Accessibility / Report Error

Lacaziosis - unusual clinical presentation* * Work performed at the Fundação Alfredo da Matta (FUAM) - Manaus (AM), Brazil.

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.1Bustamante B, Seas C, Salomon M, Bravo F. Case Report: Lobomycosis Successfully Treated with Posaconazole. Am J Trop Med Hyg. 2013;88:1207-8.

It usually affects adult male patients living in the Amazonic areas of South America.2Miranda MF, Costa VS, Bittencourt Mde J, Brito AC. Transepidermal elimination of parasites in Jorge Lobo's disease. An Bras Dermatol. 2010;85:39-43.,3Talhari C, Rabelo R, Nogueira L, Santos M, Chrusciak-Talhari A, Talhari S. Lobomycosis. An Bras Dermatol. 2010;85:239-40. Lesions often appear after trauma in exposed areas, especially in the face and limbs.4Talhari C, Oliveira CB, de Souza Santos MN, Ferreira LC, Talhari S. Disseminated lobomycosis. Int J Dermatol. 2008;47:582-3.,5Tavares 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. Due to the highly polymorphic characteristic of the lesions, it is necessary to establish differential diagnoses with several other dermatoses.6Tubilla LHM, Schettini APM, Eiras JC, Zanardo C, Frota MZM. Lacaziosis mimicking borderline tuberculoid leprosy. An Bras Dermatol. 2008;83:261-3. 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.7Brito AC, Quaresma JAS. Lacaziosis (Jorge Lobo's disease): review and update. An Bras Dermatol. 2007;82:461-74. In order to prevent recurrence, treatment with clofazimine, dapsone or itraconazole must be prescribed.5Tavares 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.

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
Sociedade Brasileira de Dermatologia Av. Rio Branco, 39 18. and., 20090-003 Rio de Janeiro RJ, Tel./Fax: +55 21 2253-6747 - Rio de Janeiro - RJ - Brazil
E-mail: revista@sbd.org.br