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hepatomegaly&#44; and free intraperitoneal fluid&#46; Face ulcer smear and histopathology reported budding yeast cells and blastoconidia &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; Despite receiving liposomal amphotericin B&#44; the patient presented lesions dissemination to the oral cavity&#44; lower gastrointestinal bleeding&#44; mixed shock&#44; and died fifteen days after admission&#46; Face ulcer culture &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41; and axillary lymph node histopathology were collected post-mortem&#46; <span class="elsevierStyleItalic">Trichosporon asahii</span> was identified by matrix-assisted laser desorption ionization-time of flight mass spectrometry &#40;MALDI-TOF MS&#44; Vitek-MS&#174;&#41;&#46; Axillary node histopathology showed Histiocytic Sarcoma &#40;HS&#41;&#44; with positive CD68 and CD163 on immunohistochemistry&#46;</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"><span class="elsevierStyleItalic">Trichosporon</span> spp&#46; are found as commensal and pathogenic fungi&#44; capable of evading the immune response and generating antimicrobial resistance through biofilm formation&#44; metabolic&#44; and phenotypic features&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a><span class="elsevierStyleItalic">Trichosporon asahii</span> affects the skin&#44; mucous membranes&#44; and internal viscera of patients with immunosuppression&#44; hematolymphoid malignancies&#44; or chemotherapy-induced neutropenia&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Disseminated mucocutaneous trichosporonosis presents as rapidly progressive papulonodular lesions and necrotic ulcers&#44; similar to cryptococcosis&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Trichosporonosis is suspected by observing hyphae&#44; arthroconidia&#44; and blastoconidia on a smear and histopathology&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> The definitive diagnosis relies on species identification from culture colonies by chromogenic or biochemical methods&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;4</span></a> MALDI-TOF MS might soon replace these processes&#44; providing higher accuracy yields&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Other techniques such as flow cytometry&#44; polymerase chain reaction&#44; and gene sequencing are still under investigation&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Comparative evidence of antifungal therapy is limited&#46; In a systematic review of 203 cases&#44; voriconazole had the highest favorable outcome rate &#40;73&#46;6&#37;&#41; in patients with hematological neoplasms&#44; and also the best <span class="elsevierStyleItalic">in vitro</span> activity against <span class="elsevierStyleItalic">Trichosporon spp&#46;</span> Similarly&#44; in Mexico&#44; minimum inhibitory concentrations were the lowest for triazoles&#44; higher for amphotericin B&#44; and the highest for echinocandins&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Together&#44; these results are in line with treatment guidelines&#44; where voriconazole is the preferred antifungal&#46; In the present case study&#44; the authors used liposomal amphotericin B due to availability at the authors&#8217; institution&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Therapeutic success depends on the underlying disease status&#46; Here&#44; the patient had an advanced case of HS&#46; This rare and aggressive cancer represents 1&#37; of all hematolymphoid neoplasms&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> HS usually affects lymph nodes&#44; but it can speedily disseminate to several organs&#46; On histopathology&#44; the tumor shows diffuse proliferation of neoplastic cells with eosinophilic cytoplasm and eccentric nuclei&#46; Immunohistochemistry is positive for CD163&#44; CD68&#44; and lysozyme&#46; Epithelial&#44; melanocytic&#44; myeloid&#44; Langerhans&#44; B&#44; and T cell markers are negative&#46; As in this patient&#44; HS is often a late diagnosis and has an estimated survival of fewer than two years&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;8</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In conclusion&#44; trichosporonosis and HS are infrequent&#44; clinically challenging diseases&#46; A swift&#44; interdisciplinary action between dermatology&#44; oncology&#44; and infectious diseases specialists is of utmost importance&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Financial support</span><p id="par0035" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Authors&#8217; contributions</span><p id="par0040" class="elsevierStylePara elsevierViewall">Arturo Robles-Tenorio&#58; Critically reviewed the literature&#44; analyzed the data&#44; and wrote the final version of the manuscript&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Rossy Anah&#237; Rivas-L&#243;pez&#58; Prepared the original draft&#44; was responsible of study conception and data collection&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Alexandro Bonifaz&#58; Critically reviewed the manuscript&#44; provided supporting references&#44; and approved the final version of the manuscript&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">V&#237;ctor Manuel Tarango-Mart&#237;nez&#58; Prepared the original draft&#44; collected the data&#44; and approved the final version of the manuscript&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conflicts of interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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Tropical/Infectoparasitary Dermatology
Disseminated mucocutaneous trichosporonosis in a patient with histiocytic sarcoma
Arturo Robles-Tenorioa, Rossy Anahí Rivas-Lópezb, Alexandro Bonifazc, Víctor Manuel Tarango-Martíneza,
Corresponding author
drtarangovic@gmail.com

Corresponding author.
