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Ferara N, Špoljar S, Lugović-Mihić L, Gverić Grginić A, Rezo Vranješ V, Bešlić I, Perović J, Regović Džombeta T. Cutaneous Hyalohyphomycosis and Its Atypical Clinical Presentations in Immunosuppressed Patients. Life (Basel) 2024; 14:154. [PMID: 38276283 PMCID: PMC10817673 DOI: 10.3390/life14010154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/06/2024] [Accepted: 01/17/2024] [Indexed: 01/27/2024] Open
Abstract
There has been a substantial increase in the number of cases of invasive fungal infections worldwide, which is associated with a growing number of immunosuppressed patients and a rise in antifungal resistance. Some fungi that were previously considered harmless to humans have become emerging pathogens. One of them is Purpureocillium lilacinum, a ubiquitous filamentous fungus commonly found in the environment, especially in the air and soil. P. lilacinum belongs to a bigger group of hyaline fungi that cause hyalohyphomycosis, a fungal infection caused by fungi with colorless hyphae. Although this is a heterogeneous group of fungi, there are similarities regarding their ubiquity, ways of transmission, affected patients, and difficulties in diagnostics and treatment. In hyalohyphomycosis, the skin is one of the most affected organs, which is why the involvement of dermatologists is crucial for the initial assessment, since the timely recognition and early diagnosis of this condition can prevent life-threatening infections and death. In this review, we covered cutaneous hyalohyphomycosis caused by P. lilacinum and other fungi in the same group, including Fusarium, Penicilium, Scedosporium, Scopulariopsis, Acremonium, and Trichoderma genera.
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Affiliation(s)
- Nikola Ferara
- Department of Dermatovenereology, Sestre Milosrdnice University Hospital Centre, 10000 Zagreb, Croatia; (N.F.); (S.Š.); (I.B.); (J.P.)
- Department of Biology, Faculty of Science, University of Zagreb, 10000 Zagreb, Croatia
| | - Sanja Špoljar
- Department of Dermatovenereology, Sestre Milosrdnice University Hospital Centre, 10000 Zagreb, Croatia; (N.F.); (S.Š.); (I.B.); (J.P.)
| | - Liborija Lugović-Mihić
- Department of Dermatovenereology, Sestre Milosrdnice University Hospital Centre, 10000 Zagreb, Croatia; (N.F.); (S.Š.); (I.B.); (J.P.)
- School of Dental Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Ana Gverić Grginić
- Department of Microbiology, Parasitology and Hospital Infections, Sestre Milosrdnice University Hospital Centre, 10000 Zagreb, Croatia;
| | - Violeta Rezo Vranješ
- Department of Clinical and Molecular Microbiology, University Hospital Centre Zagreb, 10000 Zagreb, Croatia;
| | - Iva Bešlić
- Department of Dermatovenereology, Sestre Milosrdnice University Hospital Centre, 10000 Zagreb, Croatia; (N.F.); (S.Š.); (I.B.); (J.P.)
- School of Dental Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Judita Perović
- Department of Dermatovenereology, Sestre Milosrdnice University Hospital Centre, 10000 Zagreb, Croatia; (N.F.); (S.Š.); (I.B.); (J.P.)
