Letter - Tropical/Infectious and Parasitic Dermatology
Lobomycosis: single lesion on the lip
Kananda Kesye Sousa Nunes
, Carlos Alberto Chirano Rodrigues, Antonio Pedro Mendes Schettini, Sinésio Talhari
Corresponding author
Department of Dermatology, Fundação Hospitalar Alfredo da Matta, Manaus, AM, Brazil
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On examination, an erythematous, infiltrated tumor lesion with a firm consistency was observed on the right side of the upper lip (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The general clinical examination and laboratory tests showed no changes.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">A biopsy of the lesion was performed and histopathology revealed a nodular granulomatous inflammatory infiltrate involving the entire dermis and hypodermis, consisting of epithelioid histiocytes and numerous giant cells, containing rounded fungal structures in a catenulate arrangement compatible with <span class="elsevierStyleItalic">Lacazia loboi</span> (<a class="elsevierStyleCrossRefs" href="#fig0010">Figs. 2 and 3</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Surgical excision of the lesion was performed (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>) and itraconazole, at a dose of 100 mg, every 12 hours, orally, for six months was prescribed, in an attempt to prevent recurrence. The patient is in the eighth month of follow-up, progressing satisfactorily, without recurrence of the lesion.</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Lobomycosis (Jorge Lobo's disease) was first described in 1931 by the dermatologist Jorge Oliveira Lobo. It is a subcutaneous mycosis, usually characterized by nodular lesions with a keloid appearance; however, there may be lesion polymorphism, as plaques, papules, macules, verrucous lesions, ulcerations and scarring lesions; it evolutes slowly, sometimes making clinical diagnosis difficult.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> The lesions are generally asymptomatic, although pruritus and dysesthesia may occur.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The disease is caused by a yeast-like fungus called <span class="elsevierStyleItalic">Lacazia loboi</span>, which was recently renamed <span class="elsevierStyleItalic">Paracoccidioides lobogeorgii</span> following current taxonomic rules, after a broad nomenclature review.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Although the disease occurs throughout Central and South America, it is mainly observed in the Amazon region, in patients from rural areas.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The transmission mechanism is not exactly known, although traumatic implantation of the fungus into the skin is plausible. To date, the etiological agent has not been cultivated.</p><p id="par0030" class="elsevierStylePara elsevierViewall">In most cases, lobomycosis is located mainly in the distal extremities and ears. Lip location is rare ‒ there are only two cases recorded in the consulted literature.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The diagnosis is based on clinical aspects, direct mycological examination by scarification, scraping, or curettage of the lesion, and histopathology.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Currently, there is no completely satisfactory therapy. The treatment of choice for unifocal and localized forms is surgical excision, with safety margins, associated or not with clinical treatment to prevent recurrence. Multifocal forms should be treated, whenever possible, with a combination of excision surgery and adjuvant systemic treatment. Effective medications previously reported in the literature include posaconazole, itraconazole and clofazimine. It is worth highlighting the need for long-term follow-up, as recurrence is possible.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,5</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">New studies investigating the etiopathogenesis, transmission and treatment of lobomycosis are necessary to better elucidate this neglected and still obscure tropical disease that remains a challenge in dermatological practice.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0050" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors' contributions</span><p id="par0055" class="elsevierStylePara elsevierViewall">Kananda Kesye Sousa Nunes: Drafting and editing of the manuscript; critical review of the literature; critical review of the manuscript; approval of the final version of the manuscript.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Antonio Pedro Mendes Schettini: Drafting and editing of the manuscript; effective participation in research orientation; critical review of the literature; critical review of the manuscript; approval of the final version of the manuscript.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Carlos Alberto Chirano Rodrigues: Effective participation in research orientation; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the manuscript; approval of the final version of the manuscript.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Sinésio Talhari: Drafting and editing of the manuscript; effective participation in research orientation; critical review of the literature; critical review of the manuscript; approval of the final version of the manuscript.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0075" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Financial support" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Authors' contributions" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflicts of interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2024-02-03" "fechaAceptado" => "2024-03-14" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Study conducted at the Fundação Hospitalar Alfredo da Matta, Manaus, AM, Brazil.</p>" ] ] "multimedia" => array:4 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 535 "Ancho" => 755 "Tamanyo" => 56387 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Tumor lesion with a 10-year evolution.</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" => 1198 "Ancho" => 905 "Tamanyo" => 265092 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Histopathology of the surgical specimen. A granulomatous inflammatory reaction with a large number of giant cells containing rounded fungal elements can be seen (Hematoxylin & eosin, ×200).</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" => 965 "Ancho" => 905 "Tamanyo" => 172987 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Histopathology of the surgical specimen. Presence of fungal elements, of similar size, with thick and birefringent walls inside giant cells (Hematoxylin & eosin, ×400). Microphotography: Rounded, birefringent fungal structures in a catenulate arrangement. (Grocott, ×600).</p>" ] ] 3 => array:8 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1728 "Ancho" => 905 "Tamanyo" => 231008 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">(A) Surgical markings before resection. (B) Five months after the procedure.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lacaziosis (Jorge Lobo’s disease): review and update" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A.C. Brito" 1 => "J.A.S. Quaresma" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "An Bras Dermatol" "fecha" => "2007" "volumen" => "82" "paginaInicial" => "461" "paginaFinal" => "474" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lobomycosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S. 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