Esporotricosis: presentación de un caso inusual / An unusual presentation of sporotrichosis: a case report

La esporotricosis es una micosis subcutánea de evolución crónica que puede afectar a humanos y animales, causada por el complejo Sporothrix schenckii, se considera un padecimiento ocupacional y su vía de entrada es a través de traumatismos, es frecuente en niños y adolescentes. Se comunica el caso de una adolescente de 12 años, con historia clínica de un año de evolución de causas no bien identificadas de dermatosis facial localizada en región pre-auricular izquierda, constituida por una placa eritematosa, escamosa, indurada, de bordes definidos. Se confirmó el diagnóstico de esporotricosis cutánea fija por el aislamiento en el cultivo y biopsia de lesión. La paciente fue dada de alta con tratamiento de yoduro de potasio durante dos meses.

Sporotrichosis is a chronic subcutaneous mycosis that can affect humans and animals caused by Sporothrix schenckii complex, it is considered an occupational disease and its route of entry is through injuries, it is common in children and adolescents. A 12-year-old female patient with a lesion of one year of evolution, not well identified causes of facial dermatosis localized in left preauricular region, consisting of an erythematous, scaly, indurated and defined edges. The diagnosis of fixed cutaneous sporotrichosis by isolation in culture and wound biopsy was confirmed. The patient was discharged with potassium iodide treatment for two months.

A Case of Fixed Cutaneous Sporotrichosis Caused by Sporothrix globosa on the Face / 대한의진균학회지

Sporotrichosis is a chronic cutaneous fungal infection caused by Sporothrix (S.) schenckii complex. Fixed cutaneous sporotrichosis is one of the three subtype of sprotrichosis and accounts for 20% of total sporotrichosis cases. However, the incidence of total sporotrichosis cases is decreasing recently due to improvement of personal hygiene and industrialization. A 60-year-old woman presented to the hospital with multiple erythematous papules and ulcers on left cheek for 5 months. Histopathologic examination revealed chronic granulomatous inflammation and immunohistochemical staining was positive for GMS and PAS stain. The fungal culture on Sabouraud dextrose agar showed grayish dark brown colonies and the sequences of ribosomal DNA internal transcribed spacer region of clinical sample was 100% similarity with S. globosa. The patient was treated with oral itraconazole 200 mg daily and topical ketoconazole cream for 3 months. At that time after this treatment, skin lesion was almost cured and recurrence is not observed to date.

Esporotricosis granulomatosa: presentación de dos casos inusuales / Granulomatous sporotrichosis: report of two unusual cases

Sporotrichosis is a subcutaneous mycosis caused by Sporothrix complex, endemic in Abancay, Peru. Is acquired by traumatic inoculation with plant material. Common clinical presentations are lymphatic cutaneous and fixed cutaneous disease. We report 2 cases of fixed cutaneous sporotrichosis with granulomatous appearance. The first case was a patient of 65 years old with no risk factors and the second case was a 67 year old diabetic patient. Subjects underwent mycological culture with Sabouraud agar, with isolation of Sporothrix schenckii and clinical dignosis of fixed cutaneous sporotrichosis with granulomatous appearance. One patient received oral treatment with saturated solution of potassium iodide (SSKI) with a initial dose of 3 drops tid up to a maximum dose of 40 drops tid. Mycological and clinical cure was achieved after 2 months of treatment. We should consider the unusual clinical presentations of fixed cutaneous sporotrichosis with granulomatous appearance that present morphological and clinical features in diabetic and nondiabetic patients older than 60 years from endemic areas and communicate adequate response to treatment with SSKI in one case.

