5 visiting Venezuela, Brazil, and Mexico.…”

Section: Discussionmentioning

confidence: 99%

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Case Report: Molecular Confirmation of Lobomycosis in an Italian Traveler Acquired in the Amazon Region of Venezuela

Beltrame

Danesi

Farina

et al. 2017

The American Journal of Tropical Medicine and Hygiene

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Lobomycosis is a chronic skin mycosis endemic in Amazon regions characterized by chronic nodular or keloidal lesions caused by , an uncultivable fungus. Imported cases in nonendemic countries are rare and diagnosed after years. We describe a case of lobomycosis in a healthy 55-year-old Italian traveler who had acquired the infection during 5-day-honeymoon in the Amazon region of Venezuela in 1999. Several weeks after return, he recalled pruritus and papular skin lesions on the left lower limb, subsequently evolving to a plaque-like lesion. Blastomycosis and cryptococcosis were hypothesized based on microscopic morphology of yeast-like bodies found in three consecutive biopsies, although fungal cultures were always negative. In 2016, exfoliative cytology and a biopsy specimen examination showed round yeast-like organisms (6-12 μm), isolated or in a chain, connected by short tubular projections fulfilling the morphologic diagnostic criteria of spp. The microscopic diagnosis was confirmed by molecular identification.

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Section: Discussionmentioning

confidence: 99%

“…5,6 Till date, only nine cases of imported lobomycosis in nonendemic countries have been described. 5,[7][8][9][10][11][12][13][14] In all cases, a long period elapsed between the exposure to endemic areas and the diagnosis.…”

mentioning

confidence: 99%

Case Report: Molecular Confirmation of Lobomycosis in an Italian Traveler Acquired in the Amazon Region of Venezuela

Beltrame

Danesi

Farina

et al. 2017

The American Journal of Tropical Medicine and Hygiene

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“…Considering the fact that L . loboi is an intracellular organism [ 9 , 27 , 28 ], IFN-γ may play a critical role in the elimination of L . loboi through the activation of macrophages, as described in studies on other intracellular pathogens [ 18 , 29 ].…”

Section: Discussionmentioning

confidence: 99%

“…JLD is endemic to the Amazon rainforest region [ 1 , 5 , 6 ]; out of the 322 cases reported in Brazil thus far, 249 cases have been from the state of Acre, which is located in the Amazon region [ 1 , 2 ]. Though it is endemic to this area [ 1 , 5 , 6 ], JLD has also been diagnosed in Central America, North America, Europe and South Africa [ 1 , 7 , 8 , 9 ], with approximately 550 cases reported worldwide [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Analysis of Immune Response Markers in Jorge Lobo's Disease Lesions Suggests the Occurrence of Mixed T Helper Responses with the Dominance of Regulatory T Cell Activity

et al. 2015

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Jorge Lobo’s disease (JLD) is a chronic infection that affects the skin and subcutaneous tissues. Its etiologic agent is the fungus Lacazia loboi. Lesions are classified as localized, multifocal, or disseminated, depending on their location. Early diagnosis and the surgical removal of lesions are the best therapeutic options currently available for JLD. The few studies that evaluate the immunological response of JLD patients show a predominance of Th2 response, as well as a high frequency of TGF-β and IL-10 positive cells in the lesions; however, the overall immunological status of the lesions in terms of their T cell phenotype has yet to be determined. Therefore, the objective of this study was to evaluate the pattern of Th1, Th2, Th17 and regulatory T cell (Treg) markers mRNA in JLD patients by means of real-time PCR. Biopsies of JLD lesions (N = 102) were classified according to their clinical and histopathological features and then analyzed using real-time PCR in order to determine the expression levels of TGF-β1, FoxP3, CTLA4, IKZF2, IL-10, T-bet, IFN-γ, GATA3, IL-4, IL-5, IL-13, IL-33, RORC, IL-17A, IL-17F, and IL-22 and to compare these levels to those of healthy control skin (N = 12). The results showed an increased expression of FoxP3, CTLA4, TGF-β1, IL-10, T-bet, IL-17F, and IL-17A in lesions, while GATA3 and IL-4 levels were found to be lower in diseased skin than in the control group. When the clinical forms were compared, TGF-β1 was found to be highly expressed in patients with a single localized lesion while IL-5 and IL-17A levels were higher in patients with multiple/disseminated lesions. These results demonstrate the occurrence of mixed T helper responses and suggest the dominance of regulatory T cell activity, which could inhibit Th-dependent protective responses to intracellular fungi such as L. loboi. Therefore, Tregs may play a key role in JLD pathogenesis.

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“…Lobomycosis is a chronic granulomatous infection of the cutis and subcutis caused by the fungal species Lacazia loboi (Arju et al, 2014;de Sousa et al, 2015;Grayson & Colonje, 2020;Hall et al, 2017;Pasqualotto et al, 2021;Queiroz-Telles et al, 2017). This disease is endemic to tropical forest areas of Central and South America, particularly in the Amazon basin, (Grayson & Colonje, 2020) and cases are very rarely reported outside this area (Beltrame et al, 2017).…”

Section: Introductionmentioning

confidence: 99%

Lobomycosis post long-term corticosteroid therapy: a case report

Saputra

Sriwidyani

Paskarani

et al. 2022

RSD

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Introdução: A lobomicose é uma das infecções fúngicas mais raramente relatadas em todo o mundo. A maioria dos casos relatados de lobomicose é endêmica na América Central e do Sul, especialmente em torno da Amazônia. As áreas do corpo afetadas geralmente são as orelhas, extremidades inferiores, extremidades superiores, rosto, tórax e costas. Objetivo: apresentar a evolução da lobomicose após corticoterapia de longa duração. Metodologia: Estudo descritivo do tipo relato de caso, cujos dados foram obtidos no prontuário do paciente. Apresentação do caso: Este artigo relata uma mulher de 23 anos, que sofreu feridas que cobriam quase toda a superfície do corpo sem qualquer febre. Ao exame físico, foram encontradas múltiplas úlceras com maceração das bordas da ferida e múltiplas saliências avermelhadas nas regiões anterior e posterior do tronco. Não há aparecimento de quelóides. O paciente tinha história de pênfigo vulgar e pênfigo vegetante e estava em uso de corticoterapia por longo prazo. O exame microbiológico não revelou crescimento de fungos. O exame histopatológico do tecido com coloração de Hematoxilina-Eosina e Ácido Periódico de Schiff (PAS) confirmou o diagnóstico de lobomicose. Conclusão: Com base nos achados clínicos e laboratoriais, o paciente foi diagnosticado com Lobomicose.

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Jorge Lobo’s disease: a case of keloidal blastomycosis (lobomycosis) in a nonendemic area

Abstract: Lobomycosis or lacaziosis is a chronic subcutaneous fungal infection, caused by the fungus Lacazia loboi, which is phylogenetically related to Coccidioides, Blastomyces,

Cited by 8 publications

References 15 publications

Case Report: Molecular Confirmation of Lobomycosis in an Italian Traveler Acquired in the Amazon Region of Venezuela

Case Report: Molecular Confirmation of Lobomycosis in an Italian Traveler Acquired in the Amazon Region of Venezuela

Analysis of Immune Response Markers in Jorge Lobo's Disease Lesions Suggests the Occurrence of Mixed T Helper Responses with the Dominance of Regulatory T Cell Activity

Lobomycosis post long-term corticosteroid therapy: a case report

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