Tullia Cuzzi

Canine sporotrichosis in Rio de Janeiro, Brazil: clinical presentation, laboratory diagnosis and therapeutic response in 44 cases (1998 /2003)

A sporotichosis epidemic involving forty-four dogs in the Metropolitan area of Rio de Janeiro is described. Solitary skin lesions were noted in 18 dogs (40.9%), 2-4 such lesions were observed in 17 animals (38.6%), and nine (20.5%) animals had five or more lesions. Twenty-five (56.8%) animals had single ulcerated skin lesions on the nose and nine (20.5%) showed nasal mucosal involvement (three of which also has a skin lesion). Respiratory symptoms were observed in 17 (38.6%) dogs and were found to be the most common extracutaneous signs of infection. Anemia, leukocytosis with neutrophilia, hypoalbuminemia and hyperglobulinemia were the most frequent hematological abnormalities. Histopathological analysis of skin biopsies in most cases revealed granulomatous reactions characterized by histiocytic hyperplasia and neutrophil infiltration. Yeast-like cells were observed in seven (16.7%) of 42 dogs examined histologically. During the study, eight (18.2%) animals were lost to follow-up and three (6.8%) were submitted to euthanasia. Of the remaining 33 dogs, five (15.2%) presented spontaneous regression of the lesions, 26 (78.8%) were cured after treatment, and two (6%) continue to be treated. The present cases indicate that many dogs with sporotrichosis respond well to treatment and in a few dogs, the disease may be self-limiting.

American cutaneous leishmaniasis in two cats from Rio de Janeiro, Brazil: first report of natural infection with Leishmania (Viannia) braziliensis

We describe the isolation of Leishmania (Viannia) braziliensis from two female cats with American cutaneous leishmaniasis in Rio de Janeiro, Brazil. The isolates were identified as L. (V.) braziliensis by isoenzyme electrophoresis.

Histopathology of cutaneous sporotrichosis in Rio de Janeiro: a series of 119 consecutive cases

Background: Sporotrichosis is the most common subcutaneous mycosis in Rio de Janeiro. Histopathological examination reveals diffuse granulomatous and suppurative dermatitis, and the fungus is rarely identifiable in tissue. We describe the histopathological features of cutaneous sporotrichosis, and investigate the association between them and the lack of visualization of the fungus.

Tuberculoid leprosy in a patient with AIDS: a manifestation of immune restoration syndrome

An HIV positive male from Brazil, living in Italy since 1989, developed a single non-itching, papulo-erythematous infiltrative lesion on the face after 2 months from the beginning of HAART. A diagnosis of leprosy was made, suggesting that the immunodeficiency masked the disease, until the skin manifestation became evident with immune-recovery.

Acroangiodermatite (pseudossarcoma de Kaposi): uma condição raramente reconhecida. Um caso na planta do pé associado a insuficiência venosa crônica

Acroangiodermatitis, often known as pseudo-Kaposi sarcoma, is an uncommon angioproliferative entity related to chronic venous insufficiency, arteriovenous fistulae, paralysed limbs, amputation stumps, vascular syndromes and conditions associated with thrombosis. It presents most frequently as purple macules, papules or plaques in the dorsal aspects of the feet, especially the toes, and the malleoli. We report a case of acroangiodermatitis in the plantar aspect of the foot, misdiagnosed for two years, in which haematoxylin-eosin hystopathological stain and immunolabeling with CD34 histochemistry examination were decisive for diagnosis. Patient had chronic venous insufficiency. The lesion responded well to the treatment with a combination of leg elevation and compression.

Proposal of a histopathological predictive rule for the differential diagnosis between American tegumentary leishmaniasis and sporotrichosis skin lesions

Background  American tegumentary leishmaniasis (ATL) and sporotrichosis exhibit similar histopathology and low frequencies of microorganism detection.

Sweet syndrome associated with sporotrichosis

MADAM, Sweet syndrome (SS) is characterized by fever, acute onset of painful erythematous papules, plaques or nodules, peripheral neutrophil leucocytosis, and histological findings of a dense neutrophilic infiltrate without evidence of primary vasculitis. It usually affects middle-aged women and has been associated with infection and an underlying disease. Regarding fungal infections, SS has been described in coccidioidomycosis. Here we report three cases of SS in patients with sporotrichosis. Diagnosis of sporotrichosis was based on isolation in culture of Sporothrix schenckii from the initial lesion and diagnosis of SS was based on clinical and histopathological findings. The first patient was a 47-year-old woman with a cutaneous ulcerated lesion on her right thigh followed by fever, osteoarticular pain, and disseminated cutaneous plaque lesions (Fig. 1). She reported the absence of local trauma and had not taken any medication before the diagnosis. She also reported that she took care of a diseased cat. Her white blood cell count reached 20Æ3 · 10 L and culture of the ulcerated lesion evidenced S. schenckii. She improved after 8 weeks of itraconazole 100 mg daily and 2 weeks of oral prednisone. The second patient was a 47-year-old woman with an ulcerated lesion on the knee and disseminated cutaneous erythematous plaques. She remembered taking diclofenac-cholestyramine for back pain for 5 days prior to the appearance of the lesions, and denied any contact with cats. Her white blood cell count was 11Æ0 · 10 L. Culture of her ulcerated lesion showed S. schenckii. She improved after 12 weeks of itraconazole 100 mg daily and 8 weeks of oral prednisone. The third patient was a 78-year-old woman who had a knee injury 40 days before the onset of diffuse pruriginous cutaneous papules and plaques. She also had fever and headache. She had contact with a diseased cat at home but reported no injuries caused by the animal. She had systemic arterial hypertension that was under control with the use of hydrochlorothiazide and enalapril. Her white blood cell count was 7Æ9 · 10 L and S. schenckii was isolated from ulcerated knee lesion. The patient improved after 8 weeks of itraconazole 100 mg daily and a 1-week course of oral potassium diclofenac and oral dexchlorpheniramine. Histopathological findings of one erythematous plaque from each patient were very similar (Fig. 2). There was marked oedema of the papillary dermis mimicking a subepidermal vesiculation. The underlying upper dermis contained an intense perivascular and interstitial infiltrate of neutrophils with leukocytoclasis and macrophages, some with epithelioid differentiation. In patients 1 and 2 there were dilated vessels and extravasated red blood cells while in patients 1 and 3 focal spongiosis with small spongiotic vesicles was seen. A few eosinophils were seen in patient 2. Sporotrichosis is a subcutaneous infection caused by the dimorphic fungus S. schenckii. Hypersensitivity reactions such as erythema nodosum and erythema multiforme have been described in cat-transmitted endemic sporotrichosis in Rio de Janeiro. The patients presented here were from an endemic area of sporotrichosis and two had contact with cats. They presented localized forms of sporotrichosis and developed clinical and histopathological characteristics of SS. Patient 1 had no other factor that could explain the onset of the SS. The drugs used by patients 2 and 3 are not known to be associated with SS. In all cases, patients were successfully treated for the mycosis and for the SS. BJD British Journal of Dermatology

Immunohistochemical detection of the latent nuclear antigen-1 of the human herpesvirus type 8 to differentiate cutaneous epidemic Kaposi sarcoma and its histological simulators

Kaposis sarcoma is the most common neoplasia diagnosed in AIDS patients and the expression of the human herpesvirus-8 (HHV-8) latent nuclear antigen-1 has been useful for its histological diagnosis. The aim of this study is to confirm that immunohistochemistry is a valuable tool for differentiating KS from its simulators in skin biopsies of HIV patients. Immunohistochemical and histological analyses were performed in 49 Kaposis sarcoma skin biopsies and 60 of its histological simulators. Positivity was present in the 49 Kaposis sarcoma skin biopsies and no staining was observed in the 60 simulators analyzed, resulting in sensibility and specificity of 100%. HHV-8 immunohistochemical detection is an effective tool for diagnosing Kaposis sarcoma, especially in early lesions in which neoplastic features are not evident. It also contributes to its histological differential diagnosis.

Granuloma anular: distribuição tecidual dos dendrócitos dérmicos fator XIIIa+, das células dérmicas trombomodulina+ e de macrófagos CD68+

BACKGROUND: A subgroup of macrophage related dermal cells expresses the pro-coagulation factor XIIIa, while others express the anti-coagulation cofactor thrombomodulin. These cells can be involved in inflammatory and reparative tissue events. OBJETIVES: We investigated the participation of factor XIIIa+ dermal cells and thrombomodulin+ (TM+) dermal cells in the histopathological picture of granuloma annulare which is characterized by collagen necrobiosis and macrophagic infiltrate. METHODS: The histopathological picture of granuloma annulare observed in 23 skin biopsies was classified according to presence of complete or incomplete collagen degeneration and distribution of dermal infiltrate. Factor XIIIa+ dermal dendrocytes and thrombomodulin+ dermal cells were recognized by specific antibodies applied in immunohistochemical protocols; a macrophage marker (CD68) was also used. Distribution of distinct cell subsets were observed and semiquantitative analysis performed. RESULTS: Factor XIIIa+ dendrocytes were rarely detected in the lesion while thrombomodulin+ and CD68+ cells represented a considerable part of cell infiltrate. They were seen at its periphery (palisade arrangement), among degenerated collagen or diffusely distributed. A tendency was noted for association between higher semiquantification of thrombomodulin+ cells and both lower semiquantification of FXIIIa+ dendrocytes and histological type II. Dermal dendrocyte hyperplasia around the lesion was detected. CONCLUSION: The different tissue distribution of the FXIIIa+ cells and TM+ cells could reflect their distinct and complementary roles in the recovery of dermal tissue and in the lesion evolutive process in granuloma annulare.