ABSTRACT
El fibroma perifolicular es una entidad benigna poco frecuente: se caracteriza por ser una lesión proliferante deribada de la vaina perifolicular. Topográficamente es usual su aparición en la cabeza, presentándose como pápulas o nódulos de aspecto cupular único o múltiples. El diagnóstico recae en el estudio histopatológico, donde se observa tejido fibroso alrededor del folículo piloso. Se presenta un caso inusual en un paciente de 6 años con múltiples pápulas asintomáticas en cuello, motivo por el cual acudió a la consulta.
Subject(s)
NeckABSTRACT
Antecedentes. La blastomicosis es una enfermedad infecciosa granulomatosa, causada por el hongo dimorfo Blastomyces dermatitidis. Predomina en Estados Unidos de América, y en México solo se han reportado 2 casos sistémicos importados. La forma primaria cutánea es la presentación clínica menos frecuente de la enfermedad y ocurre después de la inoculación del hongo por traumatismo. Objetivos. Se presenta el caso de un hombre de 54 años de edad, originario de Guadalajara, México, y residente en Chicago, Estados Unidos. Presentaba en la región frontal y surco nasogeniano derecho 2 nódulos verrugosos de 8mm de diámetro de 4 semanas de evolución. Métodos. Se realizó un estudio histopatológico (tinciones de hematoxilina-eosina, Gomori-Grocott y ácido peryódico de Schiff), además, estudio micológico (directo con KOH y cultivos en agar Sabouraud y micobiótico). Además, se realizaron otros estudios que descartaron afección sistémica. Resultados. La biopsia mostró una dermis con infiltrado inflamatorio compuesto por linfocitos, neutrófilos, histiocitos y células gigantes multinucleadas, y escasas levaduras monogemantes con base ancha y rodeadas por un halo. Al examen directo con KOH, se observaron levaduras monogemantes de 8 a 10mm de diámetro de B. dermatitidis. En el cultivo a 35°C creció una colonia blanca, plegada que, con el tiempo, se tornó amarillenta y cerebriforme. Resultados. Se indicó tratamiento con itraconazol a dosis de 200mg/d durante 2 meses con curación clínica y micológica. Conclusiones. El caso presentado podría ser el primero importado en México donde la blastomicosis se presenta solo con lesiones cutáneas y sin compromiso sistémico(AU)
Background. Blastomycosis is a granulomatous infectious disease. It is caused by the dimorphus fungus Blastomyces dermatitidis. It predominates in the United States of America, but in Mexico two systemic imported cases have been reported. Cutaneous primary blastomycosis is a rare clinical presentation, which occurs after traumatic inoculation of the fungus. Objectives. We present a case of a 54 year old male, born in Guadalajara, Mexico, and living in Chicago, USA, who had two verrucous nodules (8mm in diameter) on the forehead and right nasogenian fold, of 4 weeks progression. Methods. We made a histopathological study (hematoxylin and eosin, Gomori Groccot and periodic acid-Schiff stains) and mycology studies (direct microscopic examination, Sabouraud and mycobiotic agar cultures). Multiple studies were made with no evidence of systemic spread. Results. Biopsy showed a dermal inflammatory infiltrate made up of lymphocytes, neutrophils, histiocytes and multinucleated giant cells. A few large, haloed, broad-based budding yeasts were also observed. Direct examination with KOH revealed broad-based budding yeasts, 10ìm in diameter. Culture at 35°C yielded a white, pleated colony, which changed into a yellowish cerebriform. Multiple studies were made with no evidence of systemic spread. Results. Itraconazole 200mg qd PO was given over a 2 month period, with a complete clinical and mycological response. Conclusions. This is the first imported case in Mexico of blastomycosis with cutaneous lesions without systemic involvement(AU)
Subject(s)
Humans , Male , Middle Aged , Blastomycosis/diagnosis , Blastomycosis/therapy , Blastomyces/isolation & purification , Blastomyces/pathogenicity , Biopsy , Itraconazole/therapeutic use , Microscopy , Mycology/methods , Blastomycosis/microbiology , Blastomycosis/physiopathology , Radiography, ThoracicABSTRACT
BACKGROUND: Blastomycosis is a granulomatous infectious disease. It is caused by the dimorphus fungus Blastomyces dermatitidis. It predominates in the United States of America, but in Mexico two systemic imported cases have been reported. Cutaneous primary blastomycosis is a rare clinical presentation, which occurs after traumatic inoculation of the fungus. OBJECTIVES: We present a case of a 54 year old male, born in Guadalajara, Mexico, and living in Chicago, USA, who had two verrucous nodules (8mm in diameter) on the forehead and right nasogenian fold, of 4 weeks progression. METHODS: We made a histopathological study (hematoxylin and eosin, Gomori Groccot and periodic acid-Schiff stains) and mycology studies (direct microscopic examination, Sabouraud and mycobiotic agar cultures). Multiple studies were made with no evidence of systemic spread. RESULTS: Biopsy showed a dermal inflammatory infiltrate made up of lymphocytes, neutrophils, histiocytes and multinucleated giant cells. A few large, haloed, broad-based budding yeasts were also observed. Direct examination with KOH revealed broad-based budding yeasts, 10µm in diameter. Culture at 35°C yielded a white, pleated colony, which changed into a yellowish cerebriform. Multiple studies were made with no evidence of systemic spread. Itraconazole 200mg qd PO was given over a 2 month period, with a complete clinical and mycological response. CONCLUSIONS: This is the first imported case in Mexico of blastomycosis with cutaneous lesions without systemic involvement.
