Case for diagnosis. Ulcer and papular lesions in a patient with diabetes mellitus. Protothecosis | Anais Brasileiros de Dermatologia (Portuguese)

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"titulo" => "Case for diagnosis. Ulcer and papular lesions in a patient with diabetes mellitus. Protothecosis" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "613" "paginaFinal" => "616" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Larissa Daniele Machado Góes, Vinícius da Silva Monteiro, Ana Tereza Orsi de Souza" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Larissa Daniele Machado" "apellidos" => "Góes" "email" => array:1 [ 0 => "larissadaniele55@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Vinícius da Silva" "apellidos" => "Monteiro" ] 2 => array:2 [ "nombre" => "Ana Tereza Orsi de" "apellidos" => "Souza" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Fundação de Dermatologia Tropical e Venereologia Alfredo da Matta, Manaus, AM, Brazil" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 972 "Ancho" => 1505 "Tamanyo" => 299240 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "(A), Sporangia highlighted in black with silver staining (Grocott, ×400); (B), Sporangia highlighted by PAS staining (PAS, ×400)." ] ] ] "textoCompleto" => "Case reportA 79-year-old woman, born and living in the municipality of Manaus, with non-insulin-dependent diabetes mellitus, with a pacemaker, was referred with a histopathological diagnosis of cryptococcosis, and reporting a two-year evolution of the disease.The dermatological examination showed an ulcer on the right scapula and erythematous-papular lesions, isolated and confluent, forming small plaques, located on the left scapula (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A and B). Serologies were negative for HIV, syphilis, hepatitis B and C. Histopathological examination showed a granulomatous dermal infiltrate and rounded structures, isolated or grouped, of different sizes, inside histiocytes and giant cells (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A and B).<elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia>What is your diagnosis?<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005">a)Cutaneous leishmaniasis</li><li class="elsevierStyleListItem" id="lsti0010">b)Prothotecosis</li><li class="elsevierStyleListItem" id="lsti0015">c)Cryptococcosis</li><li class="elsevierStyleListItem" id="lsti0020">d)Paracoccidioidomycosis</li></ul>DiscussionPAS and Grocott staining showed rounded structures and endosporulation with a morula aspect (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>A and B). Analysis of the molecular structure of material obtained from culture showed the presence of Prototheca wickerhamii. This histopathological and molecular biology data exclude the hypotheses of cryptococcosis, leishmaniasis and paracoccidioidomycosis. The final diagnosis was protothecosis.<elsevierMultimedia ident="fig0015"></elsevierMultimedia>Protothecosis is an opportunistic disease caused by achlorophilic algae of the genus Prototheca, found in dogs, bats, in fresh and saltwater, sewage, soil, and cattle milk.<a class="elsevierStyleCrossRefs" href="#bib0005">1,2</a> Humans are accidentally contaminated through skin scratches, inhalation, or ingestion of the etiological agent.<a class="elsevierStyleCrossRef" href="#bib0015">3</a> Human protothecosis is rare and occurs, in most cases, in immunocompromised patients.<a class="elsevierStyleCrossRef" href="#bib0020">4</a> In general, the clinical manifestations are predominantly cutaneous. Bursitis and systemic involvement have also been reported.<a class="elsevierStyleCrossRefs" href="#bib0025">5,6</a> The main agents of protothecosis are Prototheca zopfii and P. wickerhamii, with the latter being the most common.<a class="elsevierStyleCrossRef" href="#bib0035">7</a> Infiltrated plaques and ulcerated lesions are the most frequent clinical presentations.<a class="elsevierStyleCrossRef" href="#bib0040">8</a> Papular, nodular, pustular, vesicular and verrucous lesions can occur.<a class="elsevierStyleCrossRef" href="#bib0025">5</a>Clinically, all the suggested diagnostic possibilities should be considered. The hypothesis of leishmaniasis is relevant, as the patient lives in Manaus (Brazil) and this disease has been diagnosed with relative frequency in patients with no history of having left the city. Residual areas of primary and/or secondary forests are the main reservoirs of the disease in the urban area.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> Paracoccidioidomycosis can cause similar clinical manifestations, but the patient had no history of activity in rural areas. This diagnosis and the hypothesis of cutaneous cryptococcosis were also ruled out through laboratory tests. The patient had no complaints or clinical evidence of systemic disease associated with protothecosis. The image exams (chest radiography and computed tomography) were normal.The patient was treated with 200 mg/day of itraconazole. There was almost total regression of the lesions; however, the patient died due to complications from COVID-19. Itraconazole has been used for varying periods from 14 to 180 days.<a class="elsevierStyleCrossRefs" href="#bib0035">7,8</a> Amphotericin B is recommended for immunosuppressed patients.<a class="elsevierStyleCrossRefs" href="#bib0045">9,10</a>Financial supportNone declared.Authors’ contributionsLarissa Daniele Machado Góes: Approval of the final version of the manuscript; design and planning of the study; drafting and editing of the manuscript; collection, analysis and interpretation of 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.Vinícius da Silva Monteiro: Design and planning of the study; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the literature; critical review of the manuscript.Ana Tereza Orsi de Souza: Approval of the final version of the manuscript; design and planning of the study; drafting and editing of the manuscript; collection, analysis and interpretation of data; effective participation in research orientation; intellectual participation in propaedeutic and/or therapeutic conduct of the studied cases; critical review of the literature; critical review of the manuscript.Conflicts of interestNone declared." 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The cutaneous form is the most common one. This study describes a patient with isolated erythematous papules and erythematous papular plaques in the scapular regions, with a previous histopathological diagnosis of cryptococcosis. New tests were conclusive for the diagnosis of protothecosis, caused by Prototheca wickerhamii." ] ] "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "How to cite this article: Góes LDM, Monteiro VS, Souza ATO. Case for Diagnosis. Ulcer and papular lesions in a patient with diabetes mellitus. Protothecosis. An Bras Dermatol. 2021;96:613–6." ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "Study conducted at the Fundação de Dermatologia Tropical e Venereologia Alfredo da Matta, Manaus, AM, Brazil." ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 930 "Ancho" => 1500 "Tamanyo" => 187900 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "(A), Ulcerated lesion, with raised edges and an erythematous and hemorrhagic fundus. 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King" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/mmy/myx162" "Revista" => array:7 [ "tituloSerie" => "Med Mycol" "fecha" => "2018" "volumen" => "56" "numero" => "suppl_1" "paginaInicial" => "S188" "paginaFinal" => "S204" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29767780" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Emergence of Fungal-Like Organisms: Prototheca" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "R. Kano" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s11046-019-00365-4" "Revista" => array:6 [ "tituloSerie" => "Mycopathologia" "fecha" => "2020" "volumen" => "185" "paginaInicial" => "747" "paginaFinal" => "754" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31401758" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/03650596/0000009600000005/v4_202110020832/S0365059621001549/v4_202110020832/en/main.assets" "Apartado" => array:4 [ "identificador" => "80633" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "What is your Diagnosis?" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/03650596/0000009600000005/v4_202110020832/S0365059621001549/v4_202110020832/en/main.pdf?idApp=UINPBA00008Z&text.app=https://clinics.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059621001549?idApp=UINPBA00008Z"]

