Tropical/Infectoparasitary Dermatology
Pseudomycetoma of the scalp caused by Microsporum canis
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Pyriform conidia arranged like a daisy flower at the end of the conidiophores.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Norami de Moura Barros, Allen de Souza Pessoa, Arles Martins Brotas" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Norami de Moura" "apellidos" => "Barros" ] 1 => array:2 [ "nombre" => "Allen de Souza" "apellidos" => "Pessoa" ] 2 => array:2 [ "nombre" => "Arles Martins" "apellidos" => "Brotas" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "pt" => array:9 [ "pii" => "S266627522030151X" "doi" => "10.1016/j.abdp.2019.08.008" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "pt" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S266627522030151X?idApp=UINPBA00008Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059620300817?idApp=UINPBA00008Z" "url" => "/03650596/0000009500000003/v4_202007210853/S0365059620300817/v4_202007210853/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S0365059620300969" "issn" => "03650596" "doi" => "10.1016/j.abd.2020.01.003" "estado" => "S300" "fechaPublicacion" => "2020-05-01" "aid" => "185" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by/4.0/" "subdocumento" => "rev" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Review</span>" "titulo" => "Update on vasculitis: an overview and dermatological clues for clinical and histopathological diagnosis – part I" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "355" "paginaFinal" => "371" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 435 "Ancho" => 1250 "Tamanyo" => 76478 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Distinct lesions normally found on the skin of patients with medium vessel vasculitis: (a) Livedo racemosa in the lower limbs, including the dorsum of the feet in a patient with cutaneous arteritis, (b) Digital necrosis in a patients with ANCA-associated vasculitis - granulomatosis with polyangiitis.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Thâmara Cristiane Alves Batista Morita, Gabriela Franco S. 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C and D, fungal culture, with white filamentous colony and yellow pigmented agar and microculture with hyaline septated hyphae in the background and three macroconidia in the center (Cotton blue, ×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">A 24-year-old immunocompetent male, with tumoral lesion in the occipital area which started at two years of age with areas of alopecia that progressively evolved to a tumor. His first consultation was at age 14, presenting at the clinical examination a hardened tumor with granular fundus ulcerations. He abandoned follow-up, returning ten years later with a considerable increase of the lesion (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Material analysis of ulcer scaling identified at direct microscope examination grains composed of septate hyaline hyphae, and micologial culture isolated <span class="elsevierStyleItalic">Microsporum canis</span> (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Histopathological examination revealed at the dermis and hypodermis clusters of septated hyaline hyphae of varied sizes involved by histiocytic Splendore-Hoeppli reaction with numerous multinucleated giant cells of foreign body type, besides neutrophilic exudate, edema and vascular congestion. No fistulated pathways were visualized promoting the continuity between the “grains” and the epidermal surface in the sample (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). He denied use of any immunosuppressive medication, presented non-reactive serology for HIV, and had no other comorbidities. Associating the clinical aspect with the complementary tests, the diagnosis of pseudomycetoma by <span class="elsevierStyleItalic">Microsporum canis</span> was confirmed. The patient was submitted to surgical excision of the tumor and associated oral griseofulvin, one gram per day for two years. In a one year follow-up after the end of griseofulvin, the patient showed no signs of relapse (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Discussion</span><p id="par0010" class="elsevierStylePara elsevierViewall">Chronic inflammatory and invasive forms of dermatophytosis are the result of an intense hypersensitivity reaction to the fungal infection, more frequent in immunocompromised individuals.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> The clinical presentations are kerion celsi, Majocchi granuloma and pseudomycetoma.