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HISTOPATHOLOGY SECTION - CASE REPORT Table of Contents   
Year : 2008  |  Volume : 51  |  Issue : 1  |  Page : 45-46
Sporotrichosis in Mysore: A case report to emphasize the role of histopathology


1 Department of Pathology, JSS Medical College, Mysore, Karnataka, India
2 Department of Microbiology, JSS Medical College, Mysore, Karnataka, India
3 Department of Dermatology, JSS Medical College, Mysore, Karnataka, India

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   Abstract 

Lymphocutaneous sporotrichosis is unusual in southern India. The diagnosis was made by histopathological examination which is purported to have poor sensitivity. The culture of the specimen confirmed the diagnosis. The pre-eminent role of a careful study of serial sections is emphasized.

Keywords: Lymphocutaneous sporotrichosis, southern India, histopathology

How to cite this article:
Suchitha S, Vijaya B, Sunila R, Anuradha K, Savitha R. Sporotrichosis in Mysore: A case report to emphasize the role of histopathology. Indian J Pathol Microbiol 2008;51:45-6

How to cite this URL:
Suchitha S, Vijaya B, Sunila R, Anuradha K, Savitha R. Sporotrichosis in Mysore: A case report to emphasize the role of histopathology. Indian J Pathol Microbiol [serial online] 2008 [cited 2020 Oct 21];51:45-6. Available from: https://www.ijpmonline.org/text.asp?2008/51/1/45/40393



   Introduction Top


Sporotrichosis is an uncommon fungal infection of worldwide distribution, caused by the dimorphic fungi Sporotrichosis schenkii . In India, a limited number of cases have been reported from the north eastern parts and Himachal Pradesh [1] and sporadic case reports from southern India. [2] Diagnosis is, therefore, difficult due to low index of suspicion. Fungal elements have been infrequently demonstrated on histopathology. We report a case of sporotrichosis to highlight the role of histopathology in diagnosing this condition.


   Case History Top


A 70-year-old farmer, a Tibetan refugee, settled close to Mysore, presented with multiple discrete erythematous nodules with central crusting linearly arranged on the forearm present since 4 months to the Dermatology outpatient department. An accidental abrasion preceded the lesion by 15 days. The clinical differential diagnoses were atypical mycobacterial infection, sporotrichosis, and botryomycosis. A skin biopsy was received and sections were stained with periodic acid-Schiff (PAS), Zeihl Neelsen, Gram, and Gomori methenamine silver. Histopathological examination revealed pseudoepitheliomatous hyperplasia in the epidermis. The dermis and subcutaneous tissue showed a dense inflammatory infiltrate consisting of lymphocytes, epithelioid cells, multinucleated giant cells, and aggregates of neutrophils [Figure - 1]. Basophilic bacterial clumps within the neutrophilic abscesses and acid-fast bacilli were not seen which ruled out botryomycosis and tuberculosis. Serial sections with PAS stain revealed the spores of S. schenkii which appeared as round to oval bodies which stained more strongly in the periphery than in the center [Figure - 2]. Sporothrix asteroids were present in the center of the suppurative granulomas. Occasional nonseptate hyphae were also seen. A fungal culture confirmed the diagnosis and the patient responded well to the treatment.


   Discussion Top


The lymphocutaneous form of sporotrichosis presents a distinctive clinical picture with nodules and ulcers arranged linearly along the lymphatics, with thickened lymphatic cords between the nodules, usually on the exposed skin. [3]

Lymphocutaneous sporotrichosis is sporadically reported from Southern India. It is the commonest clinical form of the disease in immunocompetent hosts, with a frequency ranging from 46% to 92%, followed by fixed cutaneous type (0 to 54%).The underlying mechanism as why some persons develop the fixed cutaneous lesion is not clearly understood. Among the possible factors determining clinical manifestations of the disease are the size of the inoculum, thermotolerance of the infecting S. schenckii strain and immune status of the host. [4] A sporotrichoid distribution of lesions has been observed in lupus vulgaris. [5] In our country, with a high prevalence of tuberculosis, a sporotrichoid like lesion should be investigated for tuberculosis.

The traditional view has always been that fungal elements are infrequently demonstrated in tissue sections, in human cases of Sporotrichosis. [6] However, in a study of 39 cases reported by Bulpitt and Weedon D, fungal elements were found in all cases. The authors achieved this by examining multiple serial sections, some with H&E and others with PAS stain. [7] The present case showed yeast like forms on serial sections stained with PAS stain and occasional hyphae, amidst a suppurative granulomatous infiltrate. Sporothrix asteroids which are characteristic of sporotrichosis were present in the centre of suppurative granulomas. The identification of S. schenckii was subsequently confirmed by isolation of the fungus in culture on Sabouraud Dextrose Agar.

Although reports say that histopathological examination of tissue stained with conventional H&E lacks sensitivity, a high index of suspicion of sporotrichosis should be exercised, whenever a biopsy of a sporotrichoid lesion is received. Also, it is essential that multiple serial sections stained with PAS stain be meticulously studied for the evidence of spores and hyphae of S. schenckii . The present case effectively illustrates this view and reiterates the role of the pathologist in diagnosing fungal infections.

 
   References Top

1.Sanyal M, Basu N, Thammaya A, Tutkane MA, Gaind ML. Subcutaneous sporotrichosis in India. Indian J Dermatol Venereol Leprol 1973;39:88-91.  Back to cited text no. 1    
2.Hemashettar BM, Kauchabal DS, Hanchinamani S, Patil CS. Fixed cutaneous sporotrichosis from North Karnataka. Indian J Dermatol Venereal Leprol 1992;58:45-7.  Back to cited text no. 2    
3.Itoh M, Okamoto S, Kanya S. Survey of 260 cases of sporotrichosis. Dermatologica 1986;172:203-13.  Back to cited text no. 3    
4.Randhwa HS, Chand R, Mussa AY, Khan ZU, Kowshik T. Sporotrichosis in India: first case in a Delhi resident and an update. Indian J Medical Microbiology 2003;21:12-6.  Back to cited text no. 4    
5.Sharma S, Choudary R, Juneja M, Nagireddy BS. Cutaneous Tuberculosis mimicking sporotrichosis. Indian J Paediatr. 2005;72:86-8.  Back to cited text no. 5    
6.Weedon D. Mycoses and algal infections. In: Weedon D, editor. Chapter 25 in Skin pathology. 2 nd ed. Philadelphia: Churchill Livingstone; 2002. p. 673-4.  Back to cited text no. 6    
7.Bulpitt P, Weedon D. Sporotrichosis: a review of 39 cases. Pathology 1978;10:249-56.  Back to cited text no. 7    

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Correspondence Address:
S Suchitha
892, I Block, Ist Cross, Rama Krishna Nagar, Mysore 570022. Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.40393

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  [Figure - 1], [Figure - 2]



 

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    Abstract
    Introduction
    Case History
    Discussion
    References
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