Sporotrichoid cutaneous leishmaniasis: atypical form

Leishmaniasis comprises a heterogeneous and extensive group of infectious and non-contagious diseases caused by protozoa of the genus Leishmania spp. It is a disease considered endemic in 92 countries, with at least 1 million new cases of integumentary forms annually. Cutaneous leishmaniasis is endemic in the tropics and neotropics. It is often referred to as a group of diseases because of the varied spectrum of clinical manifestations, which range from small cutaneous nodules to gross mucosal tissue destruction. Cutaneous leishmaniasis can be caused by several Leishmania spp. and is transmitted to human beings and animals by sandflies. Despite its increasing worldwide incidence, because it is rarely fatal, cutaneous leishmaniasis has become one of the so-called neglected diseases, In endemic countries, diagnosis is often made clinically and, if possible, by microscopic examination of lesion biopsy smears to visually confirm leishmania parasites as the cause. Cutaneous leishmaniasis often presents as an ulcerated lesion, with raised, infiltrated edges, classically described as frame-like edges at the site of the mosquito bite. We report an uncommon case of a patient who presented with a lesion on the face, sporotrichoid in appearance, and thigh, which appeared simultaneously, of clinical lesions of cutaneous leishmaniasis, laboratory-confirmed and which showed excellent clinical evolution with the use of liposomal amphotericin B.

Esporotricosis, una realidad aún presente en Chile: a propósito de un caso / Sporotrichosis, a reality still present in Chile: a case report

OBJETIVO: Reportar un caso de esporotricosis linfocutánea contraída en Chile y realizar una revisión de la literatura con énfasis en los hallazgos dermatoscópicos de las lesiones y en los casos reportados en el país. CASO CLÍNICO: Paciente adulto mayor con lesiones nodulares ulceradas siguiendo trayecto linfático en extremidad superior derecha. RESULTADOS: Estudio micológico confirmó la presencia de Sporothrix schenckii. Se inició tratamiento con antifúngico oral con buena respuesta terapéutica. CONCLUSIONES: Existe un escaso número de reporte de esporotricosis linfocutánea contraída en Chile con confirmación micológica. Este es el único caso chileno con descripción dermatoscópica de las lesiones.

OBJETIVE: To report a case of lymphocutaneous sporotrichosis adquired in Chile and provide a review of the literature with emphasis on dermoscopic findings and previous cases reported in the country. CLINICAL CASE: An elderly patient presented with ulcerated nodular lesions following lymphatic vessels in his right upper limb.RESULTS: Mycological work-up confirmed the presence of Sporothrix schenkii. Oral antifungal treatment was initiated with good therapeutic response. CONCLUSIONS: Few case reports of lymphocutaneous sporotricosis adquired in Chile can be found in literature. Until now this is the only chilean case with dermoscopic description of the lesions.

Sporotrichoid leishmaniasis: a cross-sectional clinical, epidemiological and laboratory study in Rio de Janeiro State, Brazil

ABSTRACT Background Atypical presentations of cutaneous leishmaniasis include sporotrichoid leishmaniasis (SL), which is clinically described as a primary ulcer combined with lymphangitis and nodules and/or ulcerated lesions along its pathway. Aims To assess the differences between patients with sporotrichoid leishmaniasis and typical cutaneous leishmaniasis (CL). Methods From January 2004 to December 2010, 23 cases of SL (4.7%) were detected among 494 CL patients diagnosed at a reference center for the disease in Rio de Janeiro State, Brazil. These 23 cases were compared with the remaining 471 patients presenting CL. Results SL predominated in female patients (60.9%, p = 0.024), with older age (p = 0.032) and with lesions in upper limbs (52.2%, p = 0.028). CL affected more men (64.5%), at younger age, and with a higher number of lesions exclusively in lower limbs (34.8%). Conclusions Differences in clinical and epidemiological presentation were found between SL patients as compared to CL ones, in a region with a known predominance of Leishmania (Viannia) braziliensis. The results are similar to the features of most of the sporotrichosis patients as described in literature, making the differential diagnosis between ATL and sporotrichosis more important in overlapping areas for both diseases, like in Rio de Janeiro State.

Primary Cutaneous Nocardiosis with Sporotrichoid Pattern by N. brasiliensis in Lung Cancer Patient / 대한피부과학회지

Nocardia is aerobic gram positive bacteria, which is found in the soil. Cutaneous nocardiosis is divided into the primary skin infection and secondary infection due to systemic dissemination from the internal organ. Its clinical manifestations are mycetoma, lymphocutaneous infection and superficial infection, such as abscess or granuloma. In lymphocutaneous infection, it is important to make differential diagnosis with other diseases with sporotrichoid pattern, such as sporotrichosis, leishmaniasis and mycobacterial infection. In our case, 58 year old male who had history of chemotherapy due to lung cancer visited with granulomatous nodule on the left wrist, and following lymphangitis along the forearm for 2 months. Through a skin biopsy, culture, AFB stain and 16S rRNA gene sequencing, cutaneous nocardiosis by N. brasiliensis was diagnosed.

Sporotrichoid nocardiosis with cutaneous dissemination.

