Tropical/Infectoparasitary Dermatology
Immunoreactive cutaneous sporotrichosis
Gustavo de Sá Menezes Carvalho
, John Verrinder Veasey
Corresponding author
Dermatology Clinic, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil
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class="elsevierStyleTextfn">Tropical/Infectoparasitary Dermatology</span>" "titulo" => "Immunoreactive cutaneous sporotrichosis" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "737" "paginaFinal" => "739" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Gustavo de Sá Menezes Carvalho, John Verrinder Veasey" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Gustavo de Sá Menezes" "apellidos" => "Carvalho" "email" => array:1 [ 0 => "gustavo.carvalho@msn.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "John Verrinder" "apellidos" => "Veasey" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Dermatology Clinic, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "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" => 598 "Ancho" => 905 "Tamanyo" => 53497 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Dermatosis located on the lower limbs, characterized by erythematous and violet nodules of different sizes, more palpable than visible.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Sporotrichosis is an infection that affects humans and animals, with a typically subacute or chronic evolution, caused by the dimorphic fungus <span class="elsevierStyleItalic">Sporothrix</span> spp.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">1,2</span></a> Approximately 80% of patients affected by the disease present with the lymphocutaneous form<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a>; cases of hypersensitivity reaction to <span class="elsevierStyleItalic">Sporothrix</span> spp. are rare, with few reports in the literature.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> The authors report a case of a 12-year-old girl who presented a single ulcerated lesion on the left arm with a raised erythematous edge and granular bottom, measuring 1.5<span class="elsevierStyleHsp" style=""></span>cm in diameter (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). One month after the onset of the condition, painful erythematous nodules were observed on the lower limbs, more palpable than visible, accompanied by feverish episodes, without any use of medication or other infectious complaints in the period (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The chest radiography did not reveal any abnormalities, and no skin reaction was observed in the tuberculin skin test. Samples of the ulcerated lesion were collected; the direct microscopy examination (DME) did not show fungal structures or amastigote forms of <span class="elsevierStyleItalic">Leishmania</span> spp., the polymerase chain reaction for leishmaniasis was negative, and <span class="elsevierStyleItalic">Sporothrix</span> spp. was observed in the culture for fungi (<a class="elsevierStyleCrossRefs" href="#fig0015">Figs. 3 and 4</a>). The histopathological examination of the ulcerated lesion showed inflammation in the hypodermis with the formation of granulomas, but no fungi were observed with Grocott staining. The diagnosis of immunoreactive cutaneous sporotrichosis was established due to the appearance of erythema nodosum in association with the fungal infection, with no other evident cause.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">In Brazil, sporotrichosis has been an emerging zoonosis for the last 20 years. With the advent of molecular biology techniques, it has been shown that the classic agent <span class="elsevierStyleItalic">Sporothrix</span> spp. consists of a group of species among which <span class="elsevierStyleItalic">S. brasiliensis</span>, <span class="elsevierStyleItalic">S. schenckii</span>, <span class="elsevierStyleItalic">S. globosa</span>, and <span class="elsevierStyleItalic">S. luriei</span> stand out as human pathogens.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a> With the epidemic of zoonotic sporotrichosis, clinical forms hitherto uncommon are being described, such as hypersensitivity reactions,<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">4–6</span></a> which can present as erythema multiforme, Sweet's syndrome, or erythema nodosum. Patients with such presentations have an exacerbated immune response to the fungus.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">1,4,5</span></a> In the present case, it is interesting to observe that such immunological competence may have prevented dissemination of the pathogen through the lymphatic pathway, avoiding the most common lymphocutaneous manifestation, and exhibiting a localized cutaneous clinical presentation, evidenced at first by the patient. This clinical form is of difficult differentiation from ulcerated lesions caused by other tropical dermatoses such as tuberculosis, paracoccidioidomycosis, and leishmaniasis, also endemic in the country.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The gold standard for the diagnosis of sporotrichosis is the isolation of the fungal agent from clinical samples. Elongated yeast structures are rarely seen on direct examination.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">2,3,7</span></a> Isolation of the agent in culture media has superior sensitivity and specificity. The colonies present a blackish color and a membranous appearance, sometimes showing whitish areas (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>); in the microculture, septate hyaline hyphae and conidiophores that originate primary hyaline conidia in a “daisy” arrangement are observed. Similar to the direct examination, most of the time histopathology has low sensitivity, due to the scarcity of fungal elements in the sample.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">7</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The report of this case of sporotrichosis illustrates a rare presentation of this condition, aiming to contribute to early diagnosis and treatment, reducing the chronicity and morbidity of the disease.