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Marie Cheuret, Charline Miossec, Sarah Milley, Pierre Couppie, Denis Blanchet, Christine Aznar, A 43-Year-Old Brazilian Man With a Chronic Ulcerated Lesion, Clinical Infectious Diseases, Volume 59, Issue 2, 15 July 2014, Pages 314–315, https://doi.org/10.1093/cid/ciu379
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Extract
(See page 264 for the Photo Quiz.)
Diagnosis: lacaziosis, or lobomycosis [1].
The diagnosis was confirmed by direct examination of the skin biopsy, highlighting the presence of round or oval yeast-like organisms 6–12 µm in diameter, either isolated or in chains, with a birefringent membrane (Figure 1). The periodic acid-Schiff–stained and the Gomori-Grocott methenamine silver–stained sections of the sample revealed short chains of lemon-shaped fungal cells connected by thin, tubelike bridges (Figure 2). Morphology was consistent with the appearance of Lacazia loboi.
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There was a minor improvement of the lesion after pentamidine treatment, whereas the Leishmania research by microscopic examination, culture, and molecular biology was negative. However, these exams were done after treatment initiation, so an initial coinfection cannot be ruled out.
Mycological cultures on Sabouraud-gentamicin-cycloheximide with and without actidione were performed and were negative after 2 months. The patient is currently under treatment with terbinafine (250 mg twice daily), awaiting surgical excision of the lesion.