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a> Pseudomycetoma is an extremely rare mycosis, caused by the penetration of dermatophytes into the tissue from rupture of infected follicular epithelium. Ajello et al.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">3</span></a> reported several species of dermatophytes producing grains in tissues, including <span class="elsevierStyleItalic">Microsporum canis</span>, <span class="elsevierStyleItalic">Trichophyton tonsurans</span> and <span class="elsevierStyleItalic">T. mentagrophytes</span>. According to these authors, mycelium aggregates formed by the dermatophytes would be pseudo-granules and the term pseudomycetoma should be applied to this deep dermatophytic infection.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">4,5</span></a> The isolated agent in this case was compatible with the most frequent tinea capitis agent in Brazil.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">6,7</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Clinical aspects of pseudomycetoma are identical to those of eumicetoma, yet in contrast to mycetomas, pseudomycetomas are more common in the scalp and do not have a history of trauma for its inoculation.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">8</span></a> Although the dermatophytic hyphae usually are more delicate than the eumicetoma agents at mycological examinations, the same does not happen in the clusters visualized on the histopathological examination.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">7–9</span></a> However, there is a difference between the two diseases at histopathology: mycetomas typically have sinus tracts through which fibrinopurulent exudate and grains are readily excreted; by contrast, pseudomycetomas lack sinus tracts.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">8</span></a> Therefore, isolation of the agent should be obtained with fungal culture, as here presented. Although more frequent in immunosuppressed patients, there are reports of cases in immunocompetent patients, and the eosinophilic reaction of Splendore-Hoeppli around pseudogranules is present in all cases of pseudomycetoma, highlighting the intense reaction of the organism against the fungus.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The treatment of pseudomycetoma by <span class="elsevierStyleItalic">M. canis</span> is surgical excision of the fungal mass, since the systemic antifungal does not reach therapeutic concentrations,<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">8</span></a> associated with oral griseofulvin<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">1,6,7</span></a> until clinical and mycological cure.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Financial support</span><p id="par0045" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Authors’ contributions</span><p id="par0025" class="elsevierStylePara elsevierViewall">Ligia Rangel Barboza Ruiz: 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="par0030" class="elsevierStylePara elsevierViewall">Clarisse Zaitz: Approval of the final version of the manuscript; conception and planning of the study; 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.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Clarisse Zaitz: Intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases.</p><p id="par0040" class="elsevierStylePara elsevierViewall">John Verrinder Veasey: Approval of the final version of the manuscript; elaboration and writing of the manuscript; 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="par0050" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:8 [ 0 => array:3 [ "identificador" => "xres1365104" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1254937" "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" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-03-28" "fechaAceptado" => "2019-07-22" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1254937" "palabras" => array:5 [ 0 => "Histology" 1 => "Microsporum" 2 => "Mycetoma" 3 => "Tinea" 4 => "Tinea capitis" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Pseudomycetoma is an extremely rare deep mycosis, caused by dermatophytic fungi that penetrate the tissue from infected follicles of tinea capitis. Both clinically and histopathology are similar to eumycetoma, being distinguished through the isolation of the fungus, which in the case of pseudomycetoma can be <span class="elsevierStyleItalic">Microsporum</span> spp. or <span class="elsevierStyleItalic">Trichophyton</span> spp. genre. We present a 24-year-old man with an exuberant tumor in the occipital region with fistula, whose histopathological examination evidenced grains composed of hyaline hyphae and the culture for fungi isolated the agent <span class="elsevierStyleItalic">Microsporum canis</span>. Combined treatment of surgical excision followed by oral griseofulvin for two years was performed, with resolution of the condition.