Tropical/Infectoparasitary Dermatology
Tinea corporis by Nannizia gypsea: delayed diagnosis due to unusual presentation
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class="elsevierStyleTextfn">Dermatologia Tropical/Infectoparasitária</span>" "titulo" => "<span class="elsevierStyleItalic">Tinea corporis</span> por <span class="elsevierStyleItalic">Nannizia gypsea</span>: atraso no diagnóstico por apresentação incomum" "tienePdf" => "pt" "tieneTextoCompleto" => "pt" "tieneResumen" => "pt" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "91" "paginaFinal" => "93" ] ] "contieneResumen" => array:1 [ "pt" => true ] "contieneTextoCompleto" => array:1 [ "pt" => true ] "contienePdf" => array:1 [ "pt" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1009 "Ancho" => 750 "Tamanyo" => 125676 ] ] "descripcion" => array:1 [ "pt" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Aspecto clínico das lesões: placa eritematosa de aspecto numular, com pústulas periféricas e pelos tonsurados, localizada no antebraço direito, associada à lesão satélite com as mesmas características. <span class="elsevierStyleItalic">Tinea corporis</span> por <span class="elsevierStyleItalic">Nannizia gypsea</span>: atraso no diagnóstico por apresentação incomum.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Juliana de Jesus Soares, Nathalie Andrade Sousa, Luna Azulay‐Abulafia, Rosane Orofino Costa" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Juliana de Jesus" "apellidos" => "Soares" ] 1 => array:2 [ "nombre" => "Nathalie Andrade" "apellidos" => "Sousa" ] 2 => array:2 [ "nombre" => "Luna" "apellidos" => "Azulay‐Abulafia" ] 3 => array:2 [ "nombre" => "Rosane Orofino" "apellidos" => "Costa" ] ] ] ] ] "idiomaDefecto" => "pt" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S036505962030307X" "doi" => "10.1016/j.abd.2020.05.012" "estado" => "S300" "subdocumento" => "" 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elsevierViewall">(A), Two superficial oval ulcers over striae in the inguinal region. (B), Beefy red oval ulcer over a wide atrophic stria with telangiectasia, extending from the anterior to the inferior aspect of breast. Active <span class="elsevierStyleItalic">tinea corporis</span> is observed.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Shyam B. Verma, Bhushan Madke" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Shyam B." 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Overview of the rash.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Dario Palhares" "autores" => array:1 [ 0 => array:2 [ "nombre" => "Dario" "apellidos" => "Palhares" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "pt" => array:9 [ "pii" => "S2666275220303581" "doi" => "10.1016/j.abdp.2020.06.007" "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/S2666275220303581?idApp=UINPBA00008Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059620303068?idApp=UINPBA00008Z" "url" => "/03650596/0000009600000001/v3_202102051036/S0365059620303068/v3_202102051036/en/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Tropical/Infectoparasitary Dermatology</span>" "titulo" => "Tinea corporis by <span class="elsevierStyleItalic">Nannizia gypsea</span>: delayed diagnosis due to unusual presentation" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "91" "paginaFinal" => "93" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Juliana de Jesus Soares, Nathalie Andrade Sousa, Luna Azulay-Abulafia, Rosane Orofino Costa" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Juliana de Jesus" "apellidos" => "Soares" "email" => array:1 [ 0 => "jujuxsoares@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Nathalie Andrade" "apellidos" => "Sousa" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Luna" "apellidos" => "Azulay-Abulafia" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Rosane Orofino" "apellidos" => "Costa" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "General Dermatology Clinic, Hospital Universitário Pedro Ernesto, Rio de Janeiro, RJ, Brazil" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Faculty of Medicine, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil" "etiqueta" => "b" "identificador" => "aff0010" ] ] "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" => 1218 "Ancho" => 905 "Tamanyo" => 165255 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinical aspect of the lesions: nummular erythematous plaque, with peripheral pustules and tonsured hair, located on the right forearm, associated with a satellite lesion with the same characteristics.