Letter - Tropical/Infectious and parasitic dermatology
Single-lesion sporotrichosis triggering Sweet’s syndrome
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Tropical/Infectious and parasitic dermatology</span>" "titulo" => "Single-lesion sporotrichosis triggering Sweet’s syndrome" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "788" "paginaFinal" => "790" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Hiram Larangeira de Almeida, Augusto Scott da Rocha, Lilian Müller, Ana Letícia Boff" "autores" => array:4 [ 0 => array:5 [ "nombre" => "Hiram Larangeira de" "apellidos" => "Almeida" "sufijo" => "Jr" "email" => array:1 [ 0 => "hiramalmeidajr@hotmail.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Augusto" "apellidos" => "Scott da Rocha" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Lilian" "apellidos" => "Müller" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "Ana Letícia" "apellidos" => "Boff" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Postgraduation in Health and Behavior, Universidade Católica de Pelotas, Pelotas, RS, Brazil" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Dermatology, Universidade Federal de Pelotas, Pelotas, RS, Brazil" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Private Veterinary Clinic, Pelotas, RS, Brazil." "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2205 "Ancho" => 2508 "Tamanyo" => 373939 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">(A) Disseminated erythematous lesions; observe the ecthymoid lesion at the bottom (arrow). (B) Detail of the pseudo-vesicular appearance of the lesions (arrows).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Sporotrichosis is a deep mycosis caused by dimorphic fungi of the genus <span class="elsevierStyleItalic">Sporothrix</span>, which can be subacute or chronic, and is usually subcutaneous but may be systemic in rare cases. It can be classified into four categories: cutaneous-lymphatic (around 75% of cases), localized cutaneous (20%), disseminated and extracutaneous.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Skin lesions typically appear at the inoculation site, as an implantation mycosis, mainly when handling plants and infected soil or after trauma by infected animals.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">It begins as an inflammatory papule, which develops into a nodule or gumma that becomes an ulcer and later, in cutaneous-lymphatic presentations, papules and nodules appear along one or more lymphatic cords close to the initial lesion.</p><p id="par0020" class="elsevierStylePara elsevierViewall">In the last two to three decades in Brazil, sporotrichosis has spread zoonotically through the species <span class="elsevierStyleItalic">Sporothrix brasiliensis</span>, which is the species most often found in domestic cats - currently the main vectors of the disease in Brazil.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a><span class="elsevierStyleItalic">Sporothrix brasiliensis</span> is associated with hypersensitivity reactions and atypical manifestations of sporotrichosis, such as arthritis, erythema nodosum, erythema multiforme and Sweet’s syndrome.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Sweet’s syndrome is a rare reactional dermatosis that typically presents with symmetric painful skin lesions such as papules, nodules or erythematous/erythematous-violaceous plaques, which are often called pseudo-vesicles, due to the visual appearance on inspection. However, on palpation, they have a papular consistency. It is also called acute febrile neutrophilic dermatosis, as the presence of fever and neutrophilia is usual; histopathologically, it always presents a dense neutrophilic inflammatory infiltrate in the papillary dermis.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">A 51-year-old female patient who had contact with a domestic cat that was euthanized due to sporotrichosis was evaluated. The patient stated that she took care of the cat but was never scratched or bitten by it.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Two weeks after the cat had died, she developed a pustule on her thigh (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A), treated with topical neomycin, which developed into an ecthymoid lesion (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B). A few days later she started to develop disseminated lesions, with a pseudo-vesicular appearance (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>) accompanied by arthralgia, which made walking very difficult. With the suspicion of Sweet’s syndrome associated with sporotrichosis, given the history of exposure to the cat and no recent use of medications, oral itraconazole 100 mg/day and prednisone 40 mg/day were started. A culture was collected from the ecthymoid lesion, which was positive for <span class="elsevierStyleItalic">Sporothrix</span> spp. (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C) and an inflammatory lesion on the back was biopsied. On histopathology there was marked edema in the superficial dermis associated with a lymphocytic and neutrophilic infiltrate and a extravasation of red blood cells. There was no spongiosis or vacuolar damage (<a class="elsevierStyleCrossRefs" href="#fig0015">Figs. 3 and 4</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">The patient experienced rapid regression of the pain and inflammatory lesions, so corticosteroids were withdrawn within seven days, and antifungal treatment was continued for 90 days, with complete resolution.</p><p id="par0045" class="elsevierStylePara elsevierViewall">This case documents well the intense hypersensitivity reaction in a localized case of single-lesion sporotrichosis. In a series of ten cases associated with Sweet’s syndrome,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> nine were localized forms, as in the case described herein. The association of this hypersensitivity reaction with other deep mycoses is also well established, such as in histoplasmosis,<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> coccidioidomycosis and also mycobacterioses.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">This case is peculiar due to the intense reaction associated with the oligosymptomatic form of sporotrichosis. Another interesting aspect in this case is the initial pustular lesion, probably without inoculation trauma.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0055" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors’ contributions</span><p id="par0060" class="elsevierStylePara elsevierViewall">Hiram Larangeira de Almeida Jr: 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.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Augusto Scott da Rocha: 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; 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="par0070" class="elsevierStylePara elsevierViewall">Lilian Müller: 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; 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="par0075" class="elsevierStylePara elsevierViewall">Ana Letícia Boff: 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; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the literature; critical review of the manuscript.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0080" 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" => "2024-02-29" "fechaAceptado" => "2024-03-14" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "⋆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Study conducted at the Universidade Federal de Pelotas, Pelotas, RS, 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" => 2508 "Ancho" => 2508 "Tamanyo" => 336821 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Initial clinical appearance with pustule. (B) Evolution to ecthymoid lesion. (C) Positive culture for <span class="elsevierStyleItalic">Sporothrix</span> spp.</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" => 2205 "Ancho" => 2508 "Tamanyo" => 373939 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">(A) Disseminated erythematous lesions; observe the ecthymoid lesion at the bottom (arrow). (B) Detail of the pseudo-vesicular appearance of the lesions (arrows).</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" => 1256 "Ancho" => 1675 "Tamanyo" => 414877 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">On histopathology there is marked edema of the superficial dermis associated with a lymphocytic and neutrophilic infiltrate and extravasation of red blood cells. Absence of spongiosis, vasculitis or vacuolar damage (Hematoxylin & eosin, ×100).</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" => 1256 "Ancho" => 1675 "Tamanyo" => 236928 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Detail of the edema of the papillary dermis, corresponding to the clinical pseudo-vesicle (Hematoxylin & eosin, ×400).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Human sporotrichosis: recommendations from the Brazilian Society of Dermatology for the clinical, diagnostic and therapeutic management" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. 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| Ano/Mês | Html | Total | |
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| 2024 Novembro | 27 | 8 | 35 |
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