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On-line version ISSN 1806-4841
An. Bras. Dermatol. vol.85 no.2 Rio de Janeiro Mar./Apr. 2010
IMAGING IN TROPICAL DERMATOLOGY
Carolina TalhariI; Renata RabeloII; Lisiane NogueiraII; Mônica SantosI; Anette Chrusciak-TalhariIV; Sinésio TalhariIV
at the Tropical Medicine Foundation of the Amazon State. Professor of Dermatology-
University of the Amazon State - Manaus, (AM), Brazil
IIResident Physician in Dermatology at the Tropical Medicine Foundation of the Amazon State - Manaus (AM), Brazil
IVDermatologist at the Tropical Medicine Foundation of the Amazon State - Manaus, (AM), Brazil
A case of lobomycosis in a patient from the Brazilian Amazon region is presented. Lobomycosis is a subcutaneous mycosis caused by the yeast Lacazia loboi. It often affects adult males and has been reported in dolphins. Therapeutical options for localized lesions, such as the ones shown by the patient in this report, are eletrocoagulation, surgical exeresis, and cryotherapy. Disseminated lesions may be treated with Itraconazole or combination therapy with Clofazimine. There is still no curative therapy for disseminated lesions of lobomycosis.
Keywords: Bacterial infections and mycoses; Fungi; Mycoses
Lobomycosis is a chronic mycosis with lesions restricted to the skin and the subcutaneous cellular tissue.1 It is an endemic disease in the intertropical zone over the Equatorial Americas, and most registered cases are found in the Brazilian Amazon.2,3 Two autochthonous cases have been reported in South Africa.4 The disease often affects male adult patients. Dolphins have been diagnosed with an identical clinical condition.5 Its etiologic agent, Lacazia loboi, has not yet been cultivated.6 Keloid-like lesions are typical, generally affecting the upper and lower extremities and auricular pavilions. Lesions in other areas, such as the thorax of the patient in this report (Figure 1), are less frequently found.1-3 Diagnosis is accomplished through clinical findings and presence of the fungus in histopathologic (Figures 2 and 3) or cytological examination.1,2,7 Localized lesions may be treated with eletrocoagulation, cryotherapy or surgical exeresis. 1-3 Itraconazole and/or clofazimine can be used for disseminated lesions.8 However, there is still no curative therapy for these cases.1
1. Brito AC, Quaresma JAS. Lacaziose (doença de Jorge Lobo): revisão e atualização. An Bras Dermatol. 2007;82:461-74. [ Links ]
2. Talhari S, Cunha MG, Schettini AP, Talhari AC. Deep mycoses in Amazon region. Int J Dermatol. 1988;27:481-4. [ Links ]
3. Talhari S, Cunha MG, Barros ML, Gadelha AD. Jorge Lobo disease. Study of 22 new cases. Med Cutan Ibero Lat Am. 1981;9:87-96. [ Links ]
4. Al-Daraji WI, Husain E, Robson A. Lobomycosis in African patients. Br J Dermatol. 2008;159: 234-6. [ Links ]
5. Bermudez L, Van Bressem MF, Reyes-Jaimes O, Sayegh AJ, Paniz-Mondolfi AE. Lobomycosis in man and lobomycosis-like disease in bottlenose dolphin, Venezuela. Emerg Infect Dis. 2009;15:1301-3. [ Links ]
6. Taborda PR, Taborda VA, McGinnis MR. Lacazia loboi gen. nov., comb. nov., the etiologic agent of lobomycosis. J Clin Microbiol. 1999;37:2031-3. [ Links ] Erratum in: J Clin Microbiol. 2000;38:2026. [ Links ]
7. Talhari C, Chrusciak-Talhari A, de Souza JV, Araújo JR, Talhari S. Exfoliative cytology as a rapid diagnostic tool for lobomycosis. Mycoses. 2009;52:187-9. [ Links ]
8. Fischer M, Chrusciak Talhari A, Reinel D, Talhari S. Sucessful treatment with clofazimine and itraconazole in a 46 year old patient after 32 years duration of disease. Hautarzt. 2002;53:677-81. [ Links ]
Approved by the
Editorial Board and accepted for publication on March 03th,2010. * Work conducted
at the Tropical Medicine Foundation of the Amazon State - Manaus (AM), Brazil.
Conflict of interest: None
Financial funding: Fundação de Medicina Tropical do Amazonas.
Approved by the
Editorial Board and accepted for publication on March 03th,2010.
* Work conducted at the Tropical Medicine Foundation of the Amazon State - Manaus (AM), Brazil.