Tropical/Infectoparasitary Dermatology
Ocular involvement in sporotrichosis: report of two cases in children
Luciana Rodino Lemes, John Verrinder Veasey
, Silvia Soutto Mayor, Carolina Contin Proença
Corresponding author
Dermatology Clinic, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil
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"cabecera" => "<span class="elsevierStyleTextfn">Tropical/Infectoparasitary Dermatology</span>" "titulo" => "Ocular involvement in sporotrichosis: report of two cases in children" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "349" "paginaFinal" => "351" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Luciana Rodino Lemes, John Verrinder Veasey, Silvia Soutto Mayor, Carolina Contin Proença" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Luciana Rodino" "apellidos" => "Lemes" ] 1 => array:4 [ "nombre" => "John Verrinder" "apellidos" => "Veasey" "email" => array:1 [ 0 => "johnveasey@uol.com.br" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 2 => array:2 [ "nombre" => "Silvia Soutto" "apellidos" => "Mayor" ] 3 => array:2 [ "nombre" => "Carolina Contin" "apellidos" => "Proença" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Dermatology Clinic, 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:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 879 "Ancho" => 1500 "Tamanyo" => 108762 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinical presentation of patient 1: granular erythematous lesion on the right lower tarsal conjunctiva and submandibular lymphadenopathy (Parinaud's oculoglandular syndrome).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Case reports</span><p id="par0005" class="elsevierStylePara elsevierViewall">The first case is a three-year-old male patient living with a sick cat. The patient had an eye lesion in the lower portion of the tarsal conjunctiva that progressed with lymphatic dissemination, the formation of a malar nodule and ipsilateral submandibular lymph node enlargement (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The second case is a 12-year-old male patient, also contaminated through contact with a sick feline, with scratches on his lip and the ocular mucosa due to probable airborne contagion through sneezing by the cat. It progressed with nodules forming a path in the lower portion of the face and conjunctivitis on the left eye (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). In both cases, <span class="elsevierStyleItalic">Sporothrix spp</span>. was isolated from the ocular secretion by culture and showed complete resolution after treatment with itraconazole (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Discussion</span><p id="par0010" class="elsevierStylePara elsevierViewall">Ocular involvement in sporotrichosis can occur through hematogenous dissemination, leading to intraocular injury, or by inoculation/trauma, compromising the ocular adnexae. Retrobulbar lesions seem to be more related to hematogenous dissemination, whereas anterior lesions are more associated with fungal inoculation.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Both patients denied eye trauma, and the second patient categorically referred to contagion by cat sneezing on his face. Droplets from sick cats, whose secretions contain large amounts of fungi, are known to reach human membranes without the need of a local lesion for inoculation.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a> Interestingly, both patients were children, the age group that maintains intimate contact with domestic animals, often taking them close to the face, thus favoring fungal inoculation on the face and ocular mucosa.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The first patient had Parinaud's oculoglandular syndrome. It is a rare clinical condition, characterized by unilateral granulomatous conjunctivitis, accompanied by preauricular or submandibular satellite lymphadenopathy.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> In the second case, the patient had two clinical forms: the lymphocutaneous, caused by the cat scratch, and the mucosal, through spore inoculation by the droplets of the same cat on the left eye.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The approach to ocular sporotrichosis is similar to that of the cutaneous type.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,3</span></a> The diagnosis is made by collecting conjunctival secretion using a sterile swab, followed by culture to screen for fungi.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> The drugs indicated for sporotrichosis treatment are: itraconazole, potassium iodide, terbinafine, and amphotericin B. Ocular involvement in sporotrichosis should be treated with antifungals at the doses recommended for the cutaneous forms. The choice of the drug will depend on contraindications, availability and the host’s clinical conditions. Itraconazole has been the first choice at a dose of 100 to 200 mg/day until complete resolution of the lesions (or for another 2 to 4 weeks), in general, for a total of 3 to 6 months.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Treatment duration varies in the literature and is determined by the patient's clinical response.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Financial support</span><p id="par0030" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Authors’ contributions</span><p id="par0035" class="elsevierStylePara elsevierViewall">Luciana Rodino Lemes: Drafting and writing of the manuscript; review of the manuscript.</p><p id="par0040" class="elsevierStylePara elsevierViewall">John Verrinder Veasey: Drafting and writing of the manuscript; intellectual participation in the propaedeutics and therapeutic conduct of the cases; review of the manuscript; approval of the manuscript.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Silvia Soutto Mayor: Intellectual participation in the propaedeutics and therapeutic conduct of the cases; review of the manuscript; approval of the manuscript.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Carolina Contin Proença: Intellectual participation in the propaedeutics and therapeutic conduct of the cases; review of the manuscript.