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Case Reports
. 2020 Jul;47(7):659-663.
doi: 10.1111/cup.13674. Epub 2020 Mar 20.

Cutaneous microsporidiosis in an immunosuppressed patient

Daniel A Nadelman  1 , Ashley R Bradt  2 , Yvonne Qvarnstrom  3 , Cynthia S Goldsmith  4 , Sherif R Zaki  4 , Frank Wang  5 , Emily H Smith  6 , Douglas R Fullen  2   5
Affiliations
Case Reports

Cutaneous microsporidiosis in an immunosuppressed patient

Daniel A Nadelman et al. J Cutan Pathol. 2020 Jul.

Abstract

Microsporidia are a group of obligate intracellular parasites that naturally infect domestic and wild animals. Human microsporidiosis is an increasingly recognized multisystem opportunistic infection. The clinical manifestations are diverse with diarrhea being the most common presenting symptom. We present a 52-year-old woman with a history of amyopathic dermatomyositis complicated by interstitial lung disease managed with mycophenolate mofetil and hydroxychloroquine who presented with a 7-month history of recurrent subcutaneous nodules as well as intermittent diarrhea and chronic sinusitis. A punch biopsy showed superficial and deep lymphocytic and granulomatous dermatitis with focal necrosis. Tissue stains for microorganisms revealed oval 1 to 3 μm spores within the necrotic areas in multiple tissue stains. Additional studies at the Centers for Disease Control and Prevention confirmed cutaneous microsporidiosis. This case is one of very few confirmed examples of cutaneous microsporidiosis reported in the literature.

Keywords: cutaneous; immunosuppression; microsporidia; microsporidiosis.

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Figures

FIGURE 1
FIGURE 1
A and B, Diffuse flesh-colored subcutaneous nodules. Note the subtle overlying erythema of an early subcutaneous nodule in A, while B reveals the older lesions with central hyperkeratotic plugs
FIGURE 2
FIGURE 2
A and B, Biopsy from the left posterior leg. Lymphocytic infiltration within the dermis and subcutaneous tissues. Note the area of focal necrosis within the dermis (arrow), A, in which microorganisms consistent with microsporidia were present (arrows), B, Hematoxylin and eosin (H&E). A, original magnification ×2.5, B, original magnification ×100
FIGURE 3
FIGURE 3
A-D, Tissue stains for microorganisms. A, Gomori methenamine silver (GMS) stain showing Anncaliia algerae spores (arrow) (original magnification ×100). B, Immunohistochemical staining of spores (red) in same area shown in Figure 2A; naphthol fast red substrate with hematoxylin counterstain (original magnification ×100). C, L-T Gram stain highlights Gram-positive spores (arrow) (original magnification ×100). D, Polarization of the same field in (C) showing bright white spores (arrow) (original magnification ×100)
FIGURE 4
FIGURE 4
A and B, Electron microscopic images of Anncaliia algerae spores. Note cross sections of the polar tubule (arrows) in two rows in an anisofilar arrangement, which allowed for confirmation of microsporidia species. N, nucleus. Ex, exospore. En, endospore. Bars, 0.5 μm
See this image and copyright information in PMC

References

    1. Field AS, Milner DA. Intestinal microsporidiosis. Clin Lab Med. 2015; 35(2):445–459. - PubMed
    1. Nagpal A, Pritt BS, Lorenz EC, et al. Disseminated microsporidiosis in a renal transplant recipient: case report and review of the literature. Transpl Infect Dis. 2013;15(5):526–532. - PubMed
    1. Kester KE, Turiansky GW, McEvoy PL. Nodular cutaneous microsporidiosis in a patient with AIDS and successful treatment with long-term clindamycin therapy. Ann Intern Med. 1998;128(11):911–914. - PubMed
    1. Meissner EG, Bennett JE, Qvarnstrom Y, et al. Disseminated microsporidiosis in an immunosuppressed patient. Emerg Infect Dis. 2012; 18(7):1155–1158. - PMC - PubMed
    1. Weber R, Bryan RT, Schwartz DA, Owen RL. Human microsporidial infections. Clin Microbiol Rev. 1994;7(4):426–461. - PMC - PubMed

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