Tinea nigra: rare and almost never remembered superficial mycosis

Tinea nigra is a chronic fungal infection of the stratum corneum caused by the fungus Hortaea werneckii, clinically manifested by asymptomatic and hyperchromic macules ranging in color from light brown to black and affecting mainly the palmar and plantar areas. must be differentiated mainly from acral melanoma. It occurs mainly in South America (Brazil, Colombia, Venezuela), Central America and the Caribbean (Panama, Cuba), Asia (India, Japan, Sri Lanka) and the coastal regions of Africa and is uncommon in Europe, correlated with travel and immigration intercontinental. In relation to Brazil in the period 1916-2020, 203 cases were reported. We present a case of palmar tinea nigra in an adult patient with 3 months of evolution, diagnosed through clinical examination, direct mycological examination, Sabouraud agar culture, and dermatoscopy of the lesion was also performed. who fully responded to topical therapy with miconazole.

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.

Cardiac beriberi and malnutrition: rare complication of paracoccidioidomycosis

Paracoccidioidomycosis is an endemic systemic mycosis that predominates in southern Mexico, parts of Central America, and South America. It is caused by a dimorphic fungus and is generally acquired through the lungs, from where it disseminates. Paracoccidioidomycosis has different clinical manifestations that require differentiation with tuberculosis, Hodgkin disease, several systemic and subcutaneous mycoses, and squamous cell carcinoma. Radiologic abnormalities in the lung fields may be seen. Mucous membrane lesions occasionally occur. The diagnosis is confirmed by finding yeast-like elements of P. brasiliensis in microscopic examinations of wet preparations of specimens submitted for mycologic studies. The occurrence of malnutrition and particularly beri beri conditions concomitant with paracoccidioidomycosis is uncommon. We report a case of a patient of low socio-economic status, without permanent employment , possibly carrying out work as a bricklayer or working on small farms during the harvest season, with a five-year history of oral cavity lesions, which resulted in difficulty eating and thus weight loss. A diagnosis of paracoccidioidomycosis was made through direct microscopy examination, culture and multisystem involvement was confirmed through imaging tests, including dilatation and dysfunction of the right ventricle. The hypothesis of Cardiac Beri-Beri related to thiamine deficiency was raised. The treatment was carried out with thiamine supplementation and liposomal amphotericin B, with excellent clinical evolution of the patient. This case highlights the importance of early recognition of paracoccidioidomycosis in its early stages and the adoption of proactive measures in the search for possible organic complications caused by nutritional deficiencies in prolonged cases.

Mycetoma caused by Trichosporon asteroids-report of the first case

Mycetoma is a neglected disease that affects mainly the skin, but can progress to deep tissues and structures such as muscles and bones. Mycetoma can be caused by some bacterial (actinomycetoma) or fungal species (eumycetoma); furthermore, eumycetoma is estimated to account for 40% of all cases of mycetomas. Regardless of etiology, human infections occur after accidental implantation of etiological agents through the skin. In the present work, an immunocompetent patient without systemic comorbidity is reported to have exhibited a progressive increase of the left foot with multiple fistulas in the dorsum in the last 15 years, which emerged as a purulent secretion in the presence of yellowish grains. The patient reported that during a trip she suffered injuries in the affected foot. Histopathological study showed the presence of fungal grains, and the culture of skin fragments allowed the identification of fungal colonies exhibiting a dry, cream-coloured cerebriform morphology with a radiated peripheral edge. The micromorphology examination of the isolate demonstrated the presence of hyphae that swell and become multiseptate, budding cells, and lateral conidia were absent. MALD-TOF MS analysis led to the identification of Trichosporon asteroides as etiologic. Different treatment regimens were performed with no success, moderate improvement was observed with voriconazole, and treatment is still ongoing. This is the first case report to incriminate T. asteroides as an etiological agent of eumycetoma.

Chromoblastomycosis with 18 years of evolution

Chronic infectious, granulomatous and suppurative dermatosis, classified among the subcutaneous mycoses, caused by species of pigmented dematiaceous fungi, more prevalent in tropical and subtropical regions and caused by the traumatic implantation of dematiaceous fungal species, where the presence of muriform bodies are an expression of the causal agent in the grafted tissue, characteristic of chromoblastomycosis considered the second implantation mycosis in the world, it manifests itself with slow and progressive growth lesions of exophytic and verrucous plaques and black dots on the surface. The disease is considered a neglected and occupational disease, which occurs mainly among agricultural workers, and coconut and babassu harvesters, lumberjacks and traders of agricultural products. It is important to highlight that people at risk of contracting chromoblastomycosis work in tropical countries, where the temperature can be above 40 °C in summer, and generally refuse to wear protective equipment during the day (shoes, gloves, and clothes), although they know that this type of prophylactic measure can prevent different types of diseases. These vulnerable people often live in low-income countries and sometimes live far from medical services and, once infected, do not seek medical attention. We report below an exuberant and unusual case of lower limb chromoblastomycosis with a history of 18 years of evolution. The diagnosis was established by direct mycological examination, culture and microculture that identified the agent of the Fonsecaea species, and histopathological examination.