What is your diagnosis?
What is your diagnosis? Keloidal cord-like lesion on the leg
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Lesões queloidianas de distribuição linear no membro inferior" "tienePdf" => "pt" "tieneTextoCompleto" => "pt" "tieneResumen" => "pt" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "386" "paginaFinal" => "389" ] ] "contieneResumen" => array:1 [ "pt" => true ] "contieneTextoCompleto" => array:1 [ "pt" => true ] "contienePdf" => array:1 [ "pt" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1283 "Ancho" => 2167 "Tamanyo" => 492906 ] ] "descripcion" => array:1 [ "pt" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">(A) Úlcera biopsiada. 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"titulo" => "Atypical cutaneous mycobacteriosis caused by <span class="elsevierStyleItalic">M. fortuitum</span> acquired in domestic environment" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "390" "paginaFinal" => "391" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 679 "Ancho" => 905 "Tamanyo" => 207497 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Chronic and organized inflammatory process, without detection of acid-fast bacilli and fungi (Hematoxylin & eosin, ×40).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Dimitri Luz 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] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 602 "Ancho" => 905 "Tamanyo" => 87781 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Dermoscopy of the leproma: presence of light brown halo in the lesion, with a yellowish appearance, with a scarring nacreous center and telangiectasias of a centrifugal character. 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Keloidal cord-like lesion on the leg" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "386" "paginaFinal" => "389" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Flaviano da Silva Oliveira, Nadya Picanço Lopes, Carolina Talhari, Antonio Schettini" "autores" => array:4 [ 0 => array:3 [ "nombre" => "Flaviano da Silva" "apellidos" => "Oliveira" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "Nadya Picanço" "apellidos" => "Lopes" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:4 [ "nombre" => "Carolina" "apellidos" => "Talhari" "email" => array:1 [ 0 => "carolinatalhari@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 3 => array:3 [ "nombre" => "Antonio" "apellidos" => "Schettini" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Tropical Dermatology Clinic, Fundação Alfredo da Matta de Dermatologia e Venereologia, Manaus, AM, Brazil" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Dermatopathology, Fundação Alfredo da Matta de Dermatologia e Venereologia, Manaus, AM, Brazil" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1050 "Ancho" => 2167 "Tamanyo" => 315704 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">(A) Round structures were seen in reticular dermis (Hematoxylin & eosin, ×200). (B) Grocott's methenamine silver stain revealed numerous round yeasts arranged containing thick double walls, occurring singly or in chains connected by tubular projections (Groccott, ×400).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Case report</span><p id="par0005" class="elsevierStylePara elsevierViewall">In 2005, a 74-year-old male presented with a one-year history of pruritic, cutaneous lesions on his left lower extremity. Physical examination revealed an erythematous plaque and cord-like nodular lesions on the left thigh and leg. Culture, histopathological and mycological examinations were performed at that time but the patient was subsequently lost to follow-up until 2017, when he returned with complaints of recurrent, secondary bacterial infections on the left lower extremity. On physical exam, ulcers with perilesional induration, erythema, and desquamation were noted on the left leg (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). Additionally, cord-like, firm, brown, nodules were observed along the medial aspect of his left thigh and leg (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B). Routine labs were unremarkable.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">What is your diagnosis?</span><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">a)</span><p id="par0015" class="elsevierStylePara elsevierViewall">Lymphangitic cutaneous leishmaniasis;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">b)</span><p id="par0020" class="elsevierStylePara elsevierViewall">Nontuberculous mycobacteriosis;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">c)</span><p id="par0025" class="elsevierStylePara elsevierViewall">Lobomycosis;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">d)</span><p id="par0030" class="elsevierStylePara elsevierViewall">Sporothricosis.