Lacaziosis - unusual clinical presentation^*

Abstract

Lacaziosis or Jorge Lobo's disease is a fungal, granulomatous, chronic infectious disease caused by Lacazia loboi, which usually affects the skin and subcutaneous tissue. It is characterized by slow evolution and a variety of cutaneous manifestations with the most common clinical expression being nodular keloid lesions that predominate in exposed areas. We report the case of a patient who had an unusual clinical presentation, with a single-plated lesion on the back. Histopathological examination confirmed the diagnosis of Lacaziosis.

Fungi; Lobomycosis; Mycoses

A thirty-four year old female patient, working as a maid and coming from Manaus/Amazon reported the appearance of a lesion in the dorsal area two years before. Physical exam showed an infiltrated, erythematous-violaceous plate, with soft consistency, located in the left superior dorsal area and measuring approximately 6.0 x 4.5 cm (Figure 1).

FIGURE 1
Erythematous-violaceous infiltrated plate, with soft consistency

Histopathological examination of the sample obtained by incisional biopsy evidenced rectified epidermis and granulomatous infiltration on the dermis, containing spherical, double-walled structures, which appeared either isolated or grouped in chains compatible with Lacazia loboi (Figure 2).

FIGURE 2
Grocott 400x. Fungi arranged in chains are best seen through silver staining

The lesion was surgically excised and oral itraconazole 200 mg 12/12h was prescribed next. The patient evolved in a satisfactory manner, with good esthetical results and no signs of recurrence.

DISCUSSION

Lacaziosis is a disease that has low prevalence rates but significant morbidity for the patients.¹

It usually affects adult male patients living in the Amazonic areas of South America.^2,3 Lesions often appear after trauma in exposed areas, especially in the face and limbs.^4,5 Due to the highly polymorphic characteristic of the lesions, it is necessary to establish differential diagnoses with several other dermatoses.⁶ In the case reported here, the lesion was not keloidiform and was located in a mainly covered region (dorsal area).

Surgery represents, until now, the best therapeutic choice particularly for isolated lesions.⁷ In order to prevent recurrence, treatment with clofazimine, dapsone or itraconazole must be prescribed.⁵

We emphasize the importance of considering differential diagnoses for this type of lacaziosis' clinical presentation, especially in geographic areas where the disease coexists with leprosy.

• Financial funding: None
• How to cite this article: Sousa PP, Schettini APM, Rodrigues CAC, Westphal DC. Lacaziosis - unusual clinical presentation. An Bras Dermatol. 2015;90(2):268-9.
• *
  Work performed at the Fundação Alfredo da Matta (FUAM) - Manaus (AM), Brazil.

References

• ¹
  Bustamante B, Seas C, Salomon M, Bravo F. Case Report: Lobomycosis Successfully Treated with Posaconazole. Am J Trop Med Hyg. 2013;88:1207-8.
• ²
  Miranda MF, Costa VS, Bittencourt Mde J, Brito AC. Transepidermal elimination of parasites in Jorge Lobo's disease. An Bras Dermatol. 2010;85:39-43.
• ³
  Talhari C, Rabelo R, Nogueira L, Santos M, Chrusciak-Talhari A, Talhari S. Lobomycosis. An Bras Dermatol. 2010;85:239-40.
• ⁴
  Talhari C, Oliveira CB, de Souza Santos MN, Ferreira LC, Talhari S. Disseminated lobomycosis. Int J Dermatol. 2008;47:582-3.
• ⁵
  Tavares R, Souza JVB, Antunes I, Ventura F, Vieira R, Mansinho K. Lobomicose ou Doença de Jorge Lobo: revisão de literatura. Revista Portuguesa de Doenças Infecciosas. 2011;7:111-7.
• ⁶
  Tubilla LHM, Schettini APM, Eiras JC, Zanardo C, Frota MZM. Lacaziosis mimicking borderline tuberculoid leprosy. An Bras Dermatol. 2008;83:261-3.
• ⁷
  Brito AC, Quaresma JAS. Lacaziosis (Jorge Lobo's disease): review and update. An Bras Dermatol. 2007;82:461-74.

Publication Dates

• Publication in this collection
  Mar-Apr 2015

History

• Received
  05 Feb 2014
• Accepted
  06 Mar 2014