Disseminated cutaneous sporotrichosis in a patient with AIDS: report of a case

Abstract

We describe a case report of disseminated cutaneous sporotrichosis as the initial presentation of AIDS in a 24-year-old HIV-positive male patient. He presented multiple ulcerated skin lesions distributed over the face, thorax, legs and arms. Biopsy of one of the cutaneous lesions was suggestive of sporotrichosis and culture isolated Sporothrix schenckii. Itraconazole was started and the lesions progressively resolved after 15 days of medication. The patient was discharged with this medication but he did not return for follow-up. He died three months later in another hospital. Therapy of sporotrichosis in HIV-infected patients remains unclear and the response to therapy is variable. Itraconazole is highly concentrated in the skin and is one of the options for treatment of disseminated sporotrichosis. Key-words: Sporotrichosis. AIDS. Sporothrix schenkii. Itraconazole.Resumo Descrevemos um relato de caso de esporotricose cutânea disseminada como apresentação inicial de AIDS em um paciente masculino de 24 anos HIV positivo. Ele apresentava múltiplas lesões cutâneas ulceradas, distribuídas na face, tórax, pernas e braços. A biopsia de uma das lesões cutâneas foi sugestiva de esporotricose e a cultura revelou Sporothrix schenckii. Foi iniciado o tratamento com itraconazol e as lesões progressivamente involuiram depois de 15 dias de medicação. O paciente teve alta com tratamento ambulatorial, mas não retornou para seguimento. Ele morreu três meses depois em outro hospital. O tratamento da esporotricose em pacientes HIV positivos ainda não está estabelecido. Por sua boa penetração cutânea, o itraconazol é uma das melhores opções para formas disseminadas de esporotricose. Palavras-chaves: Esporotricose. SIDA. Spotothrix schenkii. Itraconazol.

Sporothrix schenckii and Sporotrichosis

“…Lesions of the fixed and lymphocutaneous forms may coexist in the same patient. Until the emergence of zoonotic transmission, this form was rare and was caused by hematogenous spread of the fungus, usually associated with immunosuppression (39,239). In transmission by cats, several inoculations in different locations may occur, during either treatment or play with animals (20).…”

TGF-β1 induces transendothelial migration of the pathogenic fungus Sporothrix schenckii by a paracellular route involving extracellular matrix proteins

“…However, there is a growing incidence of disseminated forms, especially in Brazil, mainly due to zoonotic transmission of the disease (Lima Barros et al, 2003;Welsh, 2003;Schubach et al, 2005;Lopes-Bezerra et al, 2006). Although fungaemia is rarely described in sporotrichosis, clinical complications, such as the spread of infectious fungi to the eyes, central nervous system, bones, cartilages and lungs, may arise in immunocompromised patients or in individuals with a history of alcohol abuse (Kauffman, 1999;Kauffman et al, 2000;Carvalho et al, 2002;SilvaVergara et al, 2005). Reports concerning the mechanisms involved in the interaction of S. schenckii with mammalian cells remain scarce.…”

Canine bone sporotrichosis: a case report

“…In Rio de Janeiro, between 1998 and 2004, 2,326 affected patients were registered (759 humans, 64 canines, and 1503 felines); out of these, 85% of dogs and 83.4% cats had contact with cats infected with sporotrichosis, while 55.8% of the human patients reported scratches and/or bites by felines (LARSSON, 2011); however, in immunocompromised patients, due to alcoholism, diabetes, chronic obstructive pulmonary disease, transplantation, corticosteroid therapy, and AIDS virus infection, there is an increased likelihood of disseminated fungal infections (CARVALHO et al, 2002). The animal in this report had no underlying immunosuppression.…”