</p></li></ul></p><p id="par0035" class="elsevierStylePara elsevierViewall">Cutaneous biopsy was performed on the ulcer border (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A). Histopathology showedy shows hyperkeratosis and epidermal acanthosis with a diffuse, predominantly lymphohistiocytic infiltrate. Giant cells, hemosiderin-laden histiocytes and increased vascularity are noted in the papillary dermis (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>B). Round structures are present in reticular dermis (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>A), and Grocott's methenamine silver stain reveals numerous round yeasts with thick double walls, occurring singly or in chains connected by tubular projections (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>B).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Diagnosis: Lobomycosis.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Discussion</span><p id="par0045" class="elsevierStylePara elsevierViewall">Lobomycosis, also known as Jorge Lobo's disease and lacaziosis, is a subcutaneous, chronic, granulomatous mycosis initially described by Jorge Lobo, in 1931. There are no systemic manifestations in lobomycosis.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">1,2</span></a> Due to the similarity of its etiological agent, <span class="elsevierStyleItalic">Lacazia loboi</span>, to <span class="elsevierStyleItalic">Paracoccidioides braziliensis</span>, the mycosis had also been described as keloidal blastomycosis.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">3</span></a><span class="elsevierStyleItalic">Lacazia loboi</span> has never been isolated in culture from humans or animals. Since the initial description of lobomycosis in patients from the Brazilian Amazon Region, other cases have been reported in tropical and subtropical regions of Latin American countries.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">2,4</span></a> The few lobomycosis reports from outside these regions have occurred predominantly in patients who had traveled through endemic areas. In 2008, cases were diagnosed in South Africa in patients with no history of travelling to known endemic areas.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">5</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">An important fact related to this mycosis was the discovery, in the Florida coast in 1970, of a dolphin with a clinical and histopathological disease similar to human lobomycosis.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">2,6</span></a> Subsequently, other dolphins with the same disease were found in the Atlantic coast of the United States, coastal region of Latin American and Caribbean countries, coastal region of the Southern Brazilian states of Rio Grande do Sul and Santa Catarina, Pacific coast and Indian Ocean.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a> There is only one documented case of dolphin to human transmission of lobomycosis: an aquarium attendant who worked in an aquarium pool with an infected bottlenose dolphin (<span class="elsevierStyleItalic">Tursiops truncatus</span>) caught in Bay of Biscay, Spain.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">8</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">The disease is clinically characterized by the presence of nodular, verrucous or keloidal lesions, which are found alone or in plaques, localized or disseminated, with a generally long evolution. The most common clinical presentation is keloidal, characterized by firm, shiny, pinkish-brown to brown nodules.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a> Ulceration may occur in areas subject to trauma. Development of squamous cell carcinoma in long-standing lesions may occur.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">9</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Another clinical aspect that drew attention in this patient was the linear arrangement of lesions along the leg and thigh. It is admitted that the spread of the disease occurs by contiguity, and through lymphatic route; however, an aspect similar to that observed in the present case is not common.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Financial support</span><p id="par0085" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Authors’ contributions</span><p id="par0065" class="elsevierStylePara elsevierViewall">Flaviano da Silva Oliveira: Intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Nadya Picanço Lopes: Obtaining, analysis, and interpretation of the data; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases.</p><p id="par0075" class="elsevierStylePara elsevierViewall">Carolina Talhari: Approval of the final version of the manuscript; conception and planning of the study; elaboration and writing of the manuscript; obtaining, analysis, and interpretation of the data; effective participation in research orientation; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the literature; critical review of the manuscript.