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conflicts of interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:8 [ 0 => array:3 [ "identificador" => "xres1521067" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1379243" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "sec0005" "titulo" => "Case reports" ] 3 => array:2 [ "identificador" => "sec0010" "titulo" => "Discussion" ] 4 => array:2 [ "identificador" => "sec0015" "titulo" => "Financial support" ] 5 => array:2 [ "identificador" => "sec0020" "titulo" => "Authors’ contributions" ] 6 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflicts of interest" ] 7 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaAceptado" => "2020-08-15" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1379243" "palabras" => array:3 [ 0 => "Child" 1 => "Eye infections, fungal" 2 => "Sporotrichosis" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Sporotrichosis is a subcutaneous mycosis that affects humans and animals, with a typically subacute or chronic evolution, caused by <span class="elsevierStyleItalic">Sporothrix spp</span>., a dimorphic fungus. Although the cutaneous form is the most frequent presentation, the ocular involvement has been more frequently diagnosed in endemic areas, affecting mainly children and the elderly. Approximately 80% of affected patients have the lymphocutaneous form, while only 2.3% have conjunctival lesions, with 0.7% showing primary ocular involvement. We describe two cases of sporotrichosis with ocular involvement in children through inoculation by felines, with a good response to antifungal treatment.</p></span>" ] ] "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">How to cite this article: Lemes LR, Veasey JV, Mayor SS, Proença CC. Ocular involvement in sporotrichosis: report of two cases in children. An Bras Dermatol. 2021;96:349–51.</p>" ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Study conducted at the Dermatology Clinic, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil.</p>" ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 879 "Ancho" => 1500 "Tamanyo" => 108762 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinical presentation of patient 1: granular erythematous lesion on the right lower tarsal conjunctiva and submandibular lymphadenopathy (Parinaud's oculoglandular syndrome).</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 897 "Ancho" => 1300 "Tamanyo" => 128191 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Patient 2 showing the lymphocutaneous form caused by the cat scratch on the upper lip and ocular involvement caused by sneezing of the sick cat.</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1333 "Ancho" => 750 "Tamanyo" => 75304 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Ocular secretion culture in Sabouraud agar, showing the growth of a black and white filamentous colony.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ocular sporotrichosis: a frequently misdiagnosed cause of granulomatous conjunctivitis in epidemic areas" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.P.M. Yamagata" 1 => "F.B. Rudolph" 2 => "M.C.L. Nobre" 3 => "L.V. Nascimento" 4 => "F.M.S. Sampaio" 5 => "A. Arinelli" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ajoc.2017.09.005" "Revista" => array:6 [ "tituloSerie" => "Am J Ophthalmol Case Rep" "fecha" => "2017" "volumen" => "8" "paginaInicial" => "35" "paginaFinal" => "38" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29260114" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "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. Orofino-Costa" 1 => "P.M. de Macedo" 2 => "A.M. Rodrigues" 3 => "A.R. Bernardes-Engemann" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1590/abd1806-4841.2017279" "Revista" => array:6 [ "tituloSerie" => "An Bras Dermatol" "fecha" => "2017" "volumen" => "92" "paginaInicial" => "606" "paginaFinal" => "620" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29166494" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Disseminated cutaneous sporotrichosis associated with ocular lesion in an immunocompetent patient" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "K.B. Medeiros" 1 => "L.G. Landeiro" 2 => "L.M. Diniz" 3 => "A. Falqueto" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1590/abd1806-4841.20164859" "Revista" => array:6 [ "tituloSerie" => "An Bras Dermatol" "fecha" => "2016" "volumen" => "91" "paginaInicial" => "537" "paginaFinal" => "539" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27579758" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Parinaud’s oculoglandular syndrome caused by Sporotrichosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A.S.A. Ribeiro" 1 => "T. Bisol" 2 => "M.S. Menezes" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Rev Bras Oftalmol" "fecha" => "2010" "volumen" => "69" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/03650596/0000009600000003/v2_202106040718/S0365059621000738/v2_202106040718/en/main.assets" "Apartado" => array:4 [ "identificador" => "80635" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Tropical/Infectoparasitary Dermatology" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/03650596/0000009600000003/v2_202106040718/S0365059621000738/v2_202106040718/en/main.pdf?idApp=UINPBA00008Z&text.app=https://clinics.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059621000738?idApp=UINPBA00008Z" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 11 | 8 | 19 |
| 2024 October | 102 | 76 | 178 |
| 2024 September | 156 | 80 | 236 |
| 2024 August | 136 | 119 | 255 |
| 2024 July | 128 | 107 | 235 |
| 2024 June | 127 | 69 | 196 |
| 2024 May | 110 | 61 | 171 |
| 2024 April | 111 | 77 | 188 |
| 2024 March | 77 | 75 | 152 |
| 2024 February | 90 | 72 | 162 |
| 2024 January | 68 | 52 | 120 |
| 2023 December | 75 | 66 | 141 |
| 2023 November | 85 | 74 | 159 |
| 2023 October | 83 | 83 | 166 |
| 2023 September | 68 | 70 | 138 |
| 2023 August | 82 | 39 | 121 |
| 2023 July | 88 | 31 | 119 |
| 2023 June | 61 | 36 | 97 |
| 2023 May | 57 | 25 | 82 |
| 2023 April | 67 | 30 | 97 |
| 2023 March | 59 | 60 | 119 |
| 2023 February | 59 | 42 | 101 |
| 2023 January | 70 | 50 | 120 |
| 2022 December | 50 | 46 | 96 |
| 2022 November | 85 | 68 | 153 |
| 2022 October | 113 | 111 | 224 |
| 2022 September | 68 | 75 | 143 |
| 2022 August | 83 | 57 | 140 |
| 2022 July | 63 | 62 | 125 |
| 2022 June | 85 | 67 | 152 |
| 2022 May | 62 | 72 | 134 |
| 2022 April | 64 | 57 | 121 |
| 2022 March | 66 | 79 | 145 |
| 2022 February | 52 | 41 | 93 |
| 2022 January | 73 | 88 | 161 |
| 2021 December | 64 | 73 | 137 |
| 2021 November | 76 | 235 | 311 |
| 2021 October | 78 | 97 | 175 |
| 2021 September | 74 | 61 | 135 |
| 2021 August | 75 | 61 | 136 |
| 2021 July | 101 | 62 | 163 |
| 2021 June | 272 | 87 | 359 |
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| 2021 April | 150 | 317 | 467 |
| 2021 March | 28 | 27 | 55 |
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