Tungíase sob dermatoscopia: exame in vivo e ex vivo da infestação cutânea pela Tunga penetrans

A fêmea da pulga Tunga penetrans é responsável pela dermatose ectoparasitária denominada Tungíase. Relatamos o caso clínico de um adolescente branco de 12 anos de idade, o qual procurou atendimento em consultório dermatológico devido à lesão dolorosa na planta e cujo exame dermatoscópico sem contato com a pele permitiu visualizar o movimento do parasita dentro da pele. O diagnóstico da tungíase é clínico, porém pode ser auxiliado pelo exame dermatoscópico in vivo e ex vivo da lesão.

Dermoscopia; Doenças transmissíveis; Ectoparasitoses; Sifonápteros

Autoria

Paulo Ricardo Criado MAILING ADDRESS: Paulo Ricardo Criado Rua Carneiro Leão 33 - Vila Scarpelli 09050-430 - Santo André - SP Brazil E-mail: prcriado@uol.com.br

Dermatology Department, University of São Paulo, Medical School, Clinics Hospital, São Paulo, SP, BrazilUniversity of São PauloBrazilSão Paulo, SP, BrazilDermatology Department, University of São Paulo, Medical School, Clinics Hospital, São Paulo, SP, Brazil

Gilles Landman

Federal University of São Paulo, São Paulo, SP, BrazilFederal University of São PauloBrazilSão Paulo, SP, BrazilFederal University of São Paulo, São Paulo, SP, Brazil

Vitor Manoel Silva dos Reis

University of São Paulo, Medical School, Dermatology Department, Clinics Hospital, São Paulo, SP, BrazilUniversity of São PauloBrazilSão Paulo, SP, BrazilUniversity of São Paulo, Medical School, Dermatology Department, Clinics Hospital, São Paulo, SP, Brazil

Walter Belda Junior

Campinas State University, Medical SchoolCampinas State UniversityCampinas State University, Medical School

Dermatology Department, University of São Paulo, Medical School, São Paulo, SP, BrazilUniversity of São PauloBrazilSão Paulo, SP, BrazilDermatology Department, University of São Paulo, Medical School, São Paulo, SP, Brazil

MAILING ADDRESS: Paulo Ricardo Criado Rua Carneiro Leão 33 - Vila Scarpelli 09050-430 - Santo André - SP Brazil E-mail: prcriado@uol.com.br

Conflict of interest: None

Financial funding: None

SCIMAGO INSTITUTIONS RANKINGS

Federal University of São Paulo, São Paulo, SP, BrazilFederal University of São PauloBrazilSão Paulo, SP, BrazilFederal University of São Paulo, São Paulo, SP, Brazil

Campinas State University, Medical SchoolCampinas State UniversityCampinas State University, Medical School

Figuras | Tabelas

Figuras (2)

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FIGURE 1
A - Yellowish-white plantar papule with a central black dot 1B: Figure 1A seen in greater detail. 1C:In vivo dermoscopy performed without skin contact showing a white halo with a central orifice containing a light-brown structure (original augmentation 10x). 1D: Figure 1C seen in greater detail, showing bluish-grey areas (likely corresponding to the parasite’s exoskeleton or his gut) (●), White halo (corresponding to the parasite’s dilated abdomen containing the eggs) (❋) Light-brown structure appearing in the center of the orifice (posterior segment of the parasite) (◆)

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FIGURE 2A
Aspect of the saucerized lesion, embed in formol, the external portion of the lesion is seen through the dermatoscope. 2B: Ventral portion of the specimen, where oval structures corresponding to the eggs can be seen through the dermatoscope (❋) (original augmentation 10x). 2C: Histopathological examination of the excised skin showing the parasite, the host’s skin exhibiting compact hyperkeratosis and just below the epidermis, the parasite’s body involved by a chitin structure (HE, 100x). 2D: Figure 2C seen in greater detail where it can be observed: the patient’s straighten epidermis (●), the parasite’s chitin exoskeleton (◆), the flea’s intestinal lumen (■) the eggs inside the abdomen (✝)

FIGURE 1 A - Yellowish-white plantar papule with a central black dot 1B: Figure 1A seen in greater detail. 1C:In vivo dermoscopy performed without skin contact showing a white halo with a central orifice containing a light-brown structure (original augmentation 10x). 1D: Figure 1C seen in greater detail, showing bluish-grey areas (likely corresponding to the parasite’s exoskeleton or his gut) (●), White halo (corresponding to the parasite’s dilated abdomen containing the eggs) (❋) Light-brown structure appearing in the center of the orifice (posterior segment of the parasite) (◆)

FIGURE 2A Aspect of the saucerized lesion, embed in formol, the external portion of the lesion is seen through the dermatoscope. 2B: Ventral portion of the specimen, where oval structures corresponding to the eggs can be seen through the dermatoscope (❋) (original augmentation 10x). 2C: Histopathological examination of the excised skin showing the parasite, the host’s skin exhibiting compact hyperkeratosis and just below the epidermis, the parasite’s body involved by a chitin structure (HE, 100x). 2D: Figure 2C seen in greater detail where it can be observed: the patient’s straighten epidermis (●), the parasite’s chitin exoskeleton (◆), the flea’s intestinal lumen (■) the eggs inside the abdomen (✝)

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Tungíase sob dermatoscopia: exame in vivo e ex vivo da infestação cutânea pela Tunga penetrans

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[1] MAILING ADDRESS: Paulo Ricardo Criado Rua Carneiro Leão 33 - Vila Scarpelli 09050-430 - Santo André - SP Brazil E-mail: prcriado@uol.com.br