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Guliyeva G, Janis JE. Postsurgical Pyoderma Gangrenosum Requiring Plastic Surgical Intervention: A Practical Review. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5505. [PMID: 38250211 PMCID: PMC10798700 DOI: 10.1097/gox.0000000000005505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 11/03/2023] [Indexed: 01/23/2024]
Abstract
Pyoderma gangrenosum is a neutrophilic dermatosis characterized by immune dysfunction and pathergy. Thus, it is frequently seen in patients with underlying systemic illnesses or postoperatively. For the performance of the debridement or closure of the resultant defect, plastic surgeons are often involved in the care of pyoderma patients. However, both procedures may exacerbate the injury. Therefore, plastic surgeons must be familiar with the presentation of postsurgical pyoderma to avoid further damage and safely repair related soft tissue defects. A systematic search of the PubMed/Medline database was performed using the following keywords: "pyoderma gangrenosum" and "surgery." This online database search has identified 656 studies published between 1958 and 2022. Only reconstructed cases of postsurgical pyoderma gangrenosum were selected. Twenty-eight patients who developed pyoderma after dermatologic, plastic, orthopedic, cardiovascular, general, or obstetric surgery were included in this study. The average time to the PG presentation and diagnosis was 5.5 and 17 days, respectively. Diagnostic scoring tools were not used, and the diagnosis was primarily based on histopathology after repeated treatment failures. The patients received split- or full-thickness skin grafts, local, pedicled, and free flaps. An estimated 82.1% underwent skin grafting, whereas 42.9% underwent flap reconstruction. In addition, 21.4% got both the graft and flap. Accurate diagnosis of PSPG, prevention of further surgical injury, and timely medical management are vital for improving patient outcomes. Reconstruction can be performed, if required. However, despite the availability of different reconstructive techniques, there is no standard approach to the management of the PSPG.
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Affiliation(s)
- Gunel Guliyeva
- From the Department of Plastic and Reconstructive Surgery, The Ohio State University, Columbus, Ohio
| | - Jeffrey E. Janis
- From the Department of Plastic and Reconstructive Surgery, The Ohio State University, Columbus, Ohio
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2
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Meek MR, Farooq S, Messer A, Liu J, Jahan-Tigh RR. A 48-Year-Old Man With Bilateral Hand Edema and Ulcers. Clin Infect Dis 2022; 74:161-163. [PMID: 35016206 DOI: 10.1093/cid/ciab279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Madison R Meek
- McGovern Medical School, UTHealth Science Center at Houston, Houston, Texas, USA
| | - Sahira Farooq
- McGovern Medical School, UTHealth Science Center at Houston, Houston, Texas, USA
| | - Alison Messer
- Department of Dermatology, UTHealth Science Center at Houston, Houston, Texas, USA
| | - Jing Liu
- Department of Pathology, UTHealth Science Center at Houston, Houston, Texas, USA
| | - Richard R Jahan-Tigh
- Department of Dermatology, UTHealth Science Center at Houston, Houston, Texas, USA
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3
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Shao J, Song Y, Zhou Y, Wan Z, Li R, Yu J. Diagnostic value of fluorescein-labeled chitinase staining in formalin-fixed and paraffin-embedded tissues of fungal disease. Med Mycol 2020; 58:66-70. [PMID: 31329921 DOI: 10.1093/mmy/myz035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 03/20/2019] [Accepted: 04/08/2019] [Indexed: 12/31/2022] Open
Abstract
Common histopathologic techniques are used to diagnose fungal infections, but the diagnostic identification of mycoses in tissue specimens is often difficult, particularly when fungi rarely occur in a specimen. The aim of this study was to evaluate the application of fluorescein-labeled chitinase staining to formalin-fixed and paraffin-embedded (FFPE) tissues. We studied 79 archival FFPE tissues from patients diagnosed with fungal disease, including 38 cases of sporotrichosis and 41 cases of other fungal infections. The tissue sections were subjected to periodic acid-Schiff (PAS) staining, Gomori's methenamine silver (GMS) staining, and fluorescein-labeled chitinase staining to detect fungal elements. Culture- and/or hematoxylin-eosin-positive samples were used to estimate the diagnostic sensitivity of each staining method, with the results showing that PAS, GMS, and fluorescein-labeled chitinase staining had sensitivities of 50.6, 70.9, and 68.4%, respectively. The three staining results were the same for all fungal infections except for sporotrichosis and chromoblastomycosis. Fluorescein-labeled chitinase staining exhibited high sensitivity in cases of sporotrichosis and poor performance in detecting muriform cells of chromoblastomycosis. On the whole, the sensitivity of fluorescein-labeled chitinase staining was greater than that of PAS and similar to that of GMS staining. Therefore, the results of our study suggest that fluorescein-labeled chitinase staining is a potentially useful diagnostic tool in the diagnosis of fungal infections.