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The authors describe the case of a 43-year-old male patient, resident in Jacarepaguá, Rio de Janeiro, Brazil who, at dermatological examination, presented a discreetly pruriginous erythematous plaque, showing a nummular aspect, with peripheral pustules and tonsured hair, located on the right forearm. A similar adjacent lesion was observed; the patient indicated that their onset occurred after he returned from a farm in the countryside area of Rio de Janeiro (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). He underwent oral treatment with cephalexin and topically with corticosteroids, without improvement. As diagnostic hypotheses, sporotrichosis and pyoderma were suggested. The biopsy of a skin fragment stained with H &-E showed an enlarged hair follicle containing hyaline hyphae in its distal portion (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>), which are also evident in the silver impregnation by Grocott's method (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>), and PAS staining. There was also an inflammatory reaction in the superficial dermis, with a predominance of mononuclear cells. The culture for common germs was negative. <span class="elsevierStyleItalic">Nannizzia gypsea</span> was isolated from the skin fragment on Mycosel agar, confirming the diagnosis of tinea corporis. He underwent treatment with cyclopyroxolamine spray, which led to cure after 30 days (<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><p id="par0010" class="elsevierStylePara elsevierViewall">The prevalence of dermatophytoses caused by <span class="elsevierStyleItalic">Nannizia gypsea</span> ranges from 0.72% to 0.5%.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> It is possible that the low prevalence is due to the exuberant inflammatory reaction, as this is a geophilic fungus, not adapted to human parasitism.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a> In general, the clinical presentation of tinea corporis is quite characteristic, presenting a mild or moderate inflammatory reaction, sometimes vesicular or vesicular-crusted, on the edge of a macular, erythematous squamous lesion.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> In this case, the clinical presentation of the lesion was not typical of dermatophytosis of the body; on the contrary, it was a plaque with pustules. In Rio de Janeiro, due to the hyperendemicity of sporotrichosis, this was, naturally, the first hypothesis. Currently, in the state of Rio de Janeiro, lesions that have an infiltrated aspect, without flaking, and that do not initially respond to systemic antibiotic therapy are suggestive of sporotrichosis.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Cases of dermatophytosis with atypical clinical presentation, as reported, may be mistakenly treated with ineffective or inadequate medications, if there are no specific complementary tests. Corticosteroids and antibiotics are the most common drugs used.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In most cases, topical treatment with terbinafine, butenafine, cyclopyroxolamine, or azoles for two to four weeks is simple, cost-effective, and sufficient for healing.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7,8</span></a> Systemic treatment with oral antifungals, such as terbinafine and itraconazole, should be considered in immunosuppressed patients, in extensive and/or recurrent lesions, or in those who do not respond to the use of topical medications.</p><p id="par0025" class="elsevierStylePara elsevierViewall">With the report of this case, the authors aimed to reinforce the idea that complementing the clinical diagnosis with specific laboratory tests that exclude or confirm the initial hypothetical clinical diagnoses can avoid unnecessary and costly treatments, which often prolong the suffering of patients.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Financial support</span><p id="par0030" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Authors’ contributions</span><p id="par0035" class="elsevierStylePara elsevierViewall">Juliana de Jesus Soares: Drafting and editing of the manuscript.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Nathalie Andrade Sousa: Drafting and editing of the manuscript.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Luna Azulay-Abulafia: Critical review of the manuscript.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Rosane Orofino Costa: Critical review of the manuscript.