Sporotrichoid Distribution Research Articles

Athena: Specialty Certificate Examination case for infectious disease.

A 63-year-old man presented with an extensive pruritic and painful rash on his arm that had gradually progressed over 8 years after pricking his wrist on a bush, despite treatment with antifungals and antibiotics. Physical examination showed numerous erythematous, coalescing verrucous plaques in a sporotrichoid distribution on the arm with crust and scale. We discuss further tests, diagnosis and treatment.

Cutaneous Nodules Arranged in a Sporotrichoid Distribution Over the Lower Extremity.

Cutaneous Nodules Arranged in a Sporotrichoid Distribution Over the Lower Extremity.

Ulcerated nodules in a sporotrichoid distribution

A 42-year-old man presented with a 3-month history of persistent ulcerated nodules (Fig 1). History was relevant for deployment to the Middle East, Africa, Turkey, and South East Asia. He also reported skinning squirrels and butchering hogs on his farm in Missouri. Review of systems found intermittent fevers and night sweats. Prior treatment included multiple oral antibiotics without improvement. Examination found ulcerated, firm, pink nodules on the right forearm, elbow, and arm in sporotrichoid distribution without palpable lymphadenopathy.

Ulcerated nodules in a sporotrichoid distribution—A rare case of primary cutaneous anaplastic large cell lymphoma

Ulcerated nodules in a sporotrichoid distribution—A rare case of primary cutaneous anaplastic large cell lymphoma

Sporotrichoid Keratoacanthomas: Case Report and Review of Neoplasms Presenting in a Sporotrichoid Pattern

Sporotrichosis is a fungal infection known for its distinct pattern of infectious skin nodules. Several conditions can present with lesions that appear in a sporotrichoid pattern. An 82-year-old man that presented with three cutaneous nodules on his right leg in a sporotrichoid manner is described; biopsy of each lesion revealed a keratoacanthoma. In addition to keratoacanthomas, other neoplasms—albeit rarely—may be observed to occur in a sporotrichoid manner. These included squamous cell carcinoma (three patients), lymphoma (two patients), and one patient with each of the following: epithelioid sarcoma, Langerhans cell histiocytosis, melanoma, and peripheral nerve sheath tumor. The 10 patients whose cancer had cutaneous lesions that presented in a sporotrichoid distribution ranged from 28 to 83 years old. The tumors equally appeared on either the upper extremity (five patients) or the lower extremity (five patients). Treatments included systemic chemotherapy, surgical intervention, and radiation. Three of the patients died secondary to their tumors. In conclusion, various infections and some miscellaneous disorders can present in a sporotrichoid pattern. Keratoacanthomas can be added to the list of cancers (which include squamous cell carcinoma, lymphoma, epithelioid sarcoma, Langerhans cell histiocytosis, melanoma, and peripheral nerve sheath tumor) whose skin lesions have appeared in a sporotrichoid distribution. When cutaneous lesions appear in a sporotrichoid manner, biopsy of the tissue—for not only microscopic examination but also bacterial, fungal, and mycobacterial cultures—should be considered.

Staphylococcus lugdunensis cutaneous infection with sporotrichoid distribution

We report the occurrence of Staphylococcus lugdunensis cutaneous infection with sporotrichoid distribution of the left lower limb of a 60-year-old man. Recent studies have confirmed that Staphylococcus lugdunensis is a significant pathogen in causing skin and soft tissue infections that usually manifest in abscesses, surgical wound infections, and cellulitis. It used to be considered a skin commensal bacteria, but if unrecognized it can lead to fulminant endocarditis, meningitis, skin abscesses, peritonitis, and spondylodiscitis.

Sporotrichoid Nerve Abscess in Borderline leprosy: Rare presentation of downgrading Type 1 reaction

Nerve abscesses are seen in upper pole of leprosy as a manifestation of upgrading type 1 hypersensitivity reaction. We describe a case of borderline Hansen with sporotrichoid distribution of nerve abscesses, as a manifestation of type 1 downgrading reaction.