La esporotricosis es una micosis subcutánea ocasionada por el complejo Sporothrix, endémica en Abancay, Perú. Se adquiere por inoculación traumática con material vegetal. Las formas clínicas comúnmente descritas son la cutánea linfática y cutánea fija. Presentamos dos casos de pacientes adultos con una esporotricosis cutánea fija granulomatosa. El primer caso era una paciente de 65 años de edad, sin antecedentes de riesgo y el segundo era una paciente de 67 años, diabética. El diagnóstico se realizó por cultivo micológico aislándose Sporothrix schenckii. Un caso se trató con solución saturada de yoduro de potasio (SSKI), vía oral, alcanzando la cura micológica y clínica tras dos meses de tratamiento. La otra paciente no acudió a tratamiento. Se revisan las presentaciones clínicas inusuales de la esporotricosis cutánea fija y la forma granulomatosa que presenta características morfológicas y clínicas poco habituales en pacientes diabéticos y no diabéticos mayores de 60 años provenientes de zonas endémicas.

Cutaneous sporotrichosis: Unusual clinical presentations.

Three unusual clinical forms of sporotrichosis described in this paper will be a primer for the clinicians for an early diagnosis and treatment, especially in its unusual presentations. Case 1, a 52-year-old man, developed sporotrichosis over pre-existing facial nodulo-ulcerative basal cell carcinoma of seven-year duration, due to its contamination perhaps from topical herbal pastes and lymphocutaneous sporotrichosis over right hand/forearm from facial lesion/herbal paste. Case 2, a 25-year-old woman, presented with disseminated systemic-cutaneous, osteoarticular and possibly pleural (effusion) sporotrichosis. There was no laboratory evidence of tuberculosis and treatment with anti-tuberculosis drugs (ATT) did not benefit. Both these cases were diagnosed by histopathology/culture of S. schenckii from tissue specimens. Case 3, a 20-year-old girl, had multiple intensely pruritic, nodular lesions over/around left knee of two-year duration. She was diagnosed clinically as a case of prurigo nodularis and histologically as cutaneous tuberculosis, albeit, other laboratory investigations and treatment with ATT did not support the diagnosis. All the three patients responded well to saturated solution of potassium iodide (SSKI) therapy. A high clinical suspicion is important in early diagnosis and treatment to prevent chronicity and morbidity in these patients. SSKI is fairly safe and effective when itraconazole is not affordable/ available.

Efetividade da Terbinafina na dosagem de 250 mg por dia no tratamento da esporotricose cutânea / Effectiveness of terbinafine at a dosage of 250 mg per day in the treatment of cutaneous sporotrichosis

O tratamento de eleição para a esporotricose na sua forma cutânea é o itraconazol. Este é um fármaco eficaz e com boa tolerância pelos pacientes, mas apresenta uma série de interações medicamentosas que dificultam o seu uso. A terbinafina, um derivado alilamina com atividade fungicida, tem seu uso descrito no tratamento da esporotricose cutânea com dosagens variáveis (250 mg a 1 g/dia). Entretanto, a posologia ideal não está estabelecida. Este estudo teve como objetivo avaliar a efetividade e segurança da terbinafina na dosagem de 250 mg no tratamento da esporotricose cutânea. Foram realizados dois estudos complementares em pacientes com esporotricose cutânea com terbinafina 250 mg/dia no período de janeiro de 2005 a dezembro de 2008: 1) um estudo descritivo em pacientes com contra-indicação ao uso do itraconazol ou interação medicamentosa de moderada a grave, 2) um estudo analítico de coorte bidirecional, comparando com o itraconazol 100 mg/dia. O grupo itraconazol foi selecionado randomicamente do banco de dados do serviço, após pareamento por idade e forma clínica. O Sporothrix schenckii foi isolado em cultivo de todos os pacientes, com idade entre 18 a 70 anos e que foram submetidos ao protocolo de atendimento que incluiu avaliação clínica, hemograma e bioquímica e consultas com periodicidade determinada...