| | - Tihana Regović Džombeta
- Clinical Department of Pathology and Cytology, Sestre Milosrdnice University Hospital Center, 10000 Zagreb, Croatia;
- Department of Pathology, University of Zagreb School of Medicine, 10000 Zagreb, Croatia
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Loh AYT, Špoljar S, Neo GYW, Escande-Beillard N, Leushacke M, Luijten MNH, Venkatesh B, Bonnard C, van Steensel MAM, Hamm H, Carmichael A, Rajan N, Carney TJ, Reversade B. Huriez syndrome: Additional pathogenic variants supporting allelism to SMARCAD syndrome. Am J Med Genet A 2022; 188:1752-1760. [PMID: 35212137 DOI: 10.1002/ajmg.a.62703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 01/14/2022] [Accepted: 02/10/2022] [Indexed: 11/09/2022]
Abstract
Huriez syndrome (HRZ, OMIM181600) is a rare genodermatosis characterized by scleroatrophic hands and feet, hypoplastic nails, palmoplantar keratoderma, and predisposition to cutaneous squamous cell carcinoma (cSCC). We report herein three HRZ families from Croatia, the Netherlands, and Germany. Deep sequencing followed by Sanger validation, confirmed the presence of germline causative SMARCAD1 heterozygous pathogenic variants. All seven HRZ patients displayed hypohidrosis, adermatoglyphia, and one patient developed cSCC at 32 years of age. Two novel monoallelic germline mutations were identified which are predicted to disrupt the first exon-intron boundary of the skin-specific SMARCAD1 isoform. On the basis of phenotypic and genotypic convergence with Adermatoglyphia (OMIM136000) and Basan syndrome (OMIM129200), our results lend credence to the notion that these three Mendelian disorders are allelic. We propose adding Huriez syndrome to the previously suggested SMARCAD syndrome designation, which was originally invoked to describe the spectrum of monogenic disorders between Adermatoglyphia and Basan syndrome.
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Affiliation(s)
- Abigail Y T Loh
- Laboratory of Human Genetics and Therapeutics, Genome Institute of Singapore (GIS), Agency for Science, Technology and Research (A*STAR), Singapore.,Institute of Molecular and Cell Biology (IMCB), Agency for Science, Technology and Research (A*STAR), Singapore
| | - Sanja Špoljar
- Department for Dermatovenereology, University Hospital Center "Sestre Milosrdnice", Zagreb, Croatia
| | - Granville Y W Neo
- Laboratory of Human Genetics and Therapeutics, Genome Institute of Singapore (GIS), Agency for Science, Technology and Research (A*STAR), Singapore
| | - Nathalie Escande-Beillard
- Laboratory of Human Genetics and Therapeutics, Genome Institute of Singapore (GIS), Agency for Science, Technology and Research (A*STAR), Singapore.,Institute of Molecular and Cell Biology (IMCB), Agency for Science, Technology and Research (A*STAR), Singapore.,Medical Genetics Department, School of Medicine, Koç University, Istanbul, Turkey
| | - Marc Leushacke
- Skin Research Institute of Singapore (SRIS), Agency for Science, Technology and Research (A*STAR), Singapore
| | - Monique N H Luijten
- Institute of Molecular and Cell Biology (IMCB), Agency for Science, Technology and Research (A*STAR), Singapore
| | - Byrappa Venkatesh
- Institute of Molecular and Cell Biology (IMCB), Agency for Science, Technology and Research (A*STAR), Singapore
| | - Carine Bonnard
- Skin Research Institute of Singapore (SRIS), Agency for Science, Technology and Research (A*STAR), Singapore
| | - Maurice A M van Steensel
- Skin Research Institute of Singapore (SRIS), Agency for Science, Technology and Research (A*STAR), Singapore.,Lee Kong Chian School of Medicine, Experimental Medicine Building, Yunnan Garden Campus, Nanyang Technological University, Singapore
| | - Henning Hamm
- Department of Dermatology, Venereology and Allergology, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Andrew Carmichael
- Department of Dermatology, James Cook University Hospital, Middlesbrough, UK
| | - Neil Rajan
- Translational and Clinical Research Institute, Centre for Life, Newcastle University, Newcastle upon Tyne, UK
| | - Thomas J Carney
- Institute of Molecular and Cell Biology (IMCB), Agency for Science, Technology and Research (A*STAR), Singapore.,Lee Kong Chian School of Medicine, Experimental Medicine Building, Yunnan Garden Campus, Nanyang Technological University, Singapore
| | - Bruno Reversade