Sporotrichoid distribution of a malignant peripheral nerve sheath tumour

Sporotrichoid distribution of a malignant peripheral nerve sheath tumour

Angiosarcoma in a condensed sporotrichoid distribution arising at an ateriovenous fistula site: Case report

Angiosarcoma in a condensed sporotrichoid distribution arising at an ateriovenous fistula site: Case report

Chromomycose cutanée diffuse àPhialophora verrucosa

Chromomycosis is a chronic fungal skin infection that generally presents in the form of verrucous or vegetative lesions on uncovered areas of skin. We report an unusual case of generalised chromomycosis due to Phialophora verrucosa. A 42-year-old town-dwelling housewife was hospitalised for erythematous keratotic nodules on the arm showing sporotrichoid distribution, associated with a crusted ulcerative lesion on the homolateral index finger, as well as subcutaneous papulonodular lesions. In places, the lesions on the patient's back presented an umbilical and molluscoid appearance. The patient had suffered no previous injuries and had not visited any areas in which leishmaniasis is endemic. Her history included insulin-dependent diabetes. Screening for Leishman bodies was negative. Histopathological analysis of the skin biopsy revealed an epithelioid giant-cell granuloma with no caseous necrosis. The mycological study demonstrated the presence of fumagoid bodies and P. verrucosa was isolated. Treatment with terbinafine was initially given, followed by clarithromycin, but in the absence of any improvement, the patient was readmitted to hospital and is currently on itraconazole and amphotericin B. The novel features of our case comprise the clinical aspect of chromomycosis, the extent of the lesions, their unusual site on the back and upper limbs, and the isolation of a rare species, P. verrucosa (only the second observation in Morocco). It also highlights the therapeutic difficulties posed by this type of chromomycosis.

Sporotrichoid Mycobacterium marinum infection of the face following a cat scratch

Mycobacterium marinum infections in humans uncommonly affect the face and are not known to be associated with cat scratches. We describe a 24-year-old woman who presented with a 3-month history of multiple tender, occasionally discharging cystic nodules involving the left side of her face in a sporotrichoid distribution. She had suffered a cat scratch to her left lower eyelid 3 weeks before the onset of the eruption and owned multiple tropical fish tanks. She was systemically well and had no lymphadenopathy. She had a background history of a 4.5-mm-thick nodular melanoma of her temple treated by wide local excision and negative sentinel lymph node biopsy 4 years prior. Skin biopsies showed multiple variably sized granulomas surrounded by thick cuffs of lymphocytes involving the superficial and deep dermis with no organisms seen on Ziehl-Neelsen, peroidic acid-Schiff and methenamine silver stains. Laboratory investigations showed a mildly raised erythrocyte sedimentation rate but normal full blood count and C-reactive protein. Fluid from the left cheek grew an acid-fast bacillus identified as Mycobacterium marinum. The skin eruption cleared after 5-month treatment with oral clarithromycin 500 mg twice daily and rifampicin 600 mg daily.

Disseminated cutaneous Mycobacterium chelonae infection with multidrug resistance in a patient with panuveitis

We report the case of a 43-year-old immunosuppressed woman who presented with cellulitis of the lower limbs and multiple widespread subcutaneous nodules in a sporotrichoid distribution. Microbiological findings from skin biopsy confirmed Mycobacterium chelonae infection.

Treatment of Mycobacterium marinum cutaneous infections

Mycobacterium marinum is a non-tuberculous mycobacterium found in non-chlorinated water, with worldwide prevalence. It is the most common atypical Mycobacterium that causes opportunistic infection in humans. It presents as a solitary, red-to-violaceous plaque or nodule with an overlying crust or verrucous surface, or as inflammatory nodules or abscesses, usually in a sporotrichotic type of distribution. Deep infections may also occur. Although diagnosis is confirmed by isolation and identification of the organism in practice diagnosis remains largely presumptive based on clinicohistological features and the response to treatment. Polymerase chain reaction allows the routine early detection of the organism from a biopsy specimen. In the near future, it seems possible that histopathological examination might be greatly assisted by the rapidly improving possibilities with in vivo imaging. There have been many therapeutic modalities used effectively in the treatment of M. marinum infections. Spontaneous remission has also been reported in untreated infections and in immunocompetent hosts. However, there is no proven treatment of choice because M. marinum is naturally multi-drug resistant species and treatment is based primarily on the personal experience and preference of individual investigators, without the benefit of large studies. In superficial cutaneous infections minocycline, clarithromycin, doxycycline and trimethoprim-sulfamethoxazole as monotherapy are effective treatment options, but drug resistance varies and thereby combination therapy usually of two drugs may be required. Ciprofloxacin has shown considerable effectiveness. In cases of severe infections, including those with a sporotrichoid distribution pattern, a combination of rifampicin and ethambutol seems to be the recommended regimen. The use of isoniazid, streptomycin and pyrazinamide as empirical treatment options should be avoided. Surgical treatment is not usually recommended and must be cautiously applied. Cryotherapy, X-ray therapy, electrodesiccation, photodynamic therapy and local hyperthermic therapy have been reported as effective therapeutic alternatives. M. marinum infection should always be included in the differential diagnosis of all cases with poor-healing wounds in upper extremities and a history of exposure to aquariums.

