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On-line version ISSN 1806-4841
An. Bras. Dermatol. vol.86 no.2 Rio de Janeiro Mar./Apr. 2011
IMAGES IN TROPICAL DERMATOLOGY
Mario Fernando Ribeiro de MirandaI; Deborah Aben-Athar UngerII; Arival Cardoso de BritoIII; Fernando Augusto Ribeiro CarneiroIV
IDermatology Specialist, SBD; Dermatopathology Specialist, UEMS/ICDP - Associate Professor of Dermatology at UFPA; Head of the Dermatopathology Laboratory in the Dermatopathology Service, ICS-UFPA, Belém, PA, Brazil
IIMSc in Tropical Diseases, UFPA; Dermatology Specialist, SBD - Associate Professor of Dermatopathology at UFPA, Belém, PA, Brazil
IIIPhD and Livre-Docência (Habilitation) in Dermatology, UFPA; Dermatology Specialist, UFPA - Professor on the Graduate Program in Tropical Diseases (Institute of Tropical Medicine, UFPA); Professor on the Graduate Program in the Biology of Infectious Agents, Institute of Biological Sciences, UFPA, Belém, PA, Brazil
IVDermatology Specialist, SBD - Dermatologist in a Private Practice, Belém, PA, Brazil
Jorge Lobo's Disease (JLD) is a chronic granulomatous cutaneous mycosis caused by Lacazia loboi. The most typical lesions are keloid-like growths preferentially located on limbs and ears. To the best of the authors' knowledge, only one labial case has previously been reported. We describe the case of a man who presented with a left-sided papulonodular lesion of 10 years' duration on the vermillion border of the upper lip. A successful surgical resection of the lesion was performed and there was no recurrence in eight years of follow-up.
Keywords: Blastomycosis; Granulomatous disease, chronic; Pathology; Skin
A 55-year-old, retired, male, dark-skinned farmer (Acará, PA) who had lived in Belém (PA) for 36 years presented in 1998 with a mildly pruriginous lesion on the upper lip of 10 years' duration. The lesion, which was located on the left of the upper lip, was dome-shaped and papulonodular, measured 1.0 cm and had a central depression and firm consistency. Jorge Lobo's disease (JLD) was confirmed by direct and histopathological examination. General clinical tests and additional tests requested (complete blood count; ESR; blood glucose level; glycosylated hemoglobin; serum levels of immunoglobulins and complement; anti-HIV antibodies; cell immunology; and urinalysis) did not show any alterations worthy of note. A wedge excision of the lesion was performed. Surgical margins were clear and there was no recurrence of the lesion in eight years.
JLD is a chronic granulomatous infection produced by the yeast-like fungus Lacazia loboi 1 that primarily affects farm laborers between the ages of 21 and 40 years.2 To the authors' knowledge, there is only one case of a patient with a lesion on the lip among the 490 cases recorded worldwide up to 20063.4
1. Taborda PR, Taborda VA, McGinnis MR. Lacazia loboi gen. nov., comb. nov., the etiologic agent of lobomycosis. J Clin Microbiol. 199;37:2031-33. [ Links ]
2. Baruzzi RG, Lacaz CS, Souza FAA. História natural da doença de Jorge Lobo. Ocorrência entre índios Caiabi (Brasil Central). Rev Inst Med Trop São Paulo. 1979;21:302-30. [ Links ]
3. Brito AC, Quaresma JAS. Lacaziose (doença de Jorge Lobo): revisão e atualização. An Bras Dermatol. 2007;82:461-74. [ Links ]
4. Loureiro AAP, Brito AC, Silva D. Micose de Jorge Lobo de localização insólita. An Bras Dermatol. 1971;46:1-6. [ Links ]
Mailing address: Approved by the Editorial Board and accepted for publication on 22.02.2010. * Study conducted at the dermatology clinic of the Health Sciences Institute, Federal University of Pará, and in a private clinic.
Mario Fernando Ribeiro de Miranda
Av. Nazaré, 1.033 - Ap. 701 - Nazaré
66040-145 Belém - PA, Brazil
Tel.: 91 9985-4886
Conflict of interest: None
Financial funding: None
Approved by the Editorial Board and accepted for publication on 22.02.2010.
* Study conducted at the dermatology clinic of the Health Sciences Institute, Federal University of Pará, and in a private clinic.