Tropical/Infectoparasitary Dermatology
Systemic sporotrichosis in an alcoholic patient
Norami de Moura Barros
, Allen de Souza Pessoa, Arles Martins Brotas
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Department of Dermatology, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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Pyriform conidia arranged like a daisy flower at the end of the conidiophores.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Sporotrichosis is a subacute or chronic subcutaneous mycosis caused by dimorphic fungi of the genus <span class="elsevierStyleItalic">Sporothrix</span>. Approximately 80% of the affected patients present the lymphocutaneous form. However, in patients with immunosuppression, disseminated forms can occur.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">A 44-year-old male patient, presented with subcutaneous nodules that developed inflammation, following drainage of seropurulent secretion and ulceration. The patient had a 6 year-history of alcohol addiction. He denied comorbidities, although he reported prolonged contact with cats of unknown origin.</p><p id="par0015" class="elsevierStylePara elsevierViewall">At the physical examination, the patient had skin-colored and erythematous subcutaneous nodules, and ulcers covered with thick, blackened crusts on the face, trunk and limbs (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Due to compatible epidemiological history and the evolution pattern of the lesions, the main diagnostic hypothesis was sporotrichosis.</p><p id="par0025" class="elsevierStylePara elsevierViewall">A culture of the aspirated fluid of one of the nodules was performed, which revealed growth of <span class="elsevierStyleItalic">Sporotrix</span> sp. after 5 days (<a class="elsevierStyleCrossRefs" href="#fig0015">Figs. 3 and 4</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">The laboratory tests (hemogram, kidney function, liver function and thyroid function) did not show any abnormal results, and the serology test results (hepatitis B, hepatitis C, VDRL, HTLV and HIV) were negative.</p><p id="par0035" class="elsevierStylePara elsevierViewall">High-resolution chest CT revealed atelectasis, ground-glass infiltrate, hilar lymphadenopathy and pleural effusion in both lungs.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The disease was classified as systemic sporotrichosis, according to the classification recommended by Orofino-Costa et al,<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> illustrating an exuberant presentation in a patient immunosuppressed by alcoholism.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Patient was treated with amphotericin B lipid complex for 28 days, followed by itraconazole, during 11 months and had a good response, with healing of ulcers and without relapses in a 6-month follow-up.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The feline zoonotic transmission of sporotrichosis was observed in the 1990s in the State of Rio de Janeiro, Brazil, which is currently considered to be a hyperendemic area. In the South and Southeast Brazilian regions, <span class="elsevierStyleItalic">S. brasiliensis</span> is the main (88%) etiological agent of human and animal sporotrichosis.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Systemic forms are rare and usually affect immunocompromised individuals, mostly those with HIV .<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Chronic alcohol abuse results in lymphopenia and chronic activation of the T-cell pool, which may alter the T-cell ability to expand and respond to pathogenic agents, inducing to an anergy state and, changing Th1 and Th2 response.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Th1 response is considered as the main control factor of fungal infection. In addition to patient immunosuppression, we should emphasize that <span class="elsevierStyleItalic">S. brasiliensis</span> is the most virulent species of this genus, due to its ability to invade tissues and lead one to death.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3,5</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">The high prevalence of alcohol abuse in the Brazilian population, estimated at 13.7%, and the increasing zoonotic transmission of sporotrichosis may lead to an increase in the prevalence of disseminated forms of the disease.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Our report corroborates the association previously reported by others between alcoholism and the spread of sporotrichosis.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">7–10</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Financial support</span><p id="par0080" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Authors' contributions</span><p id="par0085" class="elsevierStylePara elsevierViewall">Norami de Moura Barros: 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; 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="par0090" class="elsevierStylePara elsevierViewall">Allen de Souza Pessoa: 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; 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="par0095" class="elsevierStylePara elsevierViewall">Arles Martins Brotas: 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; critical review of the literature; critical review of the literature.