Palate ulcer, uvular destruction and nasal septal perforation caused by Sporothrix brasiliensis in an HIV-infected patient

Abstract

Sporotrichosis is a human and animal disease caused by dimorphic pathogenic species of the genus Sporothrix. We report a dramatic presentation of Sporothrix brasiliensis infection, with destruction of the nasal septum, soft palate, and uvula of an HIV-infected woman. She was successfully treated with amphotericin B deoxycholate followed by itraconazole. Sporotrichosis remains a neglected opportunistic infection in patients with AIDS and awareness of this potentially fatal infection is of utmost importance.

Sporotrichosis in the nasal mucosa: A single-center retrospective study of 37 cases from 1998 to 2020

“…The most diagnosed clinical presentations of sporotrichosis worldwide are lymphocutaneous and fixed cutaneous [6], both localized forms of the disease. Disseminated and PLOS NEGLECTED TROPICAL DISEASES disseminated cutaneous forms are less frequent and usually associated with immunosuppression or comorbidities [7][8][9][10][11]14]. This study showed that, in addition to the increase in the total number of sporotrichosis cases, there was also an increase in the diagnosis of nasal mucosa involvement (disseminated/extracutaneous form), which occurred alone in 14 (37.84%) cases.…”

“…The most common clinical forms of the disease are lymphocutaneous and fixed cutaneous [6]. The disseminated form is uncommon but more severe, can affect multiple organs and systems and is primarily related to immunosuppression (e.g., HIV) [7][8][9][10][11][12]. There are also cases of disseminated sporotrichosis as a manifestation of immune reconstitution inflammatory syndrome (IRIS) after the initiation of antiretroviral therapy in people living with HIV (PLHIV) [13].…”

“…The mucosal form is considered by some professionals a variant of the cutaneous form [16]. In its clinical classification, it can be named as mucocutaneous [17], mucosal [6,[16][17][18] or extracutaneous/disseminated forms [8,10,11] and may appear alone or as a more extensive involvement affecting other body sites. Mucosal involvement may occur by contact of hands contaminated with the fungus, by hematogenous route, by contiguity from the skin, by inhalation of conidia (of environmental origin) [16] or yeasts (aerosols from sneezing or movements of sick cats) [3].…”

“…The lesion of the mucosa has an aspect suggestive of microabscesses (Martins, ACC-personal observation), with infiltration and often associated with nasal crusts and elimination of bloody secretions [16]. Involvement of the upper aerodigestive tract mucosa is uncommon in sporotrichosis, with few reports in the literature [2,8,9,14,[19][20][21]. In general, the resolution of cases takes longer than that of skin lesions [8,9,14,19].…”

“…Involvement of the upper aerodigestive tract mucosa is uncommon in sporotrichosis, with few reports in the literature [2,8,9,14,[19][20][21]. In general, the resolution of cases takes longer than that of skin lesions [8,9,14,19].…”