a Instituto Dermatológico de Jalisco “Dr. José Barba Rubio”, Zapopan, Jalisco, Mexico
b Centro Dermatológico de Sinaloa "Dr. Jesús Rodolfo Acedo Cárdenas", Culiacán, Sinaloa, México
c Servicio de dermatología y departamento de Micología, Hospital General de México “Dr. Eduardo Liceaga”, Ciudad de México, México
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hepatomegaly&#44; and free intraperitoneal fluid&#46; Face ulcer smear and histopathology reported budding yeast cells and blastoconidia &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; Despite receiving liposomal amphotericin B&#44; the patient presented lesions dissemination to the oral cavity&#44; lower gastrointestinal bleeding&#44; mixed shock&#44; and died fifteen days after admission&#46; Face ulcer culture &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41; and axillary lymph node histopathology were collected post-mortem&#46; <span class="elsevierStyleItalic">Trichosporon asahii</span> was identified by matrix-assisted laser desorption ionization-time of flight mass spectrometry &#40;MALDI-TOF MS&#44; Vitek-MS&#174;&#41;&#46; Axillary node histopathology showed Histiocytic Sarcoma &#40;HS&#41;&#44; with positive CD68 and CD163 on immunohistochemistry&#46;</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"><span class="elsevierStyleItalic">Trichosporon</span> spp&#46; are found as commensal and pathogenic fungi&#44; capable of evading the immune response and generating antimicrobial resistance through biofilm formation&#44; metabolic&#44; and phenotypic features&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a><span class="elsevierStyleItalic">Trichosporon asahii</span> affects the skin&#44; mucous membranes&#44; and internal viscera of patients with immunosuppression&#44; hematolymphoid malignancies&#44; or chemotherapy-induced neutropenia&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Disseminated mucocutaneous trichosporonosis presents as rapidly progressive papulonodular lesions and necrotic ulcers&#44; similar to cryptococcosis&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Trichosporonosis is suspected by observing hyphae&#44; arthroconidia&#44; and blastoconidia on a smear and histopathology&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> The definitive diagnosis relies on species identification from culture colonies by chromogenic or biochemical methods&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;4</span></a> MALDI-TOF MS might soon replace these processes&#44; providing higher accuracy yields&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Other techniques such as flow cytometry&#44; polymerase chain reaction&#44; and gene sequencing are still under investigation&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Comparative evidence of antifungal therapy is limited&#46; In a systematic review of 203 cases&#44; voriconazole had the highest favorable outcome rate &#40;73&#46;6&#37;&#41; in patients with hematological neoplasms&#44; and also the best <span class="elsevierStyleItalic">in vitro</span> activity against <span class="elsevierStyleItalic">Trichosporon spp&#46;</span> Similarly&#44; in Mexico&#44; minimum inhibitory concentrations were the lowest for triazoles&#44; higher for amphotericin B&#44; and the highest for echinocandins&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Together&#44; these results are in line with treatment guidelines&#44; where voriconazole is the preferred antifungal&#46; In the present case study&#44; the authors used liposomal amphotericin B due to availability at the authors&#8217; institution&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Therapeutic success depends on the underlying disease status&#46; Here&#44; the patient had an advanced case of HS&#46; This rare and aggressive cancer represents 1&#37; of all hematolymphoid neoplasms&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> HS usually affects lymph nodes&#44; but it can speedily disseminate to several organs&#46; On histopathology&#44; the tumor shows diffuse proliferation of neoplastic cells with eosinophilic cytoplasm and eccentric nuclei&#46; Immunohistochemistry is positive for CD163&#44; CD68&#44; and lysozyme&#46; Epithelial&#44; melanocytic&#44; myeloid&#44; Langerhans&#44; B&#44; and T cell markers are negative&#46; As in this patient&#44; HS is often a late diagnosis and has an estimated survival of fewer than two years&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;8</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In conclusion&#44; trichosporonosis and HS are infrequent&#44; clinically challenging diseases&#46; A swift&#44; interdisciplinary action between dermatology&#44; oncology&#44; and infectious diseases specialists is of utmost importance&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Financial support</span><p id="par0035" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Authors&#8217; 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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Trichosporon asahii</span> is the causal agent of trichosporonosis&#46; Patients with immunosuppression or hematological malignancies are at higher risk of infection&#46; Skin and mucosal involvement appear as fast-growing papulonodular lesions and necrotic ulcers&#46; Internal organ dissemination is lethal&#46; Therapeutic success depends on the underlying disease&#46; Here&#44; the authors present the first case of disseminated mucocutaneous trichosporonosis in a patient with a post-mortem diagnosis of histiocytic sarcoma&#44; a rare and aggressive haematolymphoid neoplasm&#46; Regretfully&#44; death occurred despite treatment with liposomal amphotericin B and supportive measures&#44; showcasing the fatality of both diseases&#46;</p></span>"
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Face ulcer culture&#46; &#40;A&#41;&#44; <span class="elsevierStyleItalic">Trichosporon spp&#46;</span> colonies showed a raised&#44; waxy appearance with radial furrows on Sabouraud culture&#46; &#40;B&#41;&#44; Culture smear revealed hyphae&#44; blastoconidia and arthroconidia with cotton blue stain&#46;</p>"
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Article information
ISSN: 03650596
Original language: English
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