P094 Atypical cutaneous manifestations of sporotrichosis in Brazil
Authors: Batista Camila , Coutinho Clara , Batista Renata , Neto Reginaldo Lima , Batista Filipe 
Published: September 2022

Abstract

Poster session 1, September 21, 2022, 12:30 PM - 1:30 PM

Objectives
Inform the general practitioner of the possibilities of cutaneous manifestations secondary to sporotrichosis 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, 35 had atypical skin manifestations (15.15%).
Of the 35 cases, most had erythema nodosum (22/35 - 63%), followed by simple cutaneous (6/35 - 17%), polymorphous erythema (5/35 - 14%), and cutaneous fistula and lymphangitis with one case each (Fig. 1).
Both erythema nodosum and erythema nodosum showed a good response to corticosteroid therapy (standard with 20 mg prednisone for 5 days). In non-responsive cases, we increased the dose to 40 mg with a good response.
Simple cutaneous lesions were infiltrating still in the process of ulceration without presenting involvement of the contiguous lymph node chain. The face, abdomen, chest, and limbs were the affected sites.
One of the cases was a dental abscess with a fistula to the face. Upon biopsy of the lesion on the right hemiface, spores suggestive of sporotrichosis were found. When examining the patient, we observed the compromised right upper malar, which was surgically removed with drainage of the gingiva and the presence of Sporotrix in both the tooth and the gingiva.
And, finally, a case of lymphangitis with improvement after specific treatment with itraconazole whose diagnosis was made by biopsy with Sporotrix findings in lymphatic vessels.
As 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 very common in the Northeast of Brazil that the association of sick cats with typical lesions of sporotrichosis is the main epidemiological factor since our case series for infections caused by soil manipulation is low. Therefore, 37% (13/35) had a clinical-epidemiological diagnosis of sporotrichosis, with an excellent clinical response to itraconazole (Fig. 2). Our standard dose is 200 mg/day after lunch, as 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
Lymphocutaneous sporotrichosis is the most common manifestation, but there is a need for care teams working in primary and secondary care to identify atypical skin lesions 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.