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Affiliation(s)
- Jin Shao
- Department of Dermatology, Peking University First Hospital; Beijing Key Laboratory of Molecular Diagnosis on Dermatoses; Research Center for Medical Mycology, Peking University, Beijing 100034, China
| | - Yinggai Song
- Department of Dermatology, Peking University First Hospital; Beijing Key Laboratory of Molecular Diagnosis on Dermatoses; Research Center for Medical Mycology, Peking University, Beijing 100034, China
| | - Yabin Zhou
- Department of Dermatology, Peking University First Hospital; Beijing Key Laboratory of Molecular Diagnosis on Dermatoses; Research Center for Medical Mycology, Peking University, Beijing 100034, China
| | - Zhe Wan
- Department of Dermatology, Peking University First Hospital; Beijing Key Laboratory of Molecular Diagnosis on Dermatoses; Research Center for Medical Mycology, Peking University, Beijing 100034, China
| | - Ruoyu Li
- Department of Dermatology, Peking University First Hospital; Beijing Key Laboratory of Molecular Diagnosis on Dermatoses; Research Center for Medical Mycology, Peking University, Beijing 100034, China
| | - Jin Yu
- Department of Dermatology, Peking University First Hospital; Beijing Key Laboratory of Molecular Diagnosis on Dermatoses; Research Center for Medical Mycology, Peking University, Beijing 100034, China
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4
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Tai F, Jakubovic H, Alabdulrazzaq S, Alavi A. A case of sporotrichosis infection mimicking pyoderma gangrenosum and the role of tissue culture in diagnosis: A case report. SAGE Open Med Case Rep 2020; 8:2050313X20919600. [PMID: 32523696 PMCID: PMC7235660 DOI: 10.1177/2050313x20919600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Sporotrichosis infections may cause cutaneous lesions mimicking other infectious or non-infectious causes such as pyoderma gangrenosum. We present a case of cutaneous sporotrichosis misdiagnosed as pyoderma gangrenosum and treated with immunosuppressants for 17 months leading to exacerbation and atypical morphology mimicking Histoplasma organisms on biopsy. Exclusion of infection prior to diagnosing pyoderma gangrenosum is important to prevent iatrogenic immunosuppression, demonstrating the challenges with application of the updated pyoderma gangrenosum diagnostic criteria.
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Affiliation(s)
- Felicia Tai
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Henry Jakubovic
- Department of Laboratory Medicine & Pathobiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Dermatology, Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - Shaikhah Alabdulrazzaq
- Division of Dermatology, Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - Afsaneh Alavi
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Dermatology, Women's College Hospital, University of Toronto, Toronto, ON, Canada
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5
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Rodríguez-Zúñiga MJM, Heath MS, Gontijo JRV, Ortega-Loayza AG. Pyoderma gangrenosum: a review with special emphasis on Latin America literature. An Bras Dermatol 2019; 94:729-743. [PMID: 31789268 PMCID: PMC6939079 DOI: 10.1016/j.abd.2019.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 06/14/2019] [Indexed: 01/01/2023] Open
Abstract
Pyoderma gangrenosum is a neutrophilic dermatosis characterized by chronic ulcers due to an abnormal immune response. Despite the existence of diagnostic criteria, there is no gold standard for diagnosis or treatment. In Latin America, recognizing and treating pyoderma gangrenosum is even more challenging since skin and soft tissue bacterial and non-bacterial infections are common mimickers. Therefore, this review aims to characterize reported cases of pyoderma gangrenosum in this region in order to assist in the assessment and management of this condition. Brazil, Mexico, Argentina, and Chile are the countries in Latin America that have reported the largest cohort of patients with this disease. The most frequent clinical presentation is the ulcerative form and the most frequently associated conditions are inflammatory bowel diseases, inflammatory arthropaties, and hematologic malignancies. The most common treatment modalities include systemic corticosteroids and cyclosporine. Other reported treatments are methotrexate, dapsone, and cyclophosphamide. Finally, the use of biological therapy is still limited in this region.
