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Case 88

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A 22-year-old otherwise healthy female patient who is a biology student and lives in a gated community near Belo Horizonte seeks for medical attention. About one month ago, she noticed the appearance of a single hyperemic nodular skin lesion on the anterior side of her right wrist. It has since evolved to the crusted lesion shown in figure 1. She also presents with painful nodules along her right forearm and enlargement of her right supratrochlear lymph nodes. The patient does not report any allergies. She mentions having three cats as well as the habit of gardening.

Based on the clinical history and photograph provided, which is the most likely diagnosis?

a) Impetigo

25%

b) Sporotrichosis

25%

c) Cat Scratch Disease

25%

d) American Cutaneous Leishmaniasis

25%
   

Comments

- Sporotrichosis is a subacute or chronic deep mycosis caused by Sporothrix schenckii,a dimorphic fungus.
- The disease is usually transmitted through the traumatic inoculation of the fungus into the skin (during leisure or occupational activities such as gardening and farming or by an infected cat scratch).
- The most frequent forms of presentation include the lymphocutaneous and fixed cutaneous sporotrichosis.
- Fungal culture of tissue samples obtained from a skin biopsy remains the gold standard method for establishing the diagnosis.
- Oral itraconazole for 3-6 months is the first-line therapy.

References

- Ramos-e-Silva M, Vasconcelos C, Carneiro S, Cestari T. Sporotrichosis. Clin Dermatol. 2007;25:181-7. 
- Cordeiro FN, Bruno CB, Paula CDR, Motta JOC. Ocorrencia familiar de esporotricose zoonotica. An Bras Dermatol. 2011;86(no Supl 1):S121-4. 
- Freire, G. Doença da Arranhadura do Gato: Relato de Caso. Rev Med Minas Gerais 2011; 21(1): 75-78.

Author

Emília Valle Santos, 5th year medical student of UFMG School of Medicine. Email: emivalle[at]gmail.com

Supervisor

Professor Unaí Tupinambás, member of the Department of Internal Medicine (UFMG School of Medicine). Email: unaitupi[at]gmail.com

Reviewers

Professor Viviane Parissoto, Júlio Guerra and Fernanda Foureaux.

Translated by

Lucas Resende Lucinda, 5th year medical student of UFMG School of Medicine. E-mail: lucasresendebh[at]hotmail.com
Renato Campanati - 4th year medical student of UFMG School of Medicine
E-mail: rapharmp[at]gmail.com

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