Oral manifestations of sporotrichosis: A neglected disease

Abstract

Sporotrichosis is an uncommon subacute or chronic infection caused by Sporothrix spp. In some urban areas of Latin America, sporotrichosis has been considered an emergent cosmopolitan disease of zoonotic transmission by domestic cats. There are four different clinical forms of the disease: fixed cutaneous, lymphocutaneous, multifocal or disseminated cutaneous, and extracutaneous. The oral mucosa is rarely involved, usually as unspecified chronic ulcers in the context of multifocal or disseminated cutaneous form of systemic sporotrichosis. Microscopical features include chronic granulomatous inflammation containing microabscesses and fungal hyphae positive for Periodic acid Schiff and silver-based stains. The diagnosis of sporotrichosis is usually based on culture detection and strict correlation of clinical, microscopical and laboratorial data. We herein contribute with two additional illustrative cases of oral manifestation of sporotrichosis in immunocompromised patients from an endemic urban area from Rio de Janeiro-Brazil. Key words:Sporotrichosis, ulcer, oral cavity, immunosuppression.

Figure 1

Clinical features of disseminated sporotrichosis with oral manifestation (case 1). (A,B) Multiple cutaneous, erosive, and erythematous papules with crust formation on perioral region, arms and thigh. (C,D) Multiple ulcers of varying size in the palate and dorsal surface of the anterior tongue.

Figure 2

Clinical features of disseminated sporotrichosis with oral manifestation in a HIV patient (case 2). A and B. Multiple crateriform ulcers affecting the skin of the centrofacial region. C and D. Diffuse ulcerated mucosa lesions with granular surface in the hard palate and gingivae, associated with pseudomembranous candidiasis co-infection in tongue, buccal mucosa and palate.

Figure 3

Microscopic features of oral sporotrichosis. A. Fragment of oral mucosa presenting granulomatous chronic inflammation with multinucleated giant cells, and pseudoepitheliomatous hyperplasia of the overlying epithelium. Fungi structures were highlighted by (B) Periodic acid Schiff and (C) Gomori-Grocott metenamine silver stain, and also observed in the smears collected by (D) exfoliative cytology (Papanicolaou). E and F. Yeast culture of sporotrichosis. Membranous colonies of white-creamy and black-leathery color (E). Microscopic evaluation of the colonies showing septate hyphae with “daisy-like” arrangement at the end of the conidiophores (F).