Dacryocystitis due to Sporothrix brasiliensis: a case report of a successful clinical and serological outcome with low‐dose potassium iodide treatment and oculoplastic surgery

• Published in: British journal of dermatology (1951) Vol. 172; no. 4; pp. 1116 - 1119
• Main Authors: Marques de Macedo, P., Sztajnbok, D.C.N., Camargo, Z.P., Rodrigues, A.M., Lopes‐Bezerra, L.M., Bernardes‐Engemann, A.R., Orofino‐Costa, R.
• Format: Journal Article
• Language: English
• Published: England 01.04.2015
• Subjects: Acute Disease; Antifungal Agents - administration & dosage; Child; Combined Modality Therapy; Dacryocystitis - drug therapy; Dacryocystitis - microbiology; Dacryocystorhinostomy; Facial Dermatoses - drug therapy; Facial Dermatoses - surgery; Female; Humans; Lacrimal Duct Obstruction - drug therapy; Lacrimal Duct Obstruction - microbiology; Nasolacrimal Duct; Potassium Iodide - administration & dosage; Reconstructive Surgical Procedures; Sporothrix; Sporotrichosis - drug therapy; Sporotrichosis - surgery
• ISSN: 0007-0963; 1365-2133
• DOI: 10.1111/bjd.13378

Summary Sporothrix brasiliensis is the main species of the S. schenckii complex implicated in the zoonotic epidemics of sporotrichosis in Rio de Janeiro, Brazil. Epidemiological features have been already described, such as zoonotic transmission by cats and increased frequency of atypical clinical aspects. The involvement of the face by contact with cats is common in childhood; as a result, ophthalmic manifestations have increased. We report a case of acute dacryocystitis in a 9‐year‐old girl. A calmodulin‐based molecular phylogeny was used to identify the agent as S. brasiliensis. This is a rare type of presentation, usually complicated with nasolacrimal duct occlusion. The patient was cured without sequelae after treatment with a low dose of saturated solution of potassium iodide and decompressive oculoplastic surgery. Therapeutic options and considerations of aetiological agents and serology are discussed. What's already known about this topic? Sporotrichosis is a worldwide granulomatous disease caused by several Sporothrix spp., commonly acquired by local trauma with contaminated organic material or via contact with diseased animals, especially cats. Usual clinical forms are cutaneous/lymphocutaneous and first‐line treatment is oral itraconazole. What does this study add? Special forms of sporotrichosis have been described mainly in zoonotic epidemics ongoing in South and Southeast Brazil and it could be related to differences in frequencies among Sporothrix spp. as well as types of transmissions involving sapronosis or zoonosis. Therefore, molecular identification may be helpful to guide treatment and for epidemiological purposes. In addition, serology may support clinical decisions. Combined treatment can avoid functional sequelae.