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SHORT COMMUNICATION
Year : 1994  |  Volume : 60  |  Issue : 5  |  Page : 283-285

Sporotrichoid reactions to mycobacterial infections




Correspondence Address:
R C Sharma


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  Abstract 

Four cases of cutaneous mycobacterial infections in which the clinical presentation was strongly suggestive of sporotrichosis are presented.


Keywords: Sporotrichoid, Lymphocutaneous, Atypical mycobacteriosis


How to cite this article:
Sharma R C, Sharma N L. Sporotrichoid reactions to mycobacterial infections. Indian J Dermatol Venereol Leprol 1994;60:283-5

How to cite this URL:
Sharma R C, Sharma N L. Sporotrichoid reactions to mycobacterial infections. Indian J Dermatol Venereol Leprol [serial online] 1994 [cited 2020 Nov 24];60:283-5. Available from: https://www.ijdvl.com/text.asp?1994/60/5/283/4077



  Introduction Top


Noduloulcerative lesions along the line of lymphatic drainage are commonly seen in sporotrichosis. However, such a distribution can also be seen in both tuberculous and atypical mycobacterial infections, more so in the later. [1],[2],[3],[4],[5] Review of indian literature did not reveal any such report. We report four cases of sporotrichoid lesions in mycobacterial infections from Himachal Pradesh.


  Case Reports Top


Case 1

A 20-years-old male farmer presented with warty lesions on left foot, lymphocutaneous type of lesions along medial side of the leg and thigh and elephantiasis of the limb [Figure - 1]. Few non-tender lymph nodes were present in the left inguinal region. There was history of injury on the foot with a wooden splinter 3 years back. The initial lesion started as warty papule and new lesions appeared proximally in gradual succession alongwith swelling of the foot and the leg. Treatment with different antibiotics did not produce any relief. Routine investigative profile and chest skiagram were normal. Skin biopsy revealed non-specific inflammatory reaction. Culture for fungus was negative. He was provisionally diaqnosed as lymphocutaneous sporotrichosis but there was no therapeutic response to Potassium iodide (given for three months). A left inguinal lymphnode was then biopsied which showed typical tubercular granuloma. With standard antitubercular treatment (Streptomycin + INH) the lesions resolved completely after 9 months.

Case 2

A 12-years-old male student from peasent family reported to skin outpatient with verrucous lesions over right heel, lupus vulgaris like lesion in right inguinal region and lymphocutaneous type of lesions along the right leg and thigh which were present for the last 1 1/ 2 years [Figure - 2]. There was no prior history of injury. General health was not affected, chest X-ray was normal, erythrocyte sedimentation rate was 30 mm/Ist hour, smear and culture studies of the pus and tissue from one of the ulcerated thigh lesions were negative for acid fast bacilli and fungus. He was put on standard antitubercular regimen but was lost to follow up.

Case 3

A 22-years-old male shopkeeper presented with multiple crusted ulcers over left side of face and bilateral cold abscesses in submandibular region of 2 1 / 2 months duration [Figure - 3]. No history of prior injury could be elicited. General health of the patient was good. Routine investigative profile including chest skiagrams were within normal limits. Smears and culture studies of the pus did not show acid fast bacilli or fungus. Skin biopsy from the margin of an ulcer showed epitheloid and giant cell granulomas. However, no AFB could be demonstrated in histopathological sections. An initial therapeutic trial with KI and Ketoconazole; presuming it to be possible sporotrichosis, had no effect. Antituberculous treatment (R+H+T), aiongwith aspiration of abscesses produced partial healing of ulcers within 6 weeks and complete resolution of lesions after 9 months.

Case 4:

A 40 years old housewife presented with a fluctuating non tender cold abscess on dorsum of left hand which had developed one month after an injury with steel wool about 1 1/2 years back. There were warty paronychial lesions over left thumb and index finger (the original sites of injury). Warty plaques were also present in the third web space and over ring finger and another one proximal to the cold abscess [Figure - 4]. General health of the patient was good. Routine blood tests and chest-X-rays were within normal limits. Smears of thick pus aspirated from the abscess did not show any AFB or fungal element. Culture was positive for Tubercle bacilli. She was treated with antituberculous drugs (R+H+T) and the lesions healed completely after 9 months of starting the treatment.


  Comments Top


In all the four cases the parts liable to injury were initially involved. In three of these cases, history clearly pointed towards inoculation at a distal site followed by appearance of new lesions proximally. The patient with facial lesions (Case-3) also had regional lymph node abscess.

Apart from the lymphocutaneous distribution of lesions two cases each had TBVC and cold abscesses and one had lupus vulgaris lesions. All the four patients were otherwise healthy with no apparent systemic involvement.

Except for one case (case-4) where the definitive diagnosis was established by culture of M. tuberculosis; the diagnosis in the remaining three is presumptive, circumstantial and it is an open question whether the lesions were due to M. tuberculosis or atypical Mycobacteria. However, the therapeutic response of two of these cases to conventional antitubercular drugs does favour their being tubercular. Third case who responded to Rifampicin and INH could be either tubercular or atypical mycobacterial infection.

This report is to emphasize the possibility of sporotrichoid patterns in cutaneous mycobacterial infections. It is probable that this particular cutaneous form of the disease is much more frequent than the paucity of the reports would make one believe. Lymph node involvement and cold abscesses seen in two cases each are two important findings which are not usually seen is sporotrichosis.

 
  References Top

1.Barlow AJE, English Mary P. Sporotrichoid reactions to mycobacteria. In: Recent Advances in Dermatology (A Rook eds) Churchill Livingstone No. 3, 1973; 48.  Back to cited text no. 1    
2.Philpott JA, Woodburne AR, Philpott AS, et al. Swimming pool granuloma. Arch Dermatol 1963:88:158.  Back to cited text no. 2    
3.Owens DW, Mc Bride ME. Sporotrichoid cutaneous infection with Mycobacterium kansasii. Arch Dermatol 1969; 100: 54.  Back to cited text no. 3    
4.Moschella S L. Sporotrichoid Dermatosis. In Dermatology (Moschella and Hurley, eds). WB Saunders Co, 1985; 932-3.  Back to cited text no. 4    
5.Savin JA. Mycobacterial infections in Rook/ Wilkinson/Ebling Text Book of Dermatology (Champion, Burton and Ebling eds) Blackwell scientific publications, Oxford 1992; 1033-63.  Back to cited text no. 5    


    Figures

[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4]

This article has been cited by
1 Cutaneous sporotrichosis in Himachal Pradesh, India
Mahajan, V.K., Sharma, N.L., Sharma, R.C., Gupta, M.L., Garg, G., Kanga, A.K.
Mycoses. 2005; 48(1): 25-31
[Pubmed]



 

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