Coccidioidomicosis cutánea primaria: presentación de un caso de diagnóstico tardío.
Resumen
La coccidiodomicosis es una micosis profunda con manifestaciones respiratorias, cutáneas o diseminadas, producida por el hongo dimorfo Coccidiodes sp. Es endémica en zonas desérticas y semidesérticas de California, Arizona, México, Centro y Sur América hasta Argentina. En Venezuela es endémica en los estados Lara, Falcón y Zulia. La coccidiodomicosis cutánea primaria (CCP), sin manifestaciones respiratorias o sistémicas es extremadamente rara. Ocurre por inoculación directa del hongo en la piel a través de un traumatismo desde una fuente en el ambiente o un accidente de laboratorio. El primer caso fue descrito en 1927. En 1953 Wilson propone los criterios diagnósticos de CCP. Se reporta un caso en un varón de 27 años de edad, quien adquirió la infección en una zona no endémica, el diagnóstico fue tardío y se realizó mediante el hallazgo del hongo en una biopsia de piel. Además se realizó una revisión de la literatura internacional y venezolana de todos los casos de CCP reportados hasta la actualidad. Se encontraron 43 casos en la literatura internacional y 5 en la nacional. Se analizan las características de estos casos, se proponen criterios clínicos, epidemiológicos y de laboratorio para su diagnóstico y se realiza una extensa revisión sobre el tema.
Primary cutaneous coccidiodomicosis: presentation of a case of late diagnosis
Summary
Coccidioidomycosis is a deep mycosis with respiratory, cutaneous and disseminated symptoms produced by the dimorphic fungi Coccidioides sp. Endemic areas include desertic and semidesertic zones of California, Arizona Mexico, Central and Southamerica. In Venezuela, it is endemic in Lara, Falcón and Zulia states. Primary cutaneous coccidioidomycosis (PCC), without respiratory or systemic symptoms, is very rare. Traumatic inoculation of the organism in the skin results from direct contact with a source in the environment or in the laboratory. We report a 27 year-old male with PPC, who was supposedly infected in a nonendemic area, