Esporotricose disseminada – Caso clínico e discussão

 

João Cláudio Barroso Pereira ¹

Amorita Grijó ²

Rosângela Ribeiro Machado Pereira ³

Andreza Noel S Oliveira ⁴

Ana Cláudia de Andrade ⁴

Ana Cláudia M Ferreira ⁴

Christiane Corrêa Brant Machado ⁴

Débora Veiga Coutinho ⁴

Danilo Vale Rios ⁴

Bárbara Pereira Pires ⁴

 

 

Resumo

Os autores relatam caso de doente com história prévia de alcoolismo que apresentou lesões cutâneas ulceradas, nodulares difusas no tronco e nos membros inferiores, acompanhando trajecto dos linfonodos. A doente tinha telerradiografia de tórax que mostrou infiltrado intersticial reticulonodular nas bases. O resultado da cultura de nódulo supraclavicular foi positiva para Sporothrix schenckii. Após tratamento específico, principalmente com iodeto de potássio, houve regressão das lesões cutâneas e do infiltrado. Foi considerada uma discussão sobre as formas de apresentação da doença, ressaltando o acometimento pulmonar. Foram também abordados diagnóstico e tratamento da esporotricose.

Palavras-chave: Esporotricose, lesões cutâneas, infiltrado intersticial nas bases.

 

 

Disseminated sporotrichosis – Clinical case and discussion

The authors report a case of a patient with a prior history of alcohol abuse who developed nodules and ulcerated skin lesions on his trunk and lower extremities along the line of the lymphatic draining area. The patient's X-ray showed reticular nodular intersticial infiltrates at the lung bases. There was a positive culture of supraclavicular lymph node for Sporothrix schenckii. After specific treatment using mainly potassium iodide, there was regression of cutaneous lesions and lung infiltrates. The authors present a discussion on the deseases' forms of presentation, highlighting the lung involvement ans further discuss the diagnosis and treatment of sporotrichosis.

Key-words: Sporotrichosis, cutaneous lesions, intersticial infiltrates of lung bases.

 

 

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Bibliografia

1. Neto RDJP, Machado AA, de Castro G, Quaglio ASS, Martinez R. Esporotricose cutânea disseminada como manifestação inicial da síndrome da imunodeficiência adquirida -relato de caso. Rev Soc Bras Med Trop 1999; 32(1): 57 -61.        [ Links ]

2. Kauffman CA, Hajjeh R, Chapman SW. Practice guidelines for the management of patients with sporotrichosis. For the Mycoses Study Group. Infectious Diseases Society of America. Clin Infect Dis 2000; 30(4): 684 -7.

3. Wescott BL, Nasser A, Jarolim DR. Sporothrix meningitis. Nurse Pract 1999; 24(2):93 -8.

4. Gori S, Lupetti A, Moscato G, Parenti M, Lofaro A. Pulmonary sporotrichosis with hypae in a human immunodeficiency virus infected patient. A case report. Acta Cytol 1997; 41(2):519 -21.

5. Davis BA. Sporotrichosis. Dermatol Clin 1996; 14(1):69 -76.

6. Severo LC, Londero AT. Micoses Subcutâneas. Veronesi R, Focaccia R. Tratado de Infectologia. Nona Edição; 1997: 1044 -5.

7. Pluss JL, Opal SM. Pulmonary sporotrichosis: review of treatment and outcome. Medicine 1986; 65(3): 143 -53.

8. Kauffman CA. Sporotrichosis. Clin Infec Dis 1999; 29: 231 -6.

9. Kauffman CA, Pappas PG, McKinsey DS e cols. Treatment of lymphocutaneous and visceral sporotrichosis with fluconazole. Clin Infec Dis 1996; 22(1): 46 -50.

10. Mattheus HJ, Joubert JR, Truter FC, van der Walt JJ. Systemic sporotrichosis: pulmonary complications of well known cutaneous fungal disease. A case report. S Afr Med J 1982; 62(13): 451 -3.

11. Yang DJ, Krishnan RS e cols. Disseminated sporotrichosis mimicking sarcoidosis. Int J Dermatol 2006; 45(4): 450 -3.

12. Losman JA, Cavanaugh K. Cases from the Osler Medical Service at Johns Hopkins University. Diagnosis: P. carinii pneumonia and primary sporotrichosis. 2004; 117(5):353 -6.

13. England DM, Hochholzer L. Primary pulmonary sporotrichosis. Report of eight cases with clinicopathologic review. Am J Surg Pathol 1985; 9(3): 193 -204.

14. Michelson E. Primary pulmonary sporotrichosis. Ann Thorac Surg 1977; 24(1):83 -6.

15. Ramirez J, Byrd RP Jr, Roy TM. Chronic cavitary pulmonary sporotrichosis : efficacy of oral itraconazole. J Ky Med Assoc 1998; 96(3):103 -5.

16. Haponik EF, Hill MK, Craighead CC. Pulmonary sporotrichosis with massive hemoptysis. Am J Med Sci 1989; 297(4):251 -3.

17. England DM, Hochholzer L. Sporothrix infection of the lung without cutaneous disease. Primary pulmonary sporotrichosis. Arch Pathol Lab Med 1987; 111(3): 298 -300.

18. Fields CL, Ossorio MA, Roy TM. Empyema associated with pulmonary sporotrichosis. South Med 1989; 82(7): 910 -3.

19. Belknap BS. Sporotrichosis. Dermatol Clin 1989; 7(2):193 -202.

20. Kauffman CA. Old and new therapies for sporotrichosis. Clin Infect Dis 1995; 21(4):981 -5.

21. Breeling JL, Weinstein L. Pulmonary sporotrichosis treated with itraconazole. Chest 1993; 103(1): 313 -4.

22. Rohatgi PK. Pulmonary sporotrichosis. South Med J 1980; 73(12): 1611 -7.

23. Mohr JA, Griffiths W, Long H. Pulmonary sporotrichosis in Oklahoma in susceptibilities in vitro. Am Rev Respir Dis 1979; 119(6): 961 -4.

24. Jung JY, Almond CH e cols. Role of surgery in the management of pulmonary sporotrichosis. J Thorac Cardiovasc Surg 1979; 77(2):234 -9.

25. Comstock C, Wolson AH. Roentgenology of sporothricosis. Am J Roentgenology Radm Ther Nucl Med. 1975; 125(3):651 -5.

 

 

1 Médico do CRA-DIP do Hospital Municipal Nelson de Sá Earp e do Programa de Controle da Tuberculose da SMS-Petrópolis e do Serviço de Atendimento Especializado da SMS-Belford Roxo – Rio de Janeiro Brasil.

2 Médica do DIP do Hospital Municipal Nelson de Sá Earp e Professora da Faculdade de Medicina – Petrópolis.

3 Médica radiologista do Hospital Estadual Carlos Chagas e Hospital Municipal Rocha Maia – Rio de Janeiro.

4 Alunos do 5.º ano do curso de Medicina da Faculdade de Medicina de Petrópolis.

Director do Hospital Municipal Nelson de Sá Earp (HMNSE): Dr. Roberto Silveira.

HMNSE – Rua Paulino Afonso, 455 – Bairro Bingen – Petrópolis – Rio de Janeiro – Brasil.

Trabalho apresentado sob forma de poster no XXII Congresso de Pneumologia e IV Congresso Luso-Brasileiro de Pneumologia pelo médico João Cláudio Barroso Pereira.

 

Recebido para publicação/received for publication: 07.10.15