Lymphoscintigraphic analysis in chromoblastomycosis.
BACKGROUND
One of the main complications of chromoblastomycosis is lymphedema. The purpose of this study was to evaluate the lymphatic system of the limbs of patients with chromoblastomycosis using lymphoscintigraphy. It is a reliable, objective and noninvasive means of supporting the diagnosis of lymphedema.


METHODS
Lymphoscintigraphy was performed in seven patients with chromoblastomycosis, six with lesions in the lower limb and one in the upper limb. Tc-99 m dextran was injected into the interdigital spaces of the upper or lower extremities. The qualitative parameters analyzed were the visibilization of the lymph vessels and the lymph nodes, dermal backflow, and existence of collateral vessels. All patients were treated with the association of itraconazole and cryotherapy with liquid nitrogen.


RESULTS
Three out of the 14 extremities examined had lymphedema clinically, and the lymphoscintigraphy showed abnormalities in the qualitative parameters; whereas these parameters were normal in the extremities without lymphedema. During the treatment of chromoblastomycosis, a second lymphoscintigraphy exam was performed on 10 limbs and did not show any improvement of the previous lymphoscintigraphic alterations.


CONCLUSIONS
The qualitative lymphoscintigraphy was a reliable method to show the morphology of the lymph vessels and confirm objectively the diagnosis of lymphedema secondary to chromoblastomycosis. The association of oral itraconazole and cryotherapy did not modify the lymphatic alterations in chromoblastomycosis.
Ogawa
Marília M
MM
Department of Dermatology, Federal University of São Paulo, Brazil.
Alchorne
Maurício M A
MM
Barbieri
Antonio
A
Castiglioni
Mário L V
ML
Penna
Adriana Porto Benatti
AP
Tomimori-Yamashita
Jane
J
D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D002862:Chromoblastomycosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy; D017679:Cryotherapy; D005260:Female; D006801:Humans; D017964:Itraconazole / Q000627:therapeutic use; D007868:Leg Dermatoses / Q000000981:diagnostic imaging* / Q000628:therapy; D008209:Lymphedema / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy; D061305:Lymphoscintigraphy; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D016896:Treatment Outcome
D000935:Antifungal Agents; D017964:Itraconazole