</p><p id="par0080" class="elsevierStylePara elsevierViewall">Antonio Schettini: Approval of the final version of the manuscript; conception and planning of the study; elaboration and writing of the manuscript; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the literature; critical review of the manuscript.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conflicts of interest</span><p id="par0090" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:8 [ 0 => array:3 [ "identificador" => "xres1365107" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1254940" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "sec0005" "titulo" => "Case report" ] 3 => array:2 [ "identificador" => "sec0010" "titulo" => "Discussion" ] 4 => array:2 [ "identificador" => "sec0020" "titulo" => "Financial support" ] 5 => array:2 [ "identificador" => "sec0015" "titulo" => "Authors’ contributions" ] 6 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflicts of interest" ] 7 => array:1 [ "titulo" => "<span class="elsevierStyleBold">References</span>" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-04-01" "fechaAceptado" => "2019-07-04" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1254940" "palabras" => array:3 [ 0 => "Histology" 1 => "Lacazia" 2 => "Lobomycosis" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">We report a 74-year-old male presented to an outpatient dermatology clinic in Manaus, Amazonas, with a one-year history of pruritic, keloidal lesions on his left lower extremity. Histopathology showed round structures in reticular dermis. Grocott methenamine silver stain revealed numerous round yeasts with thick double walls, occurring singly or in chains connected by tubular projections. The diagnosis was lobomycosis. Although the keloidal lesions presented by this patient are typical of lobomycosis, their linear distribution along the left lower limb is unusual.</p></span>" ] ] "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">How to cite this article: Oliveira FS, Lopes NP, Talhari C, Schettini A. Case for diagnosis. Keloidal cord-like lesion on the leg. An Bras Dermatol. 2020;95:386–9.</p>" ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Study conducted at the Fundação de Dermatologia Tropical e Venereologia Alfredo da Matta, Manaus, AM, Brazil.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1628 "Ancho" => 2167 "Tamanyo" => 179237 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Ulcers with perilesional hardening of the skin, erythema and desquamation were seen on the left leg (A); cord-like, hard, brownish nodular lesions were also observed along the medial aspect of his left thigh and leg at physical examination (B).</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1284 "Ancho" => 2167 "Tamanyo" => 409969 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">(A) Biopsy site (arrow). (B) Histopathology demonstrated hyperkeratosis and acanhosis, collagen fibroplasia vascular neoformation and diffuse inflammatory infiltrate consisting of lymphocytes, epithelioid cells, giant cells and hemosiderin-laden histiocytes were present in the papilar dermis (Hematoxylin & eosin, ×100).</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1050 "Ancho" => 2167 "Tamanyo" => 315704 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">(A) Round structures were seen in reticular dermis (Hematoxylin & eosin, ×200). 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 20 | 14 | 34 |
| 2024 October | 95 | 83 | 178 |
| 2024 September | 121 | 83 | 204 |
| 2024 August | 125 | 110 | 235 |
| 2024 July | 115 | 128 | 243 |
| 2024 June | 105 | 64 | 169 |
| 2024 May | 86 | 57 | 143 |
| 2024 April | 119 | 91 | 210 |
| 2024 March | 83 | 75 | 158 |
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| 2023 December | 65 | 65 | 130 |
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| 2023 October | 77 | 81 | 158 |
| 2023 September | 86 | 77 | 163 |
| 2023 August | 79 | 39 | 118 |
| 2023 July | 97 | 50 | 147 |
| 2023 June | 89 | 61 | 150 |
| 2023 May | 71 | 21 | 92 |
| 2023 April | 49 | 31 | 80 |
| 2023 March | 85 | 49 | 134 |
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| 2022 December | 69 | 29 | 98 |
| 2022 November | 89 | 62 | 151 |
| 2022 October | 188 | 62 | 250 |
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| 2022 January | 57 | 70 | 127 |
| 2021 December | 34 | 60 | 94 |
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| 2021 October | 70 | 83 | 153 |
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| 2021 July | 34 | 45 | 79 |
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| 2021 April | 77 | 211 | 288 |
| 2021 March | 49 | 57 | 106 |
| 2021 February | 23 | 15 | 38 |
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| 2020 December | 18 | 14 | 32 |
| 2020 November | 11 | 8 | 19 |
| 2020 October | 12 | 7 | 19 |
| 2020 September | 22 | 11 | 33 |
| 2020 August | 15 | 10 | 25 |
| 2020 July | 9 | 9 | 18 |
| 2020 June | 18 | 21 | 39 |
| 2020 May | 18 | 10 | 28 |
| 2020 April | 0 | 2 | 2 |
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