Estatísticas

What is your diagnosis?

Case for diagnosis. Ulcer and papular lesions in a patient with diabetes mellitus. Protothecosis

Larissa Daniele Machado Góes

Autor para correspondência

larissadaniele55@gmail.com

Corresponding author.

, Vinícius da Silva Monteiro, Ana Tereza Orsi de Souza

Fundação de Dermatologia Tropical e Venereologia Alfredo da Matta, Manaus, AM, Brazil

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5505

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    "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 79-year-old woman&#44; born and living in the municipality of Manaus&#44; with non-insulin-dependent diabetes mellitus&#44; with a pacemaker&#44; was referred with a histopathological diagnosis of cryptococcosis&#44; and reporting a two-year evolution of the disease&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The dermatological examination showed an ulcer on the right scapula and erythematous-papular lesions&#44; isolated and confluent&#44; forming small plaques&#44; located on the left scapula &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A and B&#41;&#46; Serologies were negative for HIV&#44; syphilis&#44; hepatitis B and C&#46; Histopathological examination showed a granulomatous dermal infiltrate and rounded structures&#44; isolated or grouped&#44; of different sizes&#44; inside histiocytes and giant cells &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>A and B&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">What is your diagnosis&#63;</span><p id="par0015" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">a&#41;</span><p id="par0020" class="elsevierStylePara elsevierViewall">Cutaneous leishmaniasis</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">b&#41;</span><p id="par0025" class="elsevierStylePara elsevierViewall">Prothotecosis</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">c&#41;</span><p id="par0030" class="elsevierStylePara elsevierViewall">Cryptococcosis</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">d&#41;</span><p id="par0035" class="elsevierStylePara elsevierViewall">Paracoccidioidomycosis</p></li></ul></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Discussion</span><p id="par0040" class="elsevierStylePara elsevierViewall">PAS and Grocott staining showed rounded structures and endosporulation with a morula aspect &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>A and B&#41;&#46; Analysis of the molecular structure of material obtained from culture showed the presence of <span class="elsevierStyleItalic">Prototheca wickerhamii</span>&#46; This histopathological and molecular biology data exclude the hypotheses of cryptococcosis&#44; leishmaniasis and paracoccidioidomycosis&#46; The final diagnosis was protothecosis&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">Protothecosis is an opportunistic disease caused by achlorophilic algae of the genus <span class="elsevierStyleItalic">Prototheca</span>&#44; found in dogs&#44; bats&#44; in fresh and saltwater&#44; sewage&#44; soil&#44; and cattle milk&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> Humans are accidentally contaminated through skin scratches&#44; inhalation&#44; or ingestion of the etiological agent&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Human protothecosis is rare and occurs&#44; in most cases&#44; in immunocompromised patients&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> In general&#44; the clinical manifestations are predominantly cutaneous&#46; Bursitis and systemic involvement have also been reported&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a> The main agents of protothecosis are <span class="elsevierStyleItalic">Prototheca zopfii</span> and <span class="elsevierStyleItalic">P&#46; wickerhamii</span>&#44; with the latter being the most common&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Infiltrated plaques and ulcerated lesions are the most frequent clinical presentations&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Papular&#44; nodular&#44; pustular&#44; vesicular and verrucous lesions can occur&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Clinically&#44; all the suggested diagnostic possibilities should be considered&#46; The hypothesis of leishmaniasis is relevant&#44; as the patient lives in Manaus &#40;Brazil&#41; and this disease has been diagnosed with relative frequency in patients with no history of having left the city&#46; Residual areas of primary and&#47;or secondary forests are the main reservoirs of the disease in the urban area&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Paracoccidioidomycosis can cause similar clinical manifestations&#44; but the patient had no history of activity in rural areas&#46; This diagnosis and the hypothesis of cutaneous cryptococcosis were also ruled out through laboratory tests&#46; The patient had no complaints or clinical evidence of systemic disease associated with protothecosis&#46; The image exams &#40;chest radiography and computed tomography&#41; were normal&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">The patient was treated with 200&#160;mg&#47;day of itraconazole&#46; There was almost total regression of the lesions&#59; however&#44; the patient died due to complications from COVID-19&#46; Itraconazole has been used for varying periods from 14 to 180 days&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;8</span></a> Amphotericin B is recommended for immunosuppressed patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;10</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Financial support</span><p id="par0060" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Authors&#8217; contributions</span><p id="par0065" class="elsevierStylePara elsevierViewall">Larissa Daniele Machado G&#243;es&#58; Approval of the final version of the manuscript&#59; design and planning of the study&#59; drafting and editing of the manuscript&#59; collection&#44; analysis and interpretation of data&#59; effective participation in research orientation&#59; intellectual participation in the propaedeutic and&#47;or therapeutic conduct of the studied cases&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Vin&#237;cius da Silva Monteiro&#58; Design and planning of the study&#59; intellectual participation in the propaedeutic and&#47;or therapeutic conduct of the studied cases&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Ana Tereza Orsi de Souza&#58; Approval of the final version of the manuscript&#59; design and planning of the study&#59; drafting and editing of the manuscript&#59; collection&#44; analysis and interpretation of data&#59; effective participation in research orientation&#59; 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Informação do artigo

ISSN: 03650596
Idioma original: Inglês

DOI:10.1016/j.abd.2021.03.004

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2023 Mar�o	56	43	99
2023 Fevereiro	57	42	99
2023 Janeiro	47	37	84
2022 Dezembro	53	39	92
2022 Novembro	75	57	132
2022 Outubro	72	66	138
2022 Setembro	56	71	127
2022 Agosto	45	50	95
2022 Julho	45	62	107
2022 Junho	60	60	120
2022 Maio	35	49	84
2022 Abril	63	47	110
2022 Mar�o	64	62	126
2022 Fevereiro	50	33	83
2022 Janeiro	72	109	181
2021 Dezembro	65	61	126
2021 Novembro	76	59	135
2021 Outubro	97	83	180
2021 Setembro	102	85	187
2021 Agosto	32	45	77
2021 Julho	17	22	39

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