Dissemination of primary cutaneous nocardiosis is a rare event. A 37-year-old man working as farmer presented with multiple painful suppurative nodular and ulcerative skin lesions over left lower extremities, in a linear pattern, with duration of five months and single painful nodule over right elbow since last three months. We found the presence of beaded filamentous bacteria in Gram stain smear and partial acid fast stain, from the smear taken from pus. Patient responded well to cotrimoxazole therapy. Hence, we confirm our diagnosis of sporotrichoid pattern of cutaneous nocardiosis with dissemination to other cutaneous area.

Primary Cutaneous Mucormycosis in a Immunocompetent Elderly Woman Showing Sporotrichoid Distribution / 대한피부과학회지

Primary cutaneous mucormycosis, a rare form of mucormycosis, develops where a break in the integrity of the skin has occurred as a result of surgery, burns, or other forms of trauma. It is mainly seen in immunocompromised hosts, but can sometimes also occur in immunocompetent hosts too. Various kinds of pathogens including viruses, bacteria, nontuberculous mycobacteria, protozoa, and fungi can show a sporotrichoid spread. However, there has been no report of mucormycosis showing a sporotrichoid distribution. We report a case of primary cutaneous mucormycosis occurring on the dorsal aspect of the right wrist in a 69-year-old immunocompetent woman. In our case, newlydeveloped lesions were distributed in sporotrichoid pattern 5 months after the initial lesion. The patient was successfully treated with a combined therapy of amphotericin B and itraconazole.

A Case of Sporotrichoid Cutaneous Infection Caused by Mycobacterium marinum / 감염과화학요법

Mycobacterium marinum is a nontuberculous mycobacterium responsible for skin infection. Risk factors include a history of trauma and water/fish-related hobbies or occupations. This infection is characteristically limited to the skin but deep soft tissue may be involved. We report a case of M. marinum infection in a 51-year-old man with ulcer and erythematous nodules on his right hand. The patient owned a tropical fish tank and remembered having previous hand trauma. The lesions extended to his forearm and formed sporotrichoid appearance. M. marinum was isolated from tissue specimens. The patient was treated with rifampin, etambutol and clarithromycin for 5 months, then the skin lesions were cured. The key to the diagnosis of this case are clinical awareness and a detailed history. M. marinum infection should be considered in chronic sporotrichoid skin lesions, particularly when there is a clinical suspicion on an infectious cause, and it could lead to successful treatment.

A Case of Sporotrichoid Cutaneous Infection Caused by Mycobacterium marinum / 감염과화학요법

Mycobacterium marinum is a nontuberculous mycobacterium responsible for skin infection. Risk factors include a history of trauma and water/fish-related hobbies or occupations. This infection is characteristically limited to the skin but deep soft tissue may be involved. We report a case of M. marinum infection in a 51-year-old man with ulcer and erythematous nodules on his right hand. The patient owned a tropical fish tank and remembered having previous hand trauma. The lesions extended to his forearm and formed sporotrichoid appearance. M. marinum was isolated from tissue specimens. The patient was treated with rifampin, etambutol and clarithromycin for 5 months, then the skin lesions were cured. The key to the diagnosis of this case are clinical awareness and a detailed history. M. marinum infection should be considered in chronic sporotrichoid skin lesions, particularly when there is a clinical suspicion on an infectious cause, and it could lead to successful treatment.

A Case of Sporotrichoid Fish Tank Granuloma / 대한피부과학회지

Mycobacterium marinum, group I photochromogen, is an atypical mycobacterium living in an aquatic environment including swimming pools, lagoon, lake, or fish tanks. Infections with M. marinum are not common, so only three cases have been reported in Korea. In general, skin lesions evolve as a solitary nodule or pustule but occasionally sporotrichoid spreading along the course of lymphatic vessels occurs. A 46-year-old woman visited our department with 2X1.5cm sized erythmatous ulcerated nodule on her right hand dorsum and several rice-sized subcutaneous nodules along the ascending course of lymphatic vessels on her right forearm. She had cleaned fish tank two months before the skin lesion developed. A AFB-positive microorganism was isolated by culture of the tissue specimen, which grew slowly at 30degrees C and those colonies showed yellowish color after light exposure on Ogawa medium. This microorganism was confirmed as M. marinum by polymerase chain reaction and restriction enzyme analysis. To the best of our knowledge, this is the first case of sporotrichoid granuloma due to M marinum infection occurred in association with fish tank in Korea.

A Case of Primary Cutaneous Sporotrichoid Nocardiosis Caused by Nocardia asteroides

We report a case of a 42-year-old woman who suffered from recurrent nodular skin lesions on her left foot. Sporotrichoid fungal infection was suspected and two linear nodular skin lesions that had occurred after trauma in a public pool were treated with itraconazole for 4 months. These nodular skin lesions were completely flattened. However, four months after complete flattening, a new lesion developed in the scar of a previous nodule. N. asteroides, which is extremely rare for sporotrichoid cutaneous nocardiosis, was cultured from the relapsed lesion. We treated this case with trimethoprim-sulfamethoxazole for 6 months under an emperical basis and this resulted in complete healing, and sensitivity of N. asteroide to trimethoprim-sulfamethoxazole was confirmed later. There has been no recurrence for 3 years. To our knowledge, our case is the first report in the english literature of primary sporotrichoid cutaneous nocardiosis caused by N. asteroides in terms of anatomic location below the knee and host immunocompetency.