Cutaneous and subcutaneous phaeohyphomycosis.

UNLABELLED: Case 1: A 17-year-old male rural worker from Bolivia living in La Plata (Argentina) for the past year had a lesion on the flexor side of his right forearm (6 x 4 cm). The lesion was formed by several confluent nodular areas, wine-red in color, some fistulized, with hemopurulent drainage. The area was hot and painless (Figure 1). On physical examination, no regional adenomegalies were reported. The following analyses were requested and results reported. Soft tissue ultrasound: material of solid consistency with layered liquid areas, located in the subcutaneous cellular tissue, with fistulous tract, connecting through superficial planes. Evidence of peripheral edema. Bacteriologic analysis (puncture aspiration): methicillin-sensitive Staphylococcus aureus. Mycologic analysis (puncture aspiration): negative; laboratory results: eosinophilia; and human immunodeficiency virus: nonreactive. Histopathologic examination: lesions of necrosis with granulomatous inflammatory reaction. Fungi techniques (periodic acid-Schiff, Grocott stains): negative. Bacilos acid-alcohol resistentes (acid-alcohol resistant bacillus) (BAAR) techniques (Kinyoun, Ziehl-Neelsen): negative. Foreign body examination tested with polarized light: negative. Mycologic and bacteriologic examinations were repeated, including a search for mycobacterium species using material obtained from the biopsy performed on the cutaneous lesion. Macromorphology: the colony was initially black and of creamy consistency, to later become velvety. Micromorphology: dark blastoconidia, then cylindrical phialides with elliptical conidia (Figure 2). IDENTIFICATION: Exophiala dermatitidis infection. On the basis of these characteristics, the diagnosis is phaeohyphomycosis due to Edermatitidis. The patient is treated with antimycotic therapy, with oral itraconazole (400 mg/d), plus indication of surgical procedure to remove the lesion. The patient's condition evolves favorably with no recidivant episodes after the sixth month post-treatment (Figure 3). During the first year, controls were scheduled every 2 months. Case 2: A 72-year-old diabetic man had a painful chronic varicose ulcer on the side of his left foot, with black friable exudate, 2x3 cm in diameter after 1 year. Every time the black material was removed, it would quickly grow back again. No response was obtained with different therapies applied to seal the lesion (Figure 4). Routine laboratory results included the following. Glucemy: 1.82 g/dL. Histopathology: filamentous septate fungal elements with positive Grocott stain (Figure 5 and Figure 6). Mycologic examination and culture: direct: fungal elements in dematiaceous group. Culture: positive for Curvularia lunata (Figure 7). The treatment selected was oral itraconazole (400 mg/d) for 12 months, with periodic laboratory controls, plus application of wet pads on the ulcer containing sodium borate and ketoconazole cream. At the fourth month, the ulcer had completely closed (Figure 8).

Esporotricosis cutánea micetomatoide: a propósito de un caso / Micetomatoide cutaneous sporotrichosis: a propos of a case

La esporotricosis es una infección micótica profunda de la piel, causada por un hongo dimorfo, es Sporothrix schenckii, que se encuentra en forma saprófita en la naturaleza. Tiene distribución mundial, predominantemente en regiones tropicales y subtropicales. La infección usualmente se produce por inoculación traumática. Las formas de presentación clínicas se clasifican en : cutáneas y extracutáneas. El diagnóstico definitivo se establece por cultivo. El tratamiento de elección es la solución satura de ioduro de potasio; otras alternativas son los derivados asólicos, la anfotericina B y el uso de terapia térmica. Presentamos el caso de un paciente de sexo masculino, de 30 años de edad, oriundo de Bolivia, trabajador rural, que presenta lesiones vegetantes en pie izquierdo de un año de evolución. En el cultivo micológico fue identificado el Sporothrix schenckii, observándose una excelente respuesta al tratamiento con itraconazol.