Lacaziosis (Lobomycosis) From Southern Mexico: A Case Confirmed by Molecular Biology
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MYCOPATHOLOGIA IMAGE
Lacaziosis (Lobomycosis) From Southern Mexico: A Case Confirmed by Molecular Biology
Received: 29 April 2020 / Accepted: 27 May 2020 / Published online: 7 June 2020 Ó Springer Nature B.V. 2020
A 40-year-old male patient, from Maravilla Tenejapa Chiapas (southeastern Mexico), occupation farmer and beekeeper consulted 25 years ago for skin condition, located at the right ear, with multiple, asymptomatic, firm, nodular lesions, keloid-like appearance, with telangiectasia and the presence of an ulcer in the central lesion. The patient reported that at the age of 15 he underwent surgical resection of relapse injuries. (Figs. 1, 2) Histopathological examination reported an intense dermal infiltrate consisting of histiocytes, giant cells and the special stains of PAS and Grocott and observed multiple rounds or oval yeasts of double contour and refringent measuring 5 to 6 by 12 to 14 mm in diameter, alone or forming chains of blastoconidia joined by thin tube-like connections, as well as multi-budding cells. (Figs. 3, 4) The final diagnosis was lacaziosis. With the biopsy material, deparaffining process was performed, and the amplification of the ribosomal region 18S-ITS1-5.8S-ITS228S rRNA was carried out; exact identity was determined with Lacazia loboi strain, and the sequence was deposited in the GenBank under the access number: MN403304. Treatment with sulfamethoxazole-trimethoprim (800/160 mg/12 h) was initiated for five months, and three surgical removals of the nodules were carried out, with intervals of three months each procedure, with significant improvement, and no recurrence was observed at 6 months followup.
Lacaziosis is an implantation mycosis and produced by a dimorphic fungus Lacazia loboi (formerly Loboa loboi) and is usually maintained chronically at the subcutaneous level, developing pleomorphic clinical types, predominantly nodular, keloid-like, and verrucous forms. More than 500 cases have been reported so far, mostly in South America. Undoubtedly, the Amazon region is endemic of lacaziosis. There are also reports in Central America, in Panama, Honduras, and Costa Rica. In Mexico there is only one case in Tabasco (Southeast). L. loboi has not been able to grow in vitro, and its habitat and source of infection remain an enigma. Most reports come from tropical areas, (high rainfall 2 000 mm and average temperature of 24–32 °C and located between 200 and 300 Mts above sea level). L. loboi is phylogenetically localized among the genera of Blastomyces and Paracoccidioides; its main form of identification is by sequencing the ITS region, with first ITS1 / ITS4. It is important to note that this fungus is usually confused with P. brasiliensis, and initially, lacaziosis was considered as a variety of this disease. The pathogenesis of lacaziosis is not very clear yet, but suggests that lesions appear at the same site of inoculation or implantation in the form of small lesions with keloid appearance; it is restricted to the subcutaneous cell
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