- Laboratory of Human Genetics and Therapeutics, Genome Institute of Singapore (GIS), Agency for Science, Technology and Research (A*STAR), Singapore.,Institute of Molecular and Cell Biology (IMCB), Agency for Science, Technology and Research (A*STAR), Singapore.,Medical Genetics Department, School of Medicine, Koç University, Istanbul, Turkey
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Lugović-Mihić L, Krišto M, Špoljar S, Novak-Bilić G, Bešlić I, Vučić M, Šitum M. Can Skin Be a Marker for Internal Malignancy? Evidence from Clinical Cases. Acta Clin Croat 2021; 60:711-721. [PMID: 35734490 PMCID: PMC9196211 DOI: 10.20471/acc.2021.60.04.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 10/23/2020] [Indexed: 11/24/2022] Open
Abstract
Although there are many single case reports on paraneoplastic dermatoses in the literature, there are very rare articles containing multiple cases. A retrospective study was performed to examine paraneoplastic dermatoses and accompanying malignancies based on skin manifestations and appropriate diagnostic evaluations. We recorded outcomes, current conditions, and surgical/oncologic treatments. Analysis revealed paraneoplastic dermatoses in 17 patients with various skin lesions, i.e. eczematous dermatitis, vasculitis, subacute cutaneous lupus erythematosus, pruritus, chronic urticaria/angioedema, alopecia areata, flushing, bullous pemphigoid, dermatomyositis, and localized scleroderma (morphea). They were associated with different solid and hematologic malignancies (3 gastric, 2 prostate, 2 bladder, 2 thyroid, and 2 lymphoma), along with 1 case each of the following: lung, hepatocellular, esophageal, endometrial, kidney, and multiple myeloma. The majority of skin lesions gradually regressed after malignancy treatment. To our knowledge, our three cases of paraneoplastic eczematous dermatitis are the first to be associated with gastric, prostate and endometrial cancer. Additionally, we report a case of a patient with alopecia areata of the beard associated with thyroid cancer. Early malignancy detection based on skin markers makes early introduction of surgical/oncologic therapy possible and usually leads to skin lesion regression while reducing revolving door visits to specialists and the (financial) burden on the healthcare system.
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Lugović-Mihić L, Ćesić D, Vuković P, Novak Bilić G, Šitum M, Špoljar S. Melanoma Development: Current Knowledge on Melanoma Pathogenesis. Acta Dermatovenerol Croat 2019; 27:163-168. [PMID: 31542060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The pathogenic features of melanomas include growth and amplification of atypical melanocytes associated with several features (self-sufficiency of growth factors, insensitivity to growth inhibitors, evasion of cellular apoptosis, limitless replicative potential, sustained angiogenesis, tissue invasion, and metastasis). These melanoma pathogenic events can be triggered by activating oncogenes or inactivating tumor-suppressor genes by means of molecular mechanisms such as dotted mutations, deletions, and translocations or epigenetic mechanisms such as microRNA expression and promoter methylation. In melanomas, an analysis of the gene aberrations in the genome has led to the discovery of the complex interaction of signaling pathways. Progression of melanomas also involves genetic instability and selective growth of cells with favorable mutations. Additional factors include genetic predisposition, mutagenesis, and suppressed host immune response. Some of the most important signaling pathways involved in the pathogenesis of melanoma are the MAPK, PI3K/PTEN/AKT, and MITF signaling pathways. Obtaining insight into the biology of melanocytes and pathogenesis of melanomas is important for the development of a targeted therapy (such as vemurafenib, dabrafenib, trametinib) as well as the immunotherapy (e.g. pembrolizumab, nivolumab, ipilimumab), which has enabled a substantial breakthrough in the treatment of patients with melanoma.
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Affiliation(s)
- Liborija Lugović-Mihić
- Professor Liborija Lugović-Mihić, MD, PhD, Department of Dermatovenerology , Sestre milosrdnice University Hospital Center, Vinogradska cesta 29, 10 000 Zagreb, Croatia;
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