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflicts of interest</span><p id="par0100" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:6 [ 0 => array:3 [ "identificador" => "xres1365105" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1254938" "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" => "2019-05-11" "fechaAceptado" => "2019-08-18" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1254938" "palabras" => array:3 [ 0 => "Alcoholism" 1 => "Immunosuppression" 2 => "Sporotrichosis" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A 44-year-old male patient presented with nodules that evolved with inflammation, following drainage of seropurulent secretion and ulceration. The patient had a 6 year-history of alcohol addiction and reported contact with cats. At the physical examination, the patient had skin-colored and erythematous nodules, and ulcers covered with thick, blackened crusts on the face, trunk and limbs. A culture of a nodule fluid revealed growth of <span class="elsevierStyleItalic">Sporotrix</span> sp. He also had pulmonary involvement and therefore the disease was classified as systemic sporotrichosis, a rare form that usually affect patients infected with HIV. Chronic alcohol abuse was considered the factor of immunosuppression for the patient.</p></span>" ] ] "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">How to cite this article: Barros NM, Pessoa AS, Brotas AM. Systemic sporotrichosis in an alcoholic patient. An Bras Dermatol. 2020;95:373–5.</p>" ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Study conducted at the Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, 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" => 1138 "Ancho" => 855 "Tamanyo" => 119515 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Skin-colored and erythematous nodules and ulcers covered with thick, blackened crusts.</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" => 808 "Ancho" => 855 "Tamanyo" => 73063 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Skin-colored and erythematous nodules and ulcers covered with thick, blackened crusts.</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" => 1103 "Ancho" => 855 "Tamanyo" => 110606 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Hyaline, septate, branched and regular hyphae. Pyriform conidia arranged like a daisy flower at the end of the conidiophores.</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" => 1455 "Ancho" => 855 "Tamanyo" => 83829 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Membranous colony with white and blackened areas, and colorless back.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidemiology of sporotrichosis in Latin America" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "I.A. 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| Ano/Mês | Html | Total | |
|---|---|---|---|
| 2024 Novembro | 21 | 8 | 29 |
| 2024 Outubro | 106 | 67 | 173 |
| 2024 Setembro | 124 | 87 | 211 |
| 2024 Agosto | 139 | 125 | 264 |
| 2024 Julho | 125 | 110 | 235 |
| 2024 Junho | 113 | 83 | 196 |
| 2024 Maio | 86 | 71 | 157 |
| 2024 Abril | 110 | 88 | 198 |
| 2024 Março | 113 | 76 | 189 |
| 2024 Fevereiro | 85 | 80 | 165 |
| 2024 Janeiro | 75 | 55 | 130 |
| 2023 Dezembro | 70 | 69 | 139 |
| 2023 Novembro | 80 | 80 | 160 |
| 2023 Outubro | 73 | 78 | 151 |
| 2023 Setembro | 62 | 74 | 136 |
| 2023 Agosto | 47 | 41 | 88 |
| 2023 Julho | 49 | 45 | 94 |
| 2023 Junho | 49 | 40 | 89 |
| 2023 Maio | 39 | 19 | 58 |
| 2023 Abril | 26 | 20 | 46 |
| 2023 Março | 49 | 47 | 96 |
| 2023 Fevereiro | 46 | 35 | 81 |
| 2023 Janeiro | 34 | 23 | 57 |
| 2022 Dezembro | 46 | 30 | 76 |
| 2022 Novembro | 64 | 50 | 114 |
| 2022 Outubro | 102 | 67 | 169 |
| 2022 Setembro | 39 | 62 | 101 |
| 2022 Agosto | 39 | 53 | 92 |
| 2022 Julho | 31 | 46 | 77 |
| 2022 Junho | 44 | 57 | 101 |
| 2022 Maio | 34 | 56 | 90 |
| 2022 Abril | 37 | 45 | 82 |
| 2022 Março | 39 | 62 | 101 |
| 2022 Fevereiro | 26 | 34 | 60 |
| 2022 Janeiro | 39 | 76 | 115 |
| 2021 Dezembro | 36 | 49 | 85 |
| 2021 Novembro | 37 | 65 | 102 |
| 2021 Outubro | 49 | 83 | 132 |
| 2021 Setembro | 36 | 48 | 84 |
| 2021 Agosto | 39 | 30 | 69 |
| 2021 Julho | 30 | 48 | 78 |
| 2021 Junho | 34 | 46 | 80 |
| 2021 Maio | 47 | 68 | 115 |
| 2021 Abril | 130 | 189 | 319 |
| 2021 Março | 48 | 54 | 102 |
| 2021 Fevereiro | 14 | 20 | 34 |
| 2021 Janeiro | 27 | 17 | 44 |
| 2020 Dezembro | 14 | 17 | 31 |
| 2020 Novembro | 23 | 9 | 32 |
| 2020 Outubro | 12 | 16 | 28 |
| 2020 Setembro | 20 | 13 | 33 |
| 2020 Agosto | 27 | 9 | 36 |
| 2020 Julho | 29 | 10 | 39 |
| 2020 Junho | 13 | 19 | 32 |
| 2020 Maio | 17 | 11 | 28 |
| 2020 Abril | 0 | 7 | 7 |
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