Systemic sporotrichosis in an alcoholic patient,

AnBrasDermatol.2020;95(3):376---378

Anais

Brasileiros

de

Dermatologia

TROPICAL/INFECTOPARASITARY

DERMATOLOGY

Systemic

sporotrichosis

in

an

alcoholic

patient

夽,夽夽

Norami

de

Moura

Barros

,

Allen

de

Souza

Pessoa

,

Arles

Martins

Brotas

DepartmentofDermatology,HospitalUniversitárioPedroErnesto,UniversidadedoEstadodoRiodeJaneiro,RiodeJaneiro,RJ, Brazil

Received11May2019;accepted18August2019 Availableonline20March2020

KEYWORDS Alcoholism;

Immunosuppression; Sporotrichosis

Abstract A44-year-oldmalepatientpresentedwithnodulesthatevolvedwithinflammation,

followingdrainageofseropurulentsecretionandulceration.Thepatienthada6year-historyof alcoholaddictionandreportedcontactwithcats.Atthephysicalexamination,thepatienthad skin-coloredanderythematousnodules,andulcerscoveredwiththick,blackenedcrustsonthe face,trunkandlimbs.AcultureofanodulefluidrevealedgrowthofSporotrixsp.Healsohad pulmonaryinvolvementandthereforethediseasewasclassifiedassystemicsporotrichosis,a rareformthatusuallyaffectpatientsinfectedwithHIV.Chronicalcoholabusewasconsidered thefactorofimmunosuppressionforthepatient.

©2020SociedadeBrasileiradeDermatologia.PublishedbyElsevierEspa˜na,S.L.U.Thisisan openaccessarticleundertheCCBYlicense(http://creativecommons.org/licenses/by/4.0/).

Sporotrichosisisasubacuteorchronicsubcutaneous myco-sis caused by dimorphic fungi of the genus Sporothrix.

Approximately 80% of the affected patients present the lymphocutaneousform.However,inpatientswith immuno-suppression,disseminatedformscanoccur.1,2

A44-year-oldmalepatient,presentedwithsubcutaneous nodulesthatdevelopedinflammation,followingdrainageof seropurulentsecretion and ulceration. The patient had a

夽 _{Howtocitethisarticle:BarrosNM,PessoaAS,BrotasAM.}

Sys-temic sporotrichosis in an alcoholic patient. An BrasDermatol. 2020;95:373---5.

夽夽_{StudyconductedattheHospitalUniversitárioPedroErnesto,}

UniversidadedoEstadodoRiodeJaneiro,RiodeJaneiro,RJ,Brazil.

∗_{Correspondingauthor.}

E-mail:norami.barros@gmail.com(N.M.Barros).

6 year-history of alcohol addiction. He denied comorbidi-ties,although hereportedprolonged contactwithcats of unknownorigin.

Atthephysicalexamination,thepatienthadskin-colored anderythematoussubcutaneousnodules,andulcerscovered withthick,blackened crusts onthe face,trunk andlimbs

(Figs.1and2).

Duetocompatibleepidemiologicalhistoryandthe evo-lutionpatternofthelesions,themaindiagnostichypothesis wassporotrichosis.

Acultureoftheaspiratedfluidofoneofthenoduleswas performed,whichrevealedgrowthofSporotrixsp.after5

days(Figs.3and4).

Thelaboratory tests(hemogram, kidney function,liver functionand thyroidfunction)didnot showanyabnormal results,andtheserologytestresults(hepatitisB,hepatitis C,VDRL,HTLVandHIV)werenegative.

https://doi.org/10.1016/j.abd.2019.08.029

0365-0596/©2020SociedadeBrasileiradeDermatologia.PublishedbyElsevierEspa˜na,S.L.U.ThisisanopenaccessarticleundertheCC BYlicense(http://creativecommons.org/licenses/by/4.0/).

Systemicsporotrichosisinanalcoholicpatient 377

Figure1 Skin-coloredanderythematousnodulesandulcers

coveredwiththick,blackenedcrusts.

Figure2 Skin-coloredanderythematousnodulesandulcers

coveredwiththick,blackenedcrusts.

High-resolution chest CT revealed atelectasis, ground-glassinfiltrate,hilarlymphadenopathyandpleuraleffusion inbothlungs.

The disease was classified as systemic sporotrichosis, according to the classification recommended by Orofino-Costa et al,3 _{illustrating an exuberant presentation in a}

patientimmunosuppressedbyalcoholism.3

PatientwastreatedwithamphotericinBlipidcomplexfor 28days,followedbyitraconazole,during11monthsandhad agoodresponse,withhealingofulcersandwithoutrelapses ina6-monthfollow-up.

Figure 3 Hyaline, septate, branched and regular hyphae.

Pyriformconidiaarrangedlikeadaisyflowerattheendofthe conidiophores.

The feline zoonotic transmission of sporotrichosis was observedinthe1990sintheStateofRiodeJaneiro,Brazil, whichis currentlyconsidered tobeahyperendemic area. IntheSouth andSoutheastBrazilian regions, S. brasilien-sisisthemain(88%)etiologicalagentofhumanandanimal sporotrichosis.3

Systemicformsarerareandusuallyaffect immunocom-promisedindividuals,mostlythosewithHIV.3

Chronicalcoholabuseresultsinlymphopeniaandchronic activation of the T-cell pool, which may alter the T-cell ability to expand and respond topathogenic agents, inducing to an anergy state and, changing Th1 and Th2 response.4

Th1responseisconsideredasthemaincontrolfactorof fungalinfection.Inadditiontopatientimmunosuppression, weshouldemphasizethatS.brasiliensisisthemostvirulent speciesofthisgenus,duetoitsabilitytoinvadetissuesand leadonetodeath.3,5

The high prevalence of alcohol abuse in the Brazilian population,estimatedat13.7%,andtheincreasingzoonotic transmissionofsporotrichosismayleadtoanincreaseinthe prevalenceofdisseminatedformsofthedisease.6

Our report corroborates the association previously reportedbyothers betweenalcoholism andthespread of sporotrichosis.7---10

Financial

support

378 BarrosNMetal.

Figure 4 Membranous colony with white and blackened

areas,andcolorlessback.

Authors’

contributions

NoramideMouraBarros:Approvalofthefinalversionofthe manuscript;conception and planning of thestudy; elabo-ration andwriting of the manuscript;obtaining, analysis, andinterpretationofthedata;intellectualparticipationin thepropaedeuticand/ortherapeuticconductofthestudied cases;criticalreviewoftheliterature;criticalreviewofthe manuscript.

AllendeSouza Pessoa: Approvalof thefinal version of themanuscript;conceptionandplanningofthestudy; elab-orationandwritingofthemanuscript;obtaining,analysis, andinterpretationofthedata;intellectualparticipationin thepropaedeuticand/ortherapeuticconductofthestudied cases;criticalreviewoftheliterature;criticalreviewofthe manuscript.

Arles Martins Brotas: Conception and planning of the study; obtaining,analysis,andinterpretation of thedata; effectiveparticipationinresearchorientation;intellectual participationin thepropaedeuticand/or therapeutic con-ductofthestudiedcases;criticalreviewoftheliterature; criticalreviewoftheliterature.

Conflicts

of

interest

Nonedeclared.

References

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