PMC8514908_01
(a) Ulcerated lesions with borders showing erythema and infiltration. (b) Histological section showing the dense inflammatory infiltrate with the presence of granulomas; magnification 100x. (c) Focal necrosis and neutrophil exudation; magnification 200 x. Histological sections were stained with hematoxylin and eosin. Bars = 5 mum.
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fig1
Furthermore, some ascendant subcutaneous nodular lesions were detected that suggest lymphangitis in the right upper limb (Figure 1(a)). The histopathological study showed chronic granulomatous dermatitis with focal necrosis and neutrophil exudation of neutrophils (Figures 1(b) and 1(c)).
Skin samples were cultured in an agar-dextrose Sabouraud medium. (a) (i) In the sample cultured at 37 C, the fungi presented whitish/yellowish color with leveduriform aspect, and (ii) at 25 C, the fungi presented a brownish color that corresponded to the filamentous form of (b) fungi with conidiophore bouquet-like structures (c), magnification of 400x and 200x, respectively. Bars = 5 mum.
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fig2
Skin samples cultured in agar-dextrose Sabouraud medium supplemented with chloramphenicol at 25 C allowed the growth of a whitish membranous culture, with a blackened peripheral halo (Figure 2(a)). Microscopically septate hyaline hyphae present in the apex conidiophores and bouquet-like structures were observed, suggesting a fungus belonging to the genus Sporothrix (Figures 2(b) and 2(c)).
(a) Morphological aspect of the lesions after infusion of 150 mg of amphotericin B deoxycholate and 2600 mg of liposomal amphotericin B presenting re-epithelization and absence of exudate. (b) Morphology of the lesion after infusion of 2600 mg of liposomal amphotericin B and 150 mg of amphotericin B deoxycholate, showing complete re-epithelization of ulcerated lesions and absence of exudation.
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fig3
Clinical improvement of the lesions was observed during treatment (Figures 3(a) and 3(b)).
Timeline describing the appearance of the lesion (a); treatment with the first-line drugs potassium iodide and intraconazole (b); and treatment with amphotericin B (c).
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fig4
A timeline containing the lesion appearance, diagnosis (Figure 4(a)), and treatment with iodide potassium, itraconazole (Figure 4(b)), or amphotericin B (Figure 4(c)) summarizes the whole treatment performed in this patient.