Acute dacryocystitis : another clinical manifestation of sporotrichosis

online | memorias.ioc.fiocruz.br Sporothrix schenckii is a dimorphic fungus that is responsible for cutaneous disease in endemic areas worldwide. Classically, infection is associated with a traumatic subcutaneous inoculation of contaminated soil, plants or organic matter. The most common clinical form of sporotrichosis is cutaneous, lymphatic disease, which accounts for 75% of cases, followed by localised cutaneous forms (20%) (Barros et al. 2011a). Ocular sporotrichosis has rarely been described in immunocompetent patients or in individuals without prior ocular trauma. Intraocular disease has an important association with disseminated disease (Curi et al. 2003, Iyengar et al. 2010, Kashima et al. 2010). Acute dacryocystitis presents as inflammation of the lacrimal sac and is typically caused by infection. Dacryocystitis is predominantly found in adult women and in young infants. The most common signs and symptoms include erythema, oedema and a painful area of induration that overlies the nasolacrimal sac just below the anatomical boundary of the medial canthal ligament. In addition, epiphora and discharge may be observed. When pressure is applied to the inflamed tear duct, purulent material may be expressed through the lacrimal punctum (Pinar-Sueiro et al. 2012). Cases of isolated granulomatous conjunctivitis due to Sporothrix infection after exposure to cats with sporotrichosis have been reported in Rio de Janeiro (RJ), Brazil (Barros et al. 2004, Schubach et al. 2005). In this study, we evaluated cases of dacryocystitis secondary to Sporothrix infection in this hyperendemic area. This study was approved by the Ethical Committee of the Evandro Chagas Institute of Clinical Research (IPEC)/Oswaldo Cruz Foundation (Fiocruz), RJ, Brazil (0024.0.009.000-10). The authors reviewed the clinical records of patients who were diagnosed with dacryocystitis secondary to Sporothrix infection in the dermatology and ophthalmology laboratories of IPEC/Fiocruz from July 2008-July 2010. Patients underwent dermatological and ophthalmological examinations, including visual acuity (Snellen chart), biomicroscopy and ophthalmoscopy. The patients were initially found to be free of chronic stenosis and epiphora. During this period, 2,146 patients were diagnosed with sporotrichosis and sporotrichosis with dacryocystitis was identified in four patients (Table). Three patients were children (≤ 13 years of age) and one patient was an adult (41 years of age). The patients sought medical attention at a median time period of five weeks (3-8 weeks) after the initial manifestations of sporotrichosis. Patients 1 and 4 had a history of contact with cats that had sporotrichosis. Dacryocystitis was present at the outset in all cases. One child had cutaneous nodules and ulcerated skin lesions that were culture-positive for Sporothrix (Supplementary data), whereas the other two children had conjunctivitis, but no skin lesions. The adult patient presented only with dacryocystitis (Supplementary data). The diagnosis of dacryocystitis was established by the presence of swelling at the medial canthus with erythema, epiphora and mucopurulent discharge from the lacrimal punctum. Sporothrix infection was confirmed doi: 10.1590/0074-0276130304 Financial support: FAPERJ (E-26/110.619/2012) RMZ-O was supported in part by CNPq (350338/2000-0). + Corresponding author: [email protected] Received 5 June 2013 Accepted 22 July 2013 Acute dacryocystitis: another clinical manifestation of sporotrichosis