Cassio Porto Ferreira

Pregnancy during a sporotrichosis epidemic in Rio de Janeiro, Brazil

Sporotrichosis is a subacute or chronic disease that affects animals and humans. It is caused by the dimorphic fungus Sporothrix schenckii and is the primary subcutaneous mycosis in Latin America [1,2]. Zoonotic transmission of sporotrichosis appears to be rare worldwide. An epidemic of sporotrichosis occurred in Rio de Janeiro, Brazil, from 1998 onward. Cats were found to be the main link in the epidemiological chain [1]. From 2005 through 2010, about 1000 patients were diagnosed with sporotrichosis at IPEC–Fiocruz, including 12 pregnant women. The mean age of the 12 patients was 28.3 years (range, 18–40 years). Two clinical forms of the infection, lymphocutaneous sporotrichosis (10 cases) and fixed sporotrichosis (2 cases), were recorded. Fungal culture was positive in all cases (Fig. 1). The patients underwent monthly outpatient assessments and the time of evolution ranged from 4–12 weeks. The upper limbs were the most commonly affected body area and cat scratch or bites were cited in 11 cases, suggesting that the lesions were the putative means of transmission of the fungus. All patients were instructed to perform thermotherapy with warm compresses 3 times a day. Eight patients were cured with thermotherapy, 2 patients had to use itraconazole after delivery, and 2 patients were lost to follow up. The causative fungus can be found in decaying vegetation, soil, moss, and wood and can infect a diversity of animals. The usual mode of transmission is traumatic cutaneous inoculation of the

Cryosurgery as adjuvant therapy in cutaneous sporotrichosis

We declare no conflict of interest. Sporotrichosis is a subacute or chronic disease that affects animals and humans caused by the dimorphic fungus Sporothrix schenkii.1 An epidemic of sporotrichosis has been noticed in the city of Rio de Janeiro from 1998 onwards and having the cat as the main link in the epidemiological chain.2 We have missed a large proportion of these patients and adjuvant cryosurgery with liquid nitrogen3,4 has been performed in patients that persisted with one or two active lesions whereas the other healed after 2-3 months of treatment. This study aims at evaluating the role of adjuvant treatment in these patients. Methods: 9 patients (7 women/2 men, mean age 45.8 years-old) with cutaneous-lymphatic and fixed sporotrichosis were selected (Figures 1 and 2). All patients

Parinaud's oculoglandular syndrome associated with Sporothrix schenckii

The Parinaud oculoglandular syndrome is a rare eye disease caused by different etiologic agents, including bacteria, viruses and fungi. It is characterized by a granulomatous conjunctivitis, accompanied by adjacent preauricular lymphadenopathy and can bring consequences if not treated promptly. We present a case of Parinaud oculoglandular syndrome caused by Sporothrix schenckii from the sporotrichosis epidemic in its zoonotic form occurring in Rio de Janeiro, Brazil.

Kaposi's sarcoma simulating verrucous syndrome.

A 31-year-old woman presented with a 6-year history ofintractable injury in the left foot with worsening in pain anddifficulty walking. The patient had a positive serology for HIVand reported intermittent and irregular use of antiretroviraltherapy. On examination, a vegetative lesion with 20cm inits largest diameter located on the medial side and plantarregion of the left foot (Fig. 1(1, 2)) was noted. Fungal, bacte-ria/mycobacteria cultures were negative. Skin biopsy revealedhyperkeratosis anddermiswithproliferationofmesenchymallineage cells with formation of malformed vessels with thepresence of red blood cells out of the light thereof (Fig. 1A–C).KS is a vascular neoplasm from vascular and lymphaticendothelium caused by human herpesvirus 8.

Atypical cutaneous mycobacteriosis caused by Mycobacterium avium complex

We declare no confl ict of interest. A 41-year-old woman presented with an ulcerated skin lesion, localized on the left thigh (Figures 1, 2). The lesion had been present for 5 months; it was slowly increasing, was not painful, and measured 3 cm in its largest diameter. Complementary tests were carried out as serology for human immunodefi ciency virus (HIV) was positive; CD4+ T cell count was 49 cells/mm (< 50 cell/μL); PPD and Montenegro skin test was non-reactive; and serological examination for antibodies (Paracoccidioides brasiliensis and Histoplasma capsulatum) was negative. Culture for fungi and bacteria was negative, and the histopatophological analysis of skin biopsies with Wade staining revealed numerous acid-fast bacilli resistant. Culture for mycobacteria in Loewenstein-Jensen media, after treatment with N-acetylcysteine/NaOH (Figure 3), and phenotypic identifi cation using the PRA (PCR-restriction enzyme analysis) method revealed M. avium complex (Figure 4). The patient was started on long-term antibiotic therapy with azithromicyn 500 mg daily and Atypical cutaneous mycobacteriosis caused by Mycobacterium avium complex

Giant squamous cell carcinoma in HIV-positive patient

Master – Dermatologist of IPEC/FIOCRUZ PhD/Professor – Discipline of Pathological Anatomy, Universidade Federal do Estado do Rio de Janeiro (UNIRIO) Specialist/Professor – Discipline of Dermatology, Universidade Federal do Estado do Rio de Janeiro (UNIRIO) Specialist/Professor Discipline of Dermatology, Universidade Federal do Estado do Rio de Janeiro (UNIRIO) Specialist / Professor Discipline of Dermatology, Universidade Federal do Estado do Rio de Janeiro (UNIRIO)

Crusted scabies in a patient with lepromatous leprosy.

Crusted scabies (CS) is a very contagious rare skin infestation caused by Sarcoptes scabiei var hominis, an obligate human parasite, transmitted by skin-to-skin contact.1 Clinically, it can present with psoriasiform skin lesions in acral distribution with variable whitish scaling. It usually involves the subungueal area with nail hyperkeratosis and dystrophy.2 A 56-year-old man, alcoholic, presented with a seven-month history of pruritus (with nocturnal exacerbation), weight loss and muscle weakness. The patient is a known case of lepromatous leprosy (LL), diagnosed 22 years ago with irregular treatment, neurological damage and deformities. On examination, hyperkeratosis with crusted lesions on hands and feet with severe nail dystrophy. We also noted an erythematous scaling eruption in the face, neck, scalp, trunk, and arms (Fig. 1). Laboratory results included

Secondary Syphilis Mimicking Leprosy Type1 Reaction

Secondary Syphilis Mimicking Leprosy Type1 Reaction Syphilis and leprosy have cutaneous manifestations with great lesional polymorphism with subsequent difficult differential diagnosis. Both have additional tests that, in certain situations, are inconclusive, making it difficult to confirm the clinical diagnosis. In medical literature there are several clinical cases reported in which patients with syphilis were erroneously diagnosed and treated as having leprosy. Physicians need to maintain a high index of suspicion for the diagnosis of syphilis.

Transmission Electron Microscopy Analysis of Skin Lesions from Sporotrichosis Epidemic in Rio de Janeiro, Brazil

Transmission electron microscopy can yield useful information in a range of scientific fields; it is capable of imaging at a significantly higher resolution than light microscopes and has been a very useful tool in the identification of morphological changes of the dermis as well as assessment of changes in the extracellular matrix. Our aim is to characterize by electron microscopy the cellular profile of lesions caused by Sporothrix schenckii from the sporotrichosis epidemic in its zoonotic form that occurs in Rio de Janeiro, Brazil.