Indian Journal of Dermatology
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CASE REPORT
Year : 2006  |  Volume : 51  |  Issue : 3  |  Page : 209-210
Fixed variant of cutaneous sporotrichosis: A rare entity in non-endemic belt


Department of Dermatology and Venereology, B.S. Medical College, Bankura, West Bengal, India

Correspondence Address:
Sudip Das
P-103, Bosenagore, Madhyamgram, 24 Parganas (North), Kolkata - 700 129
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5154.27991

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   Abstract 

A sporadic case of sporotrichosis restricted to the primary site of inoculation in a fifty one years old farmer from a non-endemic region of West Bengal has been described. The significance of the report is that most cases of the fixed variant of sporotrichosis had hitherto been reported from the endemic belt of sub-Himalayan region. That the fixed variant is limited to the endemic region is probably a myth.


Keywords: Sporotrichosis, endemic, dimorphic


How to cite this article:
Das S, Banerjee G, Biswas I. Fixed variant of cutaneous sporotrichosis: A rare entity in non-endemic belt. Indian J Dermatol 2006;51:209-10

How to cite this URL:
Das S, Banerjee G, Biswas I. Fixed variant of cutaneous sporotrichosis: A rare entity in non-endemic belt. Indian J Dermatol [serial online] 2006 [cited 2020 Jul 10];51:209-10. Available from: http://www.e-ijd.org/text.asp?2006/51/3/209/27991



   Introduction Top


Sporotrichosis is a subcutaneous or systemic fungal infection caused by dimorphic fungus Sporothrix schenckii. The fungus occurs in natural environment, presumably in mould from but develops into a yeast like form.[1] In nature, the fungus grows on decaying vegetable matter such as plant debris, leaves and wood. The organism is thought to be introduced into the skin through a local injury.[1] Labourers using straw as packing material, gardeners, forestry workers etc. are prone to develop the infection.[2] Two clinical variants of cutaneous sporotrichosis are known - lymphangitic form (accounts for 85-90%) and fixed variant (10-15%). In the fixed variant, a granuloma develops at one of the sites, remains localized there, and subsequently may ulcerate.[1]

In the Indian scenario, sporotrichosis is more prevalent in the sub-Himalayan belt of Himachal Pradesh, Uttaranchal,[2] Kashmir Valley[3] and also in the sub-himalayan belt of Arunachal Pradesh, Assam,[4] Meghalaya and sporadically in West Bengal.[5]


   Case Report Top


A fifty-one years old farmer from Bankura presented to us with well-defined ulcer with crusting on dorsum of right hand of 3 years duration. The lesion started as an erythematous nodule which broke down to ulcerate in two months. There were shallow ulcerations with crust formation on the floor of the ulcer and the base was indurated but non-tender. The edge of the ulcer had a few soft boggy swellings. There was no past history of any recognizable trauma or no family history of similar disease. He did not visit the so-called endemic belt of sub-Himalayan region in his lifetime.

Direct microscopic examination with KOH smear did not reveal anything, Gram's stain of the nodular aspirate revealed eosinophils, monocytes, neutrophils and foreign body type of giant cells. AFB smear from the aspirate was negative. Skin biopsy (punch) from the edge of the lesion revealed mixed granulomatous reaction with neutrophilic microabscess.

The patient was treated with saturated solution of potassium iodide starting with 5 drops thrice daily on first day. This was gradually increased by one drop in each dose to 40 drops, when the patient developed hypersalivation. He was thereafter put on 38 drops thrice daily. Within three weeks of starting potassium iodide, even when we were gradually increasing the dose there was 80% improvement in two weeks time and near complete clearance in two months time. The dose of potassium iodide was then tapered off in another six weeks time and after six months of follow up patient has not shown any recurrence.


   Discussion Top


In high endemic areas, the population is sensitized and primary infection in such a person is restricted to the site of injury.[1] Our patient, a 51 years old farmer, probably developed the infection from trivial trauma. No case from the southern part of West Bengal- in the districts of Bankura and Purulia- have been reported. Most of the reports earlier were from the sub-Himalayan belt.[2] Fixed variant have been reported to occur from the endemic belt mainly, and is as such the rarer variant of sporotrichosis.[5] We are of opinion that probably the myth of endemic belt of sub-Himalayan region needs to be rechecked. We find that sporotrichosis can occur elsewhere also because rural population is affected and majority of such cases go unreported as these are often asymptomatic.

In spite of the advent of newer drugs - 5-flucytosine, amphotericin A and B, itraconazole - potassium iodide remains the safest and cheapest drug for sporotrichosis with excellent cure rate.



 
   References Top

1.Venugopal VP, Venugopal VT. Deep fungal infections. In : Valia RG, Valia AR, Siddapa K editors, IADVL Text Book and Atlas of Dermatology 2nd ed. Indra Bhalani Publishers: Mumbai; 2001. p. 258-84.   Back to cited text no. 1      
2.Sharma NL, Sharma RC, Gupta ML, Singh Prem, Gupta N. Sporotrichosis study of 22 cases from Himachal Pradesh. Indian Dermatol Venerol Leprol 1990;56:296-8.   Back to cited text no. 2      
3.Singh P, Sharma RC, Gupta ML. Localised cutaneous sporotrichosis of face. A case report from India. Indian J Dermatol Venerol Leprol 1980;46:381.   Back to cited text no. 3      
4.Baruah BD, Saikia TC, Bhuya RN. Sporotrichosis in Assam. Indian J Med Sci 1976;29:251-6.   Back to cited text no. 4      
5.Sanyal Maya, Basu N, Thammaya A, Gaind ME. Subcutaneous sporotrichosis in India. Indian J Dermatol Venereol Leprol 1976;39:88-91.  Back to cited text no. 5      




 

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    Abstract
    Introduction
    Case Report
    Discussion
    References

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