</p></span>" ] ] "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">How to cite this article: Ruiz LRB, Zaitz C, Lellis RF, Veasey JV. Pseudomycetoma of the scalp caused by <span class="elsevierStyleItalic">Microsporum canis</span>. An Bras Dermatol. 2020;95:372–5.</p>" ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Study conducted at the Clínica de Dermatologia 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" => 595 "Ancho" => 1750 "Tamanyo" => 180533 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Clinical aspect of pseudomycetoma at occipital lesion. A and B, patient with 14-years-old. C, patient with 24-years-old.</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" => 692 "Ancho" => 1750 "Tamanyo" => 135709 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A and B, Direct mycological examination clarified with 20% KOH. ×100 augmentation, showing agglomerates of septated hyphae, and ×400 augmentation, identifying the structures of hyaline septated hyphae. C and D, fungal culture, with white filamentous colony and yellow pigmented agar and microculture with hyaline septated hyphae in the background and three macroconidia in the center (Cotton blue, ×400).</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" => 714 "Ancho" => 1500 "Tamanyo" => 360871 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Histopathological examination. A, identifying grains surrounded by inflammatory suppurative process and lymphohistiocytic reaction (Hematoxylin & Eosin, ×100). B, grain composed of septated hyaline hyphae surrounded by eosinophilic material (Splendore-Hoeppli phenomenon) (Hematoxylin & eosin, ×200). C, evidencing the morphology of hyphae (PAS, ×200).</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" => 623 "Ancho" => 1250 "Tamanyo" => 131052 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Patient with clinical aspect after treatment.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0050" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pseudomycetoma for <span class="elsevierStyleItalic">Microsporum canis</span>: report of a case diagnosed by fine needle aspiration biopsy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "O. 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| Ano/Mês | Html | Total | |
|---|---|---|---|
| 2024 Novembro | 25 | 7 | 32 |
| 2024 Outubro | 137 | 69 | 206 |
| 2024 Setembro | 158 | 83 | 241 |
| 2024 Agosto | 174 | 110 | 284 |
| 2024 Julho | 153 | 121 | 274 |
| 2024 Junho | 137 | 99 | 236 |
| 2024 Maio | 114 | 70 | 184 |
| 2024 Abril | 106 | 100 | 206 |
| 2024 Março | 95 | 81 | 176 |
| 2024 Fevereiro | 139 | 94 | 233 |
| 2024 Janeiro | 92 | 66 | 158 |
| 2023 Dezembro | 74 | 62 | 136 |
| 2023 Novembro | 92 | 87 | 179 |
| 2023 Outubro | 91 | 89 | 180 |
| 2023 Setembro | 114 | 86 | 200 |
| 2023 Agosto | 82 | 36 | 118 |
| 2023 Julho | 65 | 41 | 106 |
| 2023 Junho | 77 | 40 | 117 |
| 2023 Maio | 59 | 40 | 99 |
| 2023 Abril | 56 | 21 | 77 |
| 2023 Março | 80 | 49 | 129 |
| 2023 Fevereiro | 62 | 49 | 111 |
| 2023 Janeiro | 44 | 34 | 78 |
| 2022 Dezembro | 42 | 15 | 57 |
| 2022 Novembro | 91 | 53 | 144 |
| 2022 Outubro | 100 | 62 | 162 |
| 2022 Setembro | 53 | 67 | 120 |
| 2022 Agosto | 45 | 53 | 98 |
| 2022 Julho | 50 | 53 | 103 |
| 2022 Junho | 69 | 55 | 124 |
| 2022 Maio | 47 | 43 | 90 |
| 2022 Abril | 50 | 51 | 101 |
| 2022 Março | 49 | 65 | 114 |
| 2022 Fevereiro | 56 | 32 | 88 |
| 2022 Janeiro | 90 | 73 | 163 |
| 2021 Dezembro | 46 | 57 | 103 |
| 2021 Novembro | 47 | 61 | 108 |
| 2021 Outubro | 68 | 96 | 164 |
| 2021 Setembro | 43 | 52 | 95 |
| 2021 Agosto | 41 | 55 | 96 |
| 2021 Julho | 47 | 53 | 100 |
| 2021 Junho | 33 | 73 | 106 |
| 2021 Maio | 90 | 98 | 188 |
| 2021 Abril | 159 | 180 | 339 |
| 2021 Março | 74 | 58 | 132 |
| 2021 Fevereiro | 42 | 13 | 55 |
| 2021 Janeiro | 30 | 18 | 48 |
| 2020 Dezembro | 35 | 20 | 55 |
| 2020 Novembro | 31 | 13 | 44 |
| 2020 Outubro | 23 | 8 | 31 |
| 2020 Setembro | 34 | 12 | 46 |
| 2020 Agosto | 35 | 5 | 40 |
| 2020 Julho | 48 | 9 | 57 |
| 2020 Junho | 18 | 17 | 35 |
| 2020 Maio | 16 | 9 | 25 |
| 2020 Abril | 0 | 4 | 4 |
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