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Affiliation(s)
| | - Michael S Heath
- Oregon Health and Sciences University, Portland, United States
| | - João Renato Vianna Gontijo
- Adult Health Postgraduate Program, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Alex G Ortega-Loayza
- Department of Dermatology, Oregon Health and Sciences University, Portland, OR, United States.
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6
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Saeed L, Weber RJ, Puryear SB, Bahrani E, Peluso MJ, Babik JM, Haemel A, Coates SJ. Disseminated Cutaneous and Osteoarticular Sporotrichosis Mimicking Pyoderma Gangrenosum. Open Forum Infect Dis 2019; 6:ofz395. [PMID: 31660357 PMCID: PMC6786506 DOI: 10.1093/ofid/ofz395] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 09/05/2019] [Indexed: 12/24/2022] Open
Abstract
Disseminated sporotrichosis may present with inflammatory arthritis and cutaneous ulcerations that mimic noninfectious skin conditions such as pyoderma gangreonsum (PG). Sporotrichosis must therefore be ruled out before administering immunosuppressive agents for PG. Furthermore, dimorphic fungi such as sporotrichosis may grow as yeast in bacterial cultures, even before fungal cultures become positive. We present a case of disseminated cutaneous and osteoarticular sporotrichosis mimicking PG and describe the differential diagnosis and the diagnostic and treatment approach to this condition.
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Affiliation(s)
- Lina Saeed
- School of Medicine, University of California San Francisco, San Francisco, California, USA.,Department of Dermatology, University of California San Francisco, San Francisco, California, USA
| | - Robert J Weber
- School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Sarah B Puryear
- School of Medicine, University of California San Francisco, San Francisco, California, USA.,Division of Infectious Disease, University of California San Francisco, San Francisco, California, USA
| | - Eman Bahrani
- School of Medicine, University of California San Francisco, San Francisco, California, USA.,Department of Dermatology, University of California San Francisco, San Francisco, California, USA
| | - Michael J Peluso
- School of Medicine, University of California San Francisco, San Francisco, California, USA.,Division of Infectious Disease, University of California San Francisco, San Francisco, California, USA
| | - Jennifer M Babik
- School of Medicine, University of California San Francisco, San Francisco, California, USA.,Division of Infectious Disease, University of California San Francisco, San Francisco, California, USA
| | - Anna Haemel
- School of Medicine, University of California San Francisco, San Francisco, California, USA.,Department of Dermatology, University of California San Francisco, San Francisco, California, USA
| | - Sarah J Coates
- School of Medicine, University of California San Francisco, San Francisco, California, USA.,Department of Dermatology, University of California San Francisco, San Francisco, California, USA
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7
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White M, Adams L, Phan C, Erdag G, Totten M, Lee R, Lu X, Mehta S, Miller LS, Zhang SX. Disseminated sporotrichosis following iatrogenic immunosuppression for suspected pyoderma gangrenosum. THE LANCET. INFECTIOUS DISEASES 2019; 19:e385-e391. [PMID: 31473127 DOI: 10.1016/s1473-3099(19)30421-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 06/14/2019] [Accepted: 06/19/2019] [Indexed: 01/19/2023]
Abstract
Sporotrichosis is an infection caused by the dimorphic fungus Sporothrix schenckii and related species that often arises from traumatic inoculation of inhabited soil and organic debris into skin. The infection is usually limited to the skin in immunocompetent patients, usually as lymphocutaneous sporotrichosis. Accurate diagnosis rests on clinical data and culture, and might be facilitated by biopsy identification of suppurative and granulomatous inflammation with fungal elements. In this Grand Round, we present a dramatic case of cutaneous sporotrichosis initially presented with an atypical large ulcer without associated lymphocutaneous spread, clinically mimicking pyoderma gangrenosum, and subsequently progressed to disseminated sporotrichosis in the setting of iatrogenic immunosuppression. We further review the clinical features, risk factors, and treatment of these disseminated sporotrichosis cases, and discuss the need for improved awareness of this fungus' potential link to cause disseminated and invasive fungal infections.