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Financial support</span><p id="par0025" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Authors’ contributions</span><p id="par0030" class="elsevierStylePara elsevierViewall">Gustavo de Sá Menezes Carvalho: Elaboration and writing of the manuscript; obtaining, analyzing, and interpreting the data.</p><p id="par0035" class="elsevierStylePara elsevierViewall">John Verrinder Veasey: Approval of the final version of the manuscript; conception and planning of the study; elaboration and writing of the manuscript; obtaining, analyzing, and interpreting the data; effective participation in research orientation, critical review of the literature, critical review of the manuscript.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflicts of interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:6 [ 0 => array:3 [ "identificador" => "xres1418420" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1297629" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "sec0005" "titulo" => "Financial support" ] 3 => array:2 [ "identificador" => "sec0010" "titulo" => "Authors’ contributions" ] 4 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflicts of interest" ] 5 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-11-04" "fechaAceptado" => "2019-11-24" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1297629" "palabras" => array:4 [ 0 => "Erythema nodosum" 1 => "Mycoses" 2 => "Sporotrichosis" 3 => "Zoonoses" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Sporothrix</span> spp. infection can occur through the inoculation of the organism in the skin through direct contact with the soil (sapronotic infection), through contact with animals, such as infected cats and dogs (zoonotic infection), or less frequently <span class="elsevierStyleItalic">via</span> inhalation. With a subacute or chronic evolution, approximately 80% of patients affected by the disease present with the lymphocutaneous form; episodes associated with a hypersensitivity reaction are rare. The authors report the case of a 12-year-old child with immunoreactive sporotrichosis manifested clinically as erythema nodosum lesions in the lower limbs, associated with an ulcerated lesion in the left arm.</p></span>" ] ] "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "⋆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">How to cite this article: Carvalho GSM, Veasey JV. Immunoreactive cutaneous sporotrichosis. An Bras Dermatol. 2020. <span class="elsevierStyleInterRef" id="intr0005" href="https://doi.org/10.1016/j.abd.2019.11.015">https://doi.org/10.1016/j.abd.2019.11.015</span>.</p>" ] 1 => array:2 [ "etiqueta" => "⋆⋆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Study conducted at the Dermatology Clinic, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil.</p>" ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 680 "Ancho" => 905 "Tamanyo" => 48416 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Dermatosis located in the upper portion of the left arm, characterized by an erythematous ulcer with well-defined edges and a granular bottom measuring approximately 1.5<span class="elsevierStyleHsp" style=""></span>cm in diameter.</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" => 598 "Ancho" => 905 "Tamanyo" => 53497 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Dermatosis located on the lower limbs, characterized by erythematous and violet nodules of different sizes, more palpable than visible.</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" => 468 "Ancho" => 905 "Tamanyo" => 41313 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Fungal culture at 25<span class="elsevierStyleHsp" style=""></span>°C showing a blackish filamentous colony with whitish areas. Colony growth after seven days.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 679 "Ancho" => 905 "Tamanyo" => 45089 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Colony micromorphology at 25<span class="elsevierStyleHsp" style=""></span>°C, showing septate hyaline hyphae, conidiophores that originate primary hyaline conidia in a “daisy” arrangement (cotton blue, ×400).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0040" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sporothrichosis: an update on epidemiology, etiopathogenesis, laboratory and clinical therapeutics" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "R. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 28 | 13 | 41 |
| 2024 October | 92 | 85 | 177 |
| 2024 September | 167 | 81 | 248 |
| 2024 August | 154 | 115 | 269 |
| 2024 July | 163 | 108 | 271 |
| 2024 June | 143 | 98 | 241 |
| 2024 May | 110 | 73 | 183 |
| 2024 April | 112 | 100 | 212 |
| 2024 March | 86 | 79 | 165 |
| 2024 February | 94 | 98 | 192 |
| 2024 January | 77 | 48 | 125 |
| 2023 December | 80 | 68 | 148 |
| 2023 November | 101 | 76 | 177 |
| 2023 October | 86 | 77 | 163 |
| 2023 September | 106 | 80 | 186 |
| 2023 August | 67 | 39 | 106 |
| 2023 July | 85 | 29 | 114 |
| 2023 June | 123 | 39 | 162 |
| 2023 May | 61 | 17 | 78 |
| 2023 April | 65 | 14 | 79 |
| 2023 March | 72 | 50 | 122 |
| 2023 February | 49 | 31 | 80 |
| 2023 January | 66 | 58 | 124 |
| 2022 December | 76 | 35 | 111 |
| 2022 November | 77 | 48 | 125 |
| 2022 October | 69 | 47 | 116 |
| 2022 September | 49 | 65 | 114 |
| 2022 August | 49 | 50 | 99 |
| 2022 July | 37 | 43 | 80 |
| 2022 June | 40 | 50 | 90 |
| 2022 May | 30 | 55 | 85 |
| 2022 April | 44 | 51 | 95 |
| 2022 March | 59 | 85 | 144 |
| 2022 February | 30 | 44 | 74 |
| 2022 January | 44 | 75 | 119 |
| 2021 December | 38 | 61 | 99 |
| 2021 November | 39 | 53 | 92 |
| 2021 October | 49 | 74 | 123 |
| 2021 September | 35 | 46 | 81 |
| 2021 August | 48 | 63 | 111 |
| 2021 July | 33 | 55 | 88 |
| 2021 June | 35 | 56 | 91 |
| 2021 May | 58 | 76 | 134 |
| 2021 April | 144 | 254 | 398 |
| 2021 March | 84 | 86 | 170 |
| 2021 February | 30 | 22 | 52 |
| 2021 January | 46 | 21 | 67 |
| 2020 December | 54 | 19 | 73 |
| 2020 November | 30 | 14 | 44 |
| 2020 October | 13 | 13 | 26 |
| 2020 September | 16 | 12 | 28 |
| 2020 August | 4 | 3 | 7 |
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