An eighteen – year old man with tropical verrucous syndrome: Leishmaniasis vs, sporotrichosis

Abstract

Tropical verrucous syndrome (TVS) covers infectious, chronic, granulomatous skin conditions. They appear with plaques, nodules or ulcers with a warty surface which give the name to the syndrome. It includes forms of chromoblastomycosis, sporotrichosis, paracoccidioidomycosis, lobomycosis, leishmaniasis and tuberculosis verrucosa cutis pathologies with ample distribution in tropical and subtropical areas. The diagnosis may be difficult with confusión among them, which is more frequent between sporotrichosis and leishmaniasis. In order to differentiate them one must accede clinical, epidemiologic, intradermal rections, direct smears, skin biopsies, cultures, immunofluorescence and PCR techniques, several of which are not commonly used. We present a 18 year old man with extensive verrucous placques in one knee, interpreted by clinic, epidemiology and by biopsy as verrucous cutaneous leishmaniasis. He was treated with Glucantime R for twenty days without improvement. A new biopsy was made that was also diagnosed as cutaneous leishmaniasis. Revision of both biopsies showed inflammation with abscedated granulomas with presence of asteroid spototrichotic bodies at the center of the granulomas, that led to the diagnosis of sporotrichosis, which was confirmed by fungus culture. The patient cured with Itraconazol® treatment. Clinical and epidemiological findings of leishmaniasis and sporotrichosis can be similar. For this reason, skin biopsy and other paraclinic studies are necesary to stablish the proper diagnosis. The asteroid sporotrichotic body is patognomonic of this mycosis. We review essentials concepts of leishmaniasis and sporotrichosis and criteria for differentiate them. © 2021. All Rights Reserved.