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Affiliation(s)
- Marissa White
- Department of Pathology, Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - La'Tonzia Adams
- Department of Pathology and Laboratory Medicine, Veterans Affairs Portland Health Care System, Oregon Health and Science University, Portland, OR, USA
| | - Casey Phan
- Department of Pathology, Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Gulsun Erdag
- Department of Pathology, Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Marissa Totten
- Department of Pathology, Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Richard Lee
- Microbiology Laboratory, Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Xuelian Lu
- Department of Dermatology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Seema Mehta
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Lloyd S Miller
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, MD, USA; Department of Dermatology, Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Sean X Zhang
- Department of Pathology, Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, MD, USA; Microbiology Laboratory, Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, MD, USA.
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8
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Queiroz-Telles F, Buccheri R, Benard G. Sporotrichosis In Immunocompromised Hosts. J Fungi (Basel) 2019; 5:jof5010008. [PMID: 30641918 PMCID: PMC6463096 DOI: 10.3390/jof5010008] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 01/07/2019] [Accepted: 01/07/2019] [Indexed: 02/06/2023] Open
Abstract
Sporotrichosis is a global implantation or subcutaneous mycosis caused by several members of the genus Sporothrix, a thermo-dimorphic fungus. This disease may also depict an endemic profile, especially in tropical to subtropical zones around the world. Interestingly, sporotrichosis is an anthropozoonotic disease that may be transmitted to humans by plants or by animals, especially cats. It may be associated with rather isolated or clustered cases but also with outbreaks in different periods and geographic regions. Usually, sporotrichosis affects immunocompetent hosts, presenting a chronic to subacute evolution course. Less frequently, sporotrichosis may be acquired by inhalation, leading to disseminated clinical forms. Both modes of infection may occur in immunocompromised patients, especially associated with human immunodeficiency virus (HIV) infection, but also diabetes mellitus, chronic alcoholism, steroids, anti-TNF treatment, hematologic cancer and transplanted patients. Similar to other endemic mycoses caused by dimorphic fungi, sporotrichosis in immunocompromised hosts may be associated with rather more severe clinical courses, larger fungal burden and longer periods of systemic antifungal therapy. A prolonged outbreak of cat-transmitted sporotrichosis is in progress in Brazil and potentially crossing the border to neighboring countries. This huge outbreak involves thousands of human and cats, including immunocompromised subjects affected by HIV and FIV (feline immunodeficiency virus), respectively. We reviewed the main epidemiologic, clinical, diagnostic and therapeutic aspects of sporotrichosis in immunocompromised hosts.
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Affiliation(s)
- Flavio Queiroz-Telles
- Department of Public Health, Federal University of Paraná, Curitiba 80060-000, Brazil.
| | - Renata Buccheri
- Emilio Ribas Institute of Infectious Diseases, São Paulo 05411-000, Brazil.
| | - Gil Benard
- Laboratory of Medical Mycology, Department of Dermatology, and Tropical Medicine Institute, University of São Paulo, Sao Paulo 05403-000, Brazil.
