P162 Parinaud's Oculoglandular Syndrome as an atypical manifestation of sporotrichosis in Brazil
Authors: Coutinho Clara , Batista Camila , Batista Renata , Neto Reginaldo Lima , Batista Filipe 
Published: September 2022

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM

 

Objectives

Inform the general practitioner about the possibilities of atypical manifestations secondary to sporotrichosis, such as ocular manifestations, unrelated to the classic finding of contiguous lymphocutaneous ulcers.

Methods

This is a single-center, cross-sectional, retrospective study with patients evaluated and seen from June 2018 to April 2022 at the Mycology Outpatient Clinic of Hospital Universitário Oswaldo Cruz, University of Pernambuco.

All patients were evaluated by the same infectious disease physician throughout the course, from diagnosis to outpatient discharge.

Scrapings and cultures were collected by the institution's specialized Mycology team. Biopsies were sent to the University Pathology Service (CIAP).

Results

During the 4-year period, 231 patients started their treatment for sporotrichosis following clinical, laboratory, and histopathological criteria. Of these, 9 (3,8%) had Parinaud's Oculoglandular Syndrome, unilateral granulomatous conjunctivitis associated with ipsilateral preauricular or submandibular lymphadenitis (Fig. 1). Of the 9 reported cases, 8 presented manifestations only in the conjunctiva (88%), and 1 case also presented palpebral involvement (12%).

Since most patients had a late diagnosis due to the difficulty in carrying out the specific investigation of the agent by a non-specialized team, the diagnosis by scraping and culture was compromised by early treatment with antifungals, especially itraconazole. It is becoming common in the Northeast of Brazil that the association of sick cats with typical manifestations of sporotrichosis is the main epidemiological factor since our case series for infections caused by soil manipulation is low. Therefore, 55% (5/9) had a clinical-epidemiological diagnosis of sporotrichosis, with an excellent clinical response to itraconazole 200 mg/day, as well as the 4 patients with diagnoses confirmed by culture (Fig. 2). The antifungal was taken after lunch since a fatty diet interferes with improved medication absorption. All patients were instructed not to use medications with known interactions, especially proton pump inhibitors and alcohol use.

Conclusion

Human sporotrichosis has become endemic in Latin America in the last two decades, bringing relevant morbidity to those infected. Zoonotic transmission by direct contact with infected sick cats has been gaining ground in Northeast Brazil, creating important epidemiology when typical sporotrichosis lesions appear following contact with these animals. Lymphocutaneous sporotrichosis is known to be the most common manifestation, but there is a need for care teams working in primary and secondary care to identify atypical manifestations and expand the investigation into the possibility of fungal infections. The epidemiology of the neighborhood associated with the presence and contact with sick cats with ulcerative lesions must be considered and taken into account.