No estudo descritivo, foram selecionados 50 pacientes que apresentavam comorbidades e utilizaramm medicamentos em que não era possível o uso de itraconazol (36% psicolépticos; 28% hipoglicemiantes; 18% hipolipêmicos; 16% bloqueadores do canal de cálcio; 8% anticonvulsivantes; 6,3% cardiotrópicos; 6,3% antiácidos e anti-parkinsonianos 2,1%). A maioria (96%) curou em 14 semanas, variando de 2 a 42. A terbinafina foi suspensa em um caso por reação de hipersensibilidade (erupção cutânea) e não houve recidiva da micose. No estudo analítico de coorte bidirecional, foram incluídos 55 pacientes no grupo da terbinafina e 249 do itraconazol. A cura ocorreu respectivamente em 51 (92,7%) e 229 (92%) em média de 11 e 10,5 semanas. Em dois pacientes foi necessário o aumento da dose da terbinafina para 500 mg por não resposta e uma paciente apresentou recidiva. No grupo do itraconazol dois necessitaram aumento da dose e três apresentaram recidiva. Os efeitos adversos foram quatro (7,3%) sem necessidade de suspensão do medicamento no grupo terbinafina e 19 (7,6%) com sua suspensão em dois pacientes no grupo itraconazol. A terbinafina na dose de 250 mg/dia é uma opção para o tratamento da esporotricose cutânea sendo efetiva e bem tolerada...

Two Cases of Fixed Cutaneous Sporotrichosis / 대한의진균학회지

Sporotrichosis is a chronic infectious disease caused by Sporothrix(S.) schenckii. Regional lymphatic sporotrichosis is common type, accounting for 75% of the cases. But fixed cutaneous sporotrichosis is seen in 20% of cases. We report two cases of fixed cutaneous sporotrichosis in a 48-year-old man and 8-year-old boy. The lesions were manifested by erythematous plaques on right arm and left cheek, respectively. The fungal culture from biopsy specimen on Sabouraud's dextrose agar showed dark brown to black, moist and wrinkled colonies of S. schenckii. Histopathologically, pseudoepitheliomatous hyperplasia and chronic granulomatous inflammation were observed on H & E stain. The patients were treated with surgical excision of lesion & oral administration of 30 drops of saturated solution of potassium iodide three times a day and 100 mg of itraconazole daily for 3 months, respectively. Skin lesions were completely cured and recurrence is not observed to date.

Therapeutic Effectiveness of Oral Itraconazole for Cutaneous Sporotrichosis / 대한의진균학회지

BACKGROUND: The effectiveness of some therapeutic modalities for cutaneous sporotrichosis may be changed depending on the individual and geographic characteristics, and the clinical type. Itraconazole has been known to be effective for it, however, there have been no standard and ideal guideline on the oral dosage and duration yet. OBJECTIVE & METHODS: In this study, we evaluated the effectiveness of oral itraconazole in patients with cutaneous sporotrichosis in relation to dosage and clinical status. The observation of 17 patients with sporotrichosis were made retrospectively Oral itraconazole was administered at the dose of 200 mg daily in 15 adults over 18 years old and 100 mg in the other 2 children. RESULTS: The duration for healing was within 30 days in 4 cases, within 60 days in 4 cases, within 90 days in 2 cases, within 120 days in 3 cases, and within 150 days of therapy in 2 cases. The average duration in all cases was 12.1+/-8.6 weeks. Comparison our results to the previous reported one revealed that more shorter treatment time was needed in cases treated with 200 mg daily than that with 100 mg. There was no treatment failure by drug intolerance or resistance. The duration for healing was significantly shorter in the patient groups with prevalence duration more than 5 months, however there was not any significant difference in sex of patients, and the clinical types. The cases with the lesion on the face and cases with fixed type tended to be healed more rapidly than the others. CONCLUSION: Oral itraconazole may be a safe and e(fictive antifungal agent for the treatment of cutaneous sporotrichosis in a daily dose of 200 mg for 3 months on the average. However, duration for healing could be influenced by the clinical status.