Case report: MR features of granulomatous myositis

A 51-year-old woman with a 23-year history of systemic lupus erythematosus (SLE), on long-term low-dose steroids, presented with right thigh swelling and erythema of 2-weeks duration. She was afebrile and denied antecedent trauma or injection. Relevant past history included right caphalic vein thrombosis; and culture and biopsy proven cutaneous tuberculous granulomas of the right forearm 3 years ago, which responded to a 9-month regimen of rifampicin, isoniazid and ethambutol. The WBC count was 13.8 x 109/1 with granulocytosis (92%) and lymphopenia (690//zl). Serum creatinine phosphokinase (1211 u/l) and aldolase (32.4u/1) levels were elevated. Doppler study of the right lower limb excluded a deep vein thrombosis. Magnetic resonance (1.5 T) images showed subcutaneous oedema and abnormal signal intensity in the quadriceps femoris. On Tl-weighted (SE 600/17) images, the swollen muscles were slightly hyperintense to normal muscle with loss of inter-muscular planes (Figs la & 2a). These areas enhanced moderately following intravenous gadolinium-DTPA and were hyperintense on the T2-weighted (FSE 4000/102) images (Figs lb & 2b). Fast multiplanar inversion recovery (FMPIR 3000/102) (Fig. 2c) accentuated the abnormalities. These signal and enhancement characteristics suggested myositis. No bony abnormality was detected. Open muscle biopsy of the abnormal rectus femoris and vastus intermedialis muscles revealed granulomatous myositis, with extensive myocyte necrosis surrounded by epitheloid histiocytes, multinucleated giant cells and lymphocytes. There was no evidence of acid fast bacilli (AFB), fungus or vasculitis. The tissue and blood cultures were also sterile. The patient did not receive specific therapy for her thigh swelling and was discharged. Shortly after, dusky erythematous plaques and nodules in a sporotrichoid distribution erupted predominantly in the swollen right lower limb. The dermatologist's clinical diagnosis was an atypical mycobacterial skin infection. Skin biopsy showed granulomas with caseous necrosis and AFB, but cultures for mycobacteria were negative. Very rapid clinical response to empirical treatment with clarithromycin and ciprofloxacin for atypical mycobacterial infection ensued. After 3 months, treatrnent was ceased for suspected antibiotic-induced purpura (subsequently found to be caused by NSAIDs). Within 2 weeks, the lesions relapsed. Repeat skin biopsies all confirmed cutaneous tuberculous infection. Multiple cultures for mycobacteria from skin specimens, sputum and laryngeal swabs were negative. The chest radiograph was normal and MRI of the himbosacral spine excluded vertebral osteomyelitis. Resumption of the antibiotics, reinforced with ethambutol, isoniazid and rifampicin, finally saw gradual resolution of the right thigh swelling and skin lesions., On the follow-up MR imaging, 8 months from commencement of therapy, there was significant resolution of the abnormal signals in the right thigh (Fig. 3). literature search (Medline: 1976-March 1995), but none of atypical mycobacterial myositis. Our patient was proven on multiple skin biopsies to have cutaneous mycobacterial infection, and the clinical picture was that of atypical mycobacteria. The granulomatous myositis diagnosed on biopsy 1 month before the onset of the cutaneous lesions was also mycobacterial in origin, as there was resolution, clinically and on repeat MRI, following anti-tuberculous therapy. Pyogenic myositis, caused by Staphylococcus aureus in more than 90% of cases [5], is endemic in the tropics where it accounts for 4% of surgical admissions [6]. It occurs infrequently in the temperate climates, but has been increasingly reported in North America and Europe. It affects all ages, and typically involves a single large muscle group, usually the thigh (quadriceps femoris), although multiple muscle involvement is found in 12% to 43% [7]. It is associated with trauma (in 20% to 50% of cases), a history of travel to the tropics, nutritional deficiencies, underlying parasitic or occult viral myositis, and immunocompromised states. These include diabetes mellitus, infection with human immunodeficiency virus, leucopenia with leukaemia, Felty's syndrome, rheumatoid arthritis, and progressive systemic sclerosis [8]. We are unaware of any case previously reported in an SLE patient. Corticosteroid therapy