Atypical Clinical Presentation of Sporotrichosis Caused by Sporothrix globosa Resistant to Itraconazole.
Sporotrichosis is a polymorphic disease of humans and animals, which is acquired via traumatic inoculation of Sporothrix propagules into cutaneous or subcutaneous tissue. The etiological agents are in a clinical complex, which includes Sporothrix brasiliensis, Sporothrix schenckii, Sporothrix globosa, and Sporothrix luriei, each of which has specific epidemiological and virulence characteristics. Classical manifestation in humans includes a fixed localized lesion at the site of trauma plus lymphocutaneous sporotrichosis with fungal spreading along the lymphatic channels. Atypical sporotrichosis is a challenge to diagnosis because it can mimic many other dermatological diseases. We report an unusual, itraconazole-resistant cutaneous lesion of sporotrichosis in a 66-year-old Brazilian man. Histopathological examination of the skin revealed vascular and fibroblastic proliferation with chronic granulomatous infiltrate composed of multinucleated giant cells. Sporothrix were isolated from the skin lesion, and phylogenetic analyses confirmed it to be sporotrichosis due to S. globosa, a widespread pathogen. Immunoblotting analysis showed several IgG-reactive molecules in autochthonous preparations of the whole cellular proteins (160, 80, 60, 55, 46, 38, 35, and 30 kDa) and exoantigen (35 and 33 kDa). The patient was first unsuccessfully treated with daily itraconazole, and then successfully treated with potassium iodide.
Cell Biology Division, Department of Microbiology, Immunology and Parasitology, Federal University of São Paulo, São Paulo, Brazil; Department of Dermatology, Federal University of São Paulo, São Paulo, Brazil olga.gompertz@unifesp.br.
Olga
O
Fischman Gompertz
Cell Biology Division, Department of Microbiology, Immunology and Parasitology, Federal University of São Paulo, São Paulo, Brazil; Department of Dermatology, Federal University of São Paulo, São Paulo, Brazil.
Anderson M
AM
Rodrigues
Cell Biology Division, Department of Microbiology, Immunology and Parasitology, Federal University of São Paulo, São Paulo, Brazil; Department of Dermatology, Federal University of São Paulo, São Paulo, Brazil.
Geisa F
GF
Fernandes
Cell Biology Division, Department of Microbiology, Immunology and Parasitology, Federal University of São Paulo, São Paulo, Brazil; Department of Dermatology, Federal University of São Paulo, São Paulo, Brazil.
Henri D L
HD
Bentubo
Cell Biology Division, Department of Microbiology, Immunology and Parasitology, Federal University of São Paulo, São Paulo, Brazil; Department of Dermatology, Federal University of São Paulo, São Paulo, Brazil.
Zoilo Pires
ZP
de Camargo
Cell Biology Division, Department of Microbiology, Immunology and Parasitology, Federal University of São Paulo, São Paulo, Brazil; Department of Dermatology, Federal University of São Paulo, São Paulo, Brazil.
Valéria
V
Petri
D000368:Aged; D000935:Antifungal Agents / Q000494:pharmacology*; D025141:Drug Resistance, Fungal; D006801:Humans; D017964:Itraconazole / Q000494:pharmacology*; D008297:Male; D010802:Phylogeny; D011193:Potassium Iodide / Q000627:therapeutic use; D013175:Sporothrix / Q000187:drug effects* / Q000235:genetics; D013174:Sporotrichosis / Q000188:drug therapy / Q000382:microbiology* / Q000473:pathology*
D000935:Antifungal Agents; D011193:Potassium Iodide; D017964:Itraconazole