A 67-year-old woman, farmer, with a history of diabetes mellitus 2, born and raised in San Juan de Dios, Tamburco, Abancay, Abancay, Peru.
She presented with a crusted mucus-bloody and granular lesion on the right side of two years of evolution.
Physical examination revealed a crusted erythematous-violaceous cutaneous lesion with irregular edges of granulomatous tissue.
No purulent material was secreted under pressure, no sero-healing exudate and referred mild pain.
She had no family history of interest and no evidence of previous cutaneous sporotrichosis.
With these findings a presumptive subcutaneous mycosis was diagnosed.
Among the tests requested, high blood glucose (203 mg/dl) and normal blood count were highlighted.
Direct microscopic examination with 10% KOH revealed no fungal structures.
In this case, it was not possible to perform the histopathological study of the lesion.
For mycological culture, aspiration puncture was performed using a tuberculin syringe loaded with 0.2 ml of sterile saline.
The extracted material was plated on Sabouraud dextrose agar with chloramphenicol at 25°C. Microscopically, sclerosing and thin philosophic colonies were isolated after 10 days.
1.
Based on the clinical history and culture, a granulomatous fixed cutaneous sporotrichosis was diagnosed.
The patient was treated with oral SSKI with a starting dose of three drops, three times a day until reaching a maximum of 40 drops, three times a day (40 drops = 2 g of SSKI).
After three weeks of treatment, the wound healed with mycological negativization.
Finally, complete remission of the lesion was achieved after two months, leaving Figure 3B.
Dimorphism test: In order to perform the brain diphorphism test of S. schenckii, the mycelia culture in Sabouraud dextrose agar S. schenckii semi-array agar S.
Microscopic examination with lactophenol blue revealed thin blastoconidia, confirming the presence of S. schenckii.
Identification of the species: Sporothrix species were identified according to the morphophysiological key of Marimon et al2.
The colonies were characterized according to color, growth, texture and microscopic morphology (form and arrangement of conidia) in vitro.
The physiological study was performed in PDA agar (DifcoTM Laboratorios, BD, REF 213400) at 30, 35 and 37°C for 21 days, growth at three different temperatures.
The colonies were less than 50 mm in diameter up to 21 days, cream coloured until the second week, then became dark.
Acetylsalicylic acid (sucrose and raffinose) assimilation profile was performed on a nitrogenous base positive for both sugars.
Microscopically, thin hyphae, hyaline and branched with sessile and symptolic microconidia were observed.
Phenotypic characterization, i.e. growth at different temperatures, macroscopic and microscopic characteristics, and assimilation of carbohydrates reported by Mari S. schmonck et al yielded similar results to those found for reference strains.
1.
The certification of the species was carried out by the National Centre for Public Health of the National Institute of Health, Peru (Laboración Nacional de Salud Labora), where S. schenckii was confirmed.