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflicts of interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:6 [ 0 => array:3 [ "identificador" => "xres1461420" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1331604" "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" => "2020-02-10" "fechaAceptado" => "2020-05-02" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1331604" "palabras" => array:4 [ 0 => "Antifungal" 1 => "Corticosteroids" 2 => "Fungus" 3 => "<span class="elsevierStyleItalic">Tinea corporis</span>" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Fungal infections by dermatophytes can present with unusual clinical manifestations, which can cause diagnostic difficulties. The authors present the case of a patient with cutaneous infection by <span class="elsevierStyleItalic">Nanizzia gypsea</span>, initially treated erroneously with topical corticosteroids due to a wrong diagnosis. It was cured after antifungal treatment.</p></span>" ] ] "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">How to cite this article: Soares JJ, Sousa NA, Azulay-Abulafia L, Costa RO. Tinea corporis by <span class="elsevierStyleItalic">Nannizia gypsea</span>: delayed diagnosis due to unusual presentation. An Bras Dermatol. 2021;96:91–93.</p>" ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Study conducted at the Hospital Universitário Pedro Ernesto, Rio de Janeiro, RJ, 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" => 1218 "Ancho" => 905 "Tamanyo" => 165255 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinical aspect of the lesions: nummular erythematous plaque, with peripheral pustules and tonsured hair, located on the right forearm, associated with a satellite lesion with the same characteristics.</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" => 511 "Ancho" => 905 "Tamanyo" => 92220 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Histological section shows an enlarged hair follicle and inflammatory reaction in the superficial dermis, with a predominance of mononuclear cells (Hematoxylin & eosin, ×100).</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" => 1565 "Ancho" => 2500 "Tamanyo" => 676893 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">(A) Hyaline hyphae inside enlarged hair follicle (Hematoxylin & eosin, ×400). (B) Same, silver impregnation by the Grocott method, (Grocott, ×400).</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" => 1207 "Ancho" => 905 "Tamanyo" => 127141 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Clinical aspect of the lesions 30 days after treatment.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A case of tinea corporis on the arm caused by <span class="elsevierStyleItalic">Nannizzia gypsea</span> with dermatoscopic images" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. 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| Ano/Mês | Html | Total | |
|---|---|---|---|
| 2024 Novembro | 24 | 6 | 30 |
| 2024 Outubro | 112 | 82 | 194 |
| 2024 Setembro | 156 | 85 | 241 |
| 2024 Agosto | 141 | 125 | 266 |
| 2024 Julho | 140 | 109 | 249 |
| 2024 Junho | 136 | 90 | 226 |
| 2024 Maio | 121 | 63 | 184 |
| 2024 Abril | 128 | 90 | 218 |
| 2024 Março | 92 | 72 | 164 |
| 2024 Fevereiro | 100 | 81 | 181 |
| 2024 Janeiro | 93 | 43 | 136 |
| 2023 Dezembro | 75 | 75 | 150 |
| 2023 Novembro | 81 | 74 | 155 |
| 2023 Outubro | 66 | 72 | 138 |
| 2023 Setembro | 88 | 78 | 166 |
| 2023 Agosto | 61 | 35 | 96 |
| 2023 Julho | 67 | 42 | 109 |
| 2023 Junho | 70 | 45 | 115 |
| 2023 Maio | 82 | 25 | 107 |
| 2023 Abril | 49 | 23 | 72 |
| 2023 Março | 80 | 37 | 117 |
| 2023 Fevereiro | 54 | 28 | 82 |
| 2023 Janeiro | 53 | 52 | 105 |
| 2022 Dezembro | 64 | 26 | 90 |
| 2022 Novembro | 76 | 50 | 126 |
| 2022 Outubro | 147 | 51 | 198 |
| 2022 Setembro | 89 | 64 | 153 |
| 2022 Agosto | 75 | 52 | 127 |
| 2022 Julho | 49 | 54 | 103 |
| 2022 Junho | 49 | 55 | 104 |
| 2022 Maio | 42 | 56 | 98 |
| 2022 Abril | 56 | 48 | 104 |
| 2022 Março | 52 | 68 | 120 |
| 2022 Fevereiro | 36 | 35 | 71 |
| 2022 Janeiro | 61 | 77 | 138 |
| 2021 Dezembro | 41 | 55 | 96 |
| 2021 Novembro | 43 | 61 | 104 |
| 2021 Outubro | 65 | 86 | 151 |
| 2021 Setembro | 58 | 75 | 133 |
| 2021 Agosto | 57 | 58 | 115 |
| 2021 Julho | 51 | 53 | 104 |
| 2021 Junho | 39 | 56 | 95 |
| 2021 Maio | 59 | 103 | 162 |
| 2021 Abril | 221 | 365 | 586 |
| 2021 Março | 153 | 108 | 261 |
| 2021 Fevereiro | 55 | 33 | 88 |
| 2021 Janeiro | 30 | 19 | 49 |
| 2020 Dezembro | 9 | 11 | 20 |
| 2020 Novembro | 2 | 3 | 5 |
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