Sporotrichoid Primary Cutaneous Nocardiosis: A Rare Case of Isolated Upper-Limb Involvement in a Housewife.

Nocardiosis is a rare infection due to a ubiquitous, gram-positive, weakly acid-fast, filamentous, aerobic bacteria, that are usually responsible for opportunistic infection in immunocompromised patients. Less frequently, nocardiosis can affect immunocompetent patients, causing primary cutaneous infections. Here we present a case of a 45-year-old housewife with a 12-day history of red painful nodules arranged linearly on her right upper limb, without any apparent history of injuries or comorbidities, albeit with a hobby of gardening. The unusual yet characteristic presentation, microbiological findings, and excellent response to co-trimoxazole therapy were consistent with a diagnosis of sporotrichoid primary cutaneous nocardiosis. The uncommon lymphocutaneous presentation is often misdiagnosed. Therefore, keeping a high index of suspicion in such cases is important to improve the cure rate and prevent complications.

Cutaneous aspergillosis masquerading in sporotrichoid morphology in an immunocompetent host.

Primary cutaneous aspergillosis is an uncommon opportunistic infection, generally seen in immunocompromised individuals. However, many atypical presentations have been reported recently particularly with the increased domain of immunosuppression. Sporotrichoid pattern of aspergillosis where it invades deep lymphatics have rarely been reported and never in immunocompetent individuals previously. We hereby report a case of a 29 years old immunocompetent individual with no comorbidities who presented with multiple painful erythematous papules and nodules over the left upper limb in a sporotrichoid pattern. Microscopy revealed branched septate hyphae and culture on Sabouraud dextrose agar grew powdery greenish colonies which showed hyaline branched septate hyphae with brush-like conidiophores and globose conidia in chains. Histopathology from one of the nodules was consistent with deep fungal infection. A diagnosis of Aspergillus chivalieri was made based on 18S rRNA sequencing of the isolate. The patient showed a satisfactory response to oral Itraconazole over 12 weeks.

Clinical Spectrum of Cutaneous Tuberculosis in Central India: A Retrospective Study.

INTRODUCTION: Extrapulmonary tuberculosis (EPTB) is a significant health problem in both developing and developed countries. In India, cutaneous TB constitutes about 0.1% to 2% of the total skin diseases attending outpatients. AIM AND OBJECTIVES: To study the clinical spectrum and therapeutic outcome in cutaneous TB. MATERIAL AND METHODS: Medical records of diagnosed cases of cutaneous TB from June 2015 to June 2018 were analyzed retrospectively with respect to epidemiology, clinical features, investigations, and treatment outcome. Statistical analysis was done using mean, median, and proportion. RESULTS: Fifty-two patients with cutaneous TB were recruited. Females (61.53%) outnumbered males. The most common age group affected was 21-30 years (32.69%) followed by 41-50 years (30%). Lupus vulgaris was the most common clinical type with head and neck being the most common site of involvement. Mantoux positivity was reported in 67.30% of patients while raised ESR in 71.15% of patients. Two patients had serology positive for HIV. Conclusive evidence of TB on histopathology was reported in 86.53%. Excellent response was observed in cases of lupus vulgaris, scrofuloderma, and tuberculosis verrucosa cutis. CONCLUSION: This retrospective analysis emphasizes the importance of clinicopathological correlation and therapeutic response in cutaneous TB. Although positive results of ESR, Mantoux reactivity, and TB cultures facilitate the clinical diagnosis, negative results should not exclude the diagnosis of cutaneous TB. This prominent case detection in the era of the Revised National TB Control Programme, in short period of time signifies health burden of cutaneous TB in this part of Maharashtra.

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.

Cutaneous Botryomycosis in Immunocompetent Patients: A Case Series.

Botryomycosis is a rare chronic suppurative bacterial infection of skin and viscera mostly reported in immunocompromised adults. Most of published literature on botryomycosis are case reports. Though morphological presentation of cutaneous botryomycosis has been described as nodules, sinus, abscesses, and ulcers discharging seropurulent exudates, sequential evolution of lesions is not clear. We report a series of three cases of cutaneous botryomycosis in immunocompetent patients (one child and two adults). Two cases had localized lesion, while adult male had lesions in a sporotrichoid distribution. In all cases the lesions evolved in the form of appearance of subcutaneous swelling which later on developed multiple nodules and papules on surface which either developed erosion, ulceration or sinus on surface associated with seropurulent discharge. The organisms isolated from discharge and tissue culture were coagulase negative staphylococcus and methicillin sensitive staphylococcus aureus. All cases were treated with monotherapy of sensitive systemic antibiotic. Two patients fully recovered and one lost to follow-up in the middle of therapy.

Recurrence of cutaneous Mycobacterium chelonae infection: A case report.

Mycobacterium chelonae is a species of mycobacteria that can be found ubiquitously in the environment. It can be found in soil, water, and in aquatic animals. Infections with this pathogen usually involve the soft tissues, eyes, bones, and skin. We present the case of a recurrence of a sporotrichoid cutaneous infection by M. chelonae in an immunocompromised 31-year-old woman with systemic lupus erythematosus. The patient originally developed a swelling of her right foot followed by a sporotrichoid pattern of infection on her right lower leg. A susceptibility profile was established, and treatment with linezolid and clarithromycin was administered for 8 months, in accordance with guidelines from the American Thoracic Society. The patient was clear of new lesions for approximately 1 month before noting a re-emergence. Treatment with linezolid and clarithromycin was re-initiated with subsequent improvement. This case underlines the need for prolonged treatment of this infection in patients with an immunocompromised status.

Tuberculous gummas with sporotrichoid pattern in a 57-year-old female: A case report and review of the literature.

Sporotrichoid tuberculosis is a rare form of cutaneous tuberculosis; it primarily affects children after a post-traumatic inoculation. The diagnosis is often difficult and based on a set of arguments; it should be considered in any sporotrichoid lesion, especially in tuberculosis endemic countries. The following describes a new case of Mycobacterium tuberculosis skin infection with an unusual sporotrichoid clinical appearance in a healthy woman, emphasizing the diagnostic difficulties with a review of literature.