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9
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Takazawa M, Harada K, Kakurai M, Yamada T, Umemoto N, Sakai T, Maeda T, Kawase M, Demitsu T. Case of pyoderma gangrenosum-like sporotrichosis caused by Sporothrix globosa in a patient with ulcerative colitis. J Dermatol 2018; 45:e226-e227. [PMID: 29488248 DOI: 10.1111/1346-8138.14276] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Maya Takazawa
- Department of Dermatology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Kazutoshi Harada
- Department of Dermatology, Tokyo Medical University, Tokyo, Japan
| | - Maki Kakurai
- Department of Dermatology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Tomoko Yamada
- Department of Dermatology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Naoka Umemoto
- Department of Dermatology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Toshiyasu Sakai
- Bacterial Laboratory, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Tatsuo Maeda
- Department of Dermatology, Tokyo Medical University, Tokyo, Japan
| | - Masaaki Kawase
- Department of Dermatology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Toshio Demitsu
- Department of Dermatology, Jichi Medical University Saitama Medical Center, Saitama, Japan
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10
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Charles K, Lowe L, Shuman E, Cha KB. Painful linear ulcers: A case of cutaneous sporotrichosis mimicking pyoderma gangrenosum. JAAD Case Rep 2017; 3:519-521. [PMID: 29264381 PMCID: PMC5729013 DOI: 10.1016/j.jdcr.2017.07.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Kristy Charles
- Department of Dermatology, Michigan Medicine, Ann Arbor, Michigan
| | - Lori Lowe
- Department of Dermatology, Michigan Medicine, Ann Arbor, Michigan.,Department of Pathology, Michigan Medicine, Ann Arbor, Michigan
| | - Emily Shuman
- Department of Infectious Disease, Michigan Medicine, Ann Arbor, Michigan
| | - Kelly B Cha
- Department of Dermatology, Michigan Medicine, Ann Arbor, Michigan
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11
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Vallini V, Andreini R, Bonadio A. Pyoderma Gangrenosum: A Current Problem as Much as an Unknown One. INT J LOW EXTR WOUND 2017; 16:191-201. [DOI: 10.1177/1534734617710980] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Pyoderma gangrenosum (PG) is a rare neutrophilic inflammatory skin disease, characterized by recurrent skin ulcers, which in almost 50% of cases are associated with systemic autoimmune disorders, including rheumatoid arthritis, chronic hepatitis, inflammatory bowel disease, paraproteinemias and hematological malignancies. A systematic search of literature for PG was carried out using the PubMed, Embase, and Google Scholar databases for the purpose of this review and 2780 articles were retrieved up to February 2017. Inflammation represents the predominant aspect of the disease, but its pathophysiological mechanisms are not completely clear yet, since there are many studies showing only one or more isolated findings of the disease. The goal of PG treatment is to reduce inflammation in order to promote ulcer healing by minimizing side effects of therapy. Several systemic and local treatments are available, but the lack of large randomized double-blind studies results in an absence of a uniform therapeutic standard: thus, more clinical studies are required in order to make head-to-head comparisons between combination and single-drug therapies and to identify specific combination therapies for distinctive clinical patterns of PG.
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Affiliation(s)
- Valerio Vallini
- Ospedale Santa Maria Maddalena–Volterra, Azienda Usl Nordovest, Toscana, Italy
| | - Roberto Andreini
- Ospedale Santa Maria Maddalena–Volterra, Azienda Usl Nordovest, Toscana, Italy
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12
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Cotino Sánchez A, Torres-Alvarez B, Gurrola Morales T, Méndez Martínez S, Saucedo Gárate M, Castanedo-Cazares JP. Mycosis fungoides-like lesions in a patient with diffuse cutaneous sporotrichosis. Rev Iberoam Micol 2015; 32:200-3. [PMID: 25620646 DOI: 10.1016/j.riam.2014.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 04/22/2014] [Accepted: 06/26/2014] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Sporotrichosis is a subacute or chronic mycosis acquired by traumatic inoculation or inhalation of fungal conidia. It is caused by the dimorphic fungus Sporothrix, which causes different clinical presentations, being the cutaneous and lymphocutaneous variants being the most frequent. The disseminated cutaneous form is a rare presentation occurring in a minority of cases in Mexico. CASE REPORT We report an atypical case of disseminated sporotrichosis in an alcoholic and iatrogenically immunosuppressed patient, whose clinical lesions resembled tumoral-stage mycosis fungoides. Histological examination and culture revealed the presence of Sporothrix schenckii. CONCLUSIONS The patient was treated with itraconazole 200mg per day for 4 months with clinical resolution. To the best of our knowledge, this is the first report of this type of clinical manifestation.
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Affiliation(s)
- Adriana Cotino Sánchez
- Department of Pathology, Hospital General de Durango, Universidad Juárez del Estado de Durango, Durango, Mexico
| | - Bertha Torres-Alvarez
- Department of Dermatology, Hospital Central Dr. Ignacio Morones Prieto, Universidad Autónoma de San Luis Potosí, San Luis Potosí, Mexico
| | - Teodoro Gurrola Morales
- Department of Pathology, Hospital General de Durango, Universidad Juárez del Estado de Durango, Durango, Mexico
| | - Silvia Méndez Martínez
- Department of Pathology, Hospital General de Durango, Universidad Juárez del Estado de Durango, Durango, Mexico
| | - Mauricio Saucedo Gárate
- Department of Pathology, Hospital General de Durango, Universidad Juárez del Estado de Durango, Durango, Mexico
| | - Juan Pablo Castanedo-Cazares
- Department of Dermatology, Hospital Central Dr. Ignacio Morones Prieto, Universidad Autónoma de San Luis Potosí, San Luis Potosí, Mexico.
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13
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Sporotrichosis: an overview and therapeutic options. Dermatol Res Pract 2014; 2014:272376. [PMID: 25614735 PMCID: PMC4295339 DOI: 10.1155/2014/272376] [Citation(s) in RCA: 102] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 12/12/2014] [Indexed: 01/19/2023] Open
Abstract
Sporotrichosis is a chronic granulomatous mycotic infection caused by Sporothrix schenckii, a common saprophyte of soil, decaying wood, hay, and sphagnum moss, that is endemic in tropical/subtropical areas. The recent phylogenetic studies have delineated the geographic distribution of multiple distinct Sporothrix species causing sporotrichosis. It characteristically involves the skin and subcutaneous tissue following traumatic inoculation of the pathogen. After a variable incubation period, progressively enlarging papulo-nodule at the inoculation site develops that may ulcerate (fixed cutaneous sporotrichosis) or multiple nodules appear proximally along lymphatics (lymphocutaneous sporotrichosis). Osteoarticular sporotrichosis or primary pulmonary sporotrichosis are rare and occur from direct inoculation or inhalation of conidia, respectively. Disseminated cutaneous sporotrichosis or involvement of multiple visceral organs, particularly the central nervous system, occurs most commonly in persons with immunosuppression. Saturated solution of potassium iodide remains a first line treatment choice for uncomplicated cutaneous sporotrichosis in resource poor countries but itraconazole is currently used/recommended for the treatment of all forms of sporotrichosis. Terbinafine has been observed to be effective in the treatment of cutaneous sporotrichosis. Amphotericin B is used initially for the treatment of severe, systemic disease, during pregnancy and in immunosuppressed patients until recovery, then followed by itraconazole for the rest of the therapy.
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14
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15
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Liu X, Zhang Z, Hou B, Wang D, Sun T, Li F, Wang H, Han S. Rapid identification of Sporothrix schenckii in biopsy tissue by PCR. J Eur Acad Dermatol Venereol 2012; 27:1491-7. [PMID: 23278977 DOI: 10.1111/jdv.12030] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The dimorphic fungus Sporothrix schenckii is the etiological agent of sporotrichosis, an important cutaneous mycosis with a worldwide distribution. At present, it is challenging to rapidly discover and identify Sporothrix schenckii in biopsy tissues nowadays. AIMS To explore new methods for rapid diagnosis of sporotrichosis. MATERIALS AND METHODS We screened specific primers for Sporothrix schenckii using 50 clinical isolates from patients with sporotrichosis. DNA was extracted from the lesions of 30 cases of clinically suspected sporotrichosis using the Graham s method of CTAB and amplified by PCR using the screened specific primers. RESULTS The primer S2-R2 was applicable for the identification of S. schenckii from different geographic areas and clinical types with high specificity and sensitivity. Twenty-five out of the thirty cases (83.3%) amplified using the primer S2-R2 showed positive bands. Further positive bands were observed in 95.6% of cases tested positive by fungal culture. CONCLUSIONS Using the PCR technique and specific primers, we developed a new diagnostic method that can rapidly diagnose sporotrichosis with tissues obtained from clinical biopsies.
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Affiliation(s)
- X Liu
- Affiliated Hospital of Dalian Medical University, Dalian, ChinaHospital of Jilin University, Jilin, China
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16
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Quintella LP, Passos SRL, de Miranda LHM, Cuzzi T, Barros MBDL, Francesconi-do-Vale AC, Galhardo MCG, Madeira MDF, Figueiredo de Carvalho MH, Schubach ADO. Proposal of a histopathological predictive rule for the differential diagnosis between American tegumentary leishmaniasis and sporotrichosis skin lesions. Br J Dermatol 2012; 167:837-46. [PMID: 22950597 DOI: 10.1111/j.1365-2133.2012.11012.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND American tegumentary leishmaniasis (ATL) and sporotrichosis exhibit similar histopathology and low frequencies of microorganism detection. OBJECTIVES This study seeks to identify microscopic alterations that can distinguish between these diseases. METHODS Haematoxylin and eosin stained slides of 171 ATL and 97 sporotrichosis samples from active cutaneous lesions were examined for histopathological alterations. The lesions were diagnosed by isolating the agent (which was not visible) in culture. An intuitive diagnosis was assigned to each slide. The strength of the association between the histopathological findings and the diagnosis was estimated by an odds ratio, and each finding was graded according to a regression model. A score was assigned to each sample based on the histopathological findings. A study of the interobserver reliability was performed by calculating kappa coefficients of the histopathological findings and intuitive diagnoses. RESULTS The markers 'macrophage concentration', 'tuberculoid granuloma' and 'extracellular matrix degeneration' were associated with ATL. 'Suppurative granuloma', 'stellate granuloma', 'different types of giant cells', 'granulomas in granulation tissue' and 'abscess outside the granuloma' were associated with a diagnosis of sporotrichosis. 'Macrophage concentration' and 'suppurative granuloma' had the highest (substantial and almost perfect, respectively) reliability. The regression model score indicated 92.0% accuracy. The intuitive diagnosis had 82.5% diagnostic accuracy and substantial reliability. CONCLUSIONS Taking into account the clinical and epidemiological context, some histopathological alterations might be useful for the differential diagnosis between ATL and sporotrichosis cutaneous lesions in cases in which the aetiological agent is not visible.
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Affiliation(s)
- L P Quintella
- FIOCRUZ - Instituto de Pesquisa Clínica Evandro Chagas - Serviço de Anatomia Patológica; Av. Brasil, 4365 IPEC; Pavilhão Gaspar Vianna Térreo, Rio de Janeiro 21040-360, Brazil.
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[Skin and soft tissue infections due to non-tuberculous mycobacteria: etiology, epidemiology, pathogenesis, differential diagnostic aspects and therapeutic recommendations]. Wien Med Wochenschr 2012; 161:426-32. [PMID: 22016064 DOI: 10.1007/s10354-011-0027-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Accepted: 08/09/2011] [Indexed: 10/16/2022]
Abstract
Non-tuberculous mycobacteria are rarely responsible for skin and soft tissue infections. These infections are caused by different mycobacterial species originating from the environment (water, soil, plants, and animals). Various factors influence the clinical manifestation of the cutaneous infection: the immunological situation of the patient, the degree of cutaneous impairment, and the extent of the contact with the contaminated environment. The clinical manifestation is non-specific and often the cause of extensive diagnostic activities. The diagnosis is based on the cultural detection of the causative pathogen. The management of these skin and subcutaneous infections is a challenge for each physician. The treatment comprises administration of several antibiotics and antituberculosis drugs for many months. Surgical procedures are necessary in some patients.
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Quintella LP, Passos SRL, do Vale ACF, Galhardo MCG, Barros MBDL, Cuzzi T, Reis RDS, de Carvalho MHGF, Zappa MB, Schubach ADO. Histopathology of cutaneous sporotrichosis in Rio de Janeiro: a series of 119 consecutive cases. J Cutan Pathol 2010; 38:25-32. [PMID: 20883452 DOI: 10.1111/j.1600-0560.2010.01626.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
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. METHODS A total of 119 samples of confirmed sporotrichosis cases were studied. The characteristics of the inflammatory infiltrate, the presence of epidermal changes, necrosis and fibrosis, and the parasite burden were analyzed. The association between histopathological changes and the lack of visualization of the fungus was evaluated using prevalence ratios. RESULTS Granulomas were observed in all samples, suppurative granulomas in 100 (84%) and diffuse dermatitis in 114 (95.8%). Liquefaction and caseous necrosis were present in 78 (65.5%) and 52 (43.7%) samples, respectively. The fungus was not seen in 77 (64.7%) samples. Epithelioid, tuberculoid or foreign-body-type granulomas, caseous, fibrinoid or absent necrosis, predominance of lymphocytes among nonphagocytic cells and fibrosis were associated with the lack of visualization of the fungus. CONCLUSION The histopathological characteristics of sporotrichosis were variable when the causative fungus was not seen. In a proper context, the diagnosis of sporotrichosis remains a potential consideration even in the absence of demonstrable yeast.
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Affiliation(s)
- Leonardo Pereira Quintella
- Serviço de Anatomia Patológica, Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
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Abstract
Pyoderma gangrenosum (PG) can be differentiated into classic and atypical forms. The classic form is characterized by ulcers and the atypical form by deep erosions with bullous blue-gray margins. Pathergy, the development of cutaneous lesions at sites of trauma, is a common feature of both forms of PG. Approximately 50% of patients who have PG have underlying systemic diseases, most commonly inflammatory bowel disease, myeloproliferative disorders, and various forms of inflammatory arthritis. The diagnosis of PG is one of exclusion. The management of this disorder begins with treatment of any underlying disease and local or systemic glucocorticoids or immunomodulating therapies.
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Affiliation(s)
- Jeffrey P Callen
- Division of Dermatology, University of Louisville, 310 East Broadway, Louisville, KY 40202, USA.
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Mauermann ML, Klein CJ, Orenstein R, Dyck PJB. Disseminated sporotrichosis presenting with granulomatous inflammatory multiple mononeuropathies. Muscle Nerve 2008; 36:866-72. [PMID: 17623855 DOI: 10.1002/mus.20830] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We describe a case of sporotrichosis that disseminated to involve multiple nerves after initiation of immunosuppressive therapy and then precipitously worsened after withdrawal of therapy. This case illustrates that multiple mononeuropathies are not always caused by vasculitis, and a correct pathological diagnosis should be established before treatment. Based on clinical and pathological features, the mechanism of neuropathy may have been due to either direct nerve infection or a bystander effect of inflammatory/immune damage or, perhaps more likely, to both mechanisms.
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Affiliation(s)
- Michelle L Mauermann
- Department of Neurology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, Minnesota 55905, USA
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Abstract
Sporotrichosis is a deep fungal disease caused by a dimorphic fungus, Sporothrix schenckii. It occurs more frequently in the tropical and subtropical areas and is mainly characterized by nodular lesions of cutaneous and subcutaneous tissues and adjacent lymphatics that suppurate and ulcerate. Infection occurs by manipulation of contaminated soil, cats, or some wild animals or by inhalation of spores. Itraconazole is the best drug for treatment of sporotrichosis.
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Affiliation(s)
- Marcia Ramos-e-Silva
- Sector of Dermatology, School of Medicine and HUCFF-UFRJ, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
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Affiliation(s)
- Cindy Berthelot
- University of Texas Southwestern Medical School, Dallas, USA
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Abstract
Since its first description in 1930, the pathogenesis of pyoderma gangrenosum (PG) has remained obscure even as an ever-widening array of systemic diseases has been described in association with it. The histopathologic distinction of PG from other ulcerative processes with dermal neutrophilia is challenging and at times impossible. In consequence, when confronted with a biopsy from such a lesion, the pathologist has an obligation to obtain a full and detailed clinical history. In short, as a diagnosis of PG does not hinge exclusively upon the biopsy findings in isolation from other studies, a solid knowledge of the clinical features, the systemic disease associations and the differential diagnosis will help the pathologist to avoid diagnostic pitfalls or the generation of a report which is non-contributory to patient care. In this review, we describe in detail the different clinicopathologic forms of PG, summarize the diseases associated with this process in the literature and in our experience, and briefly review the treatment options.
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Affiliation(s)
- A Neil Crowson
- Department of Dermatology, University of Oklahoma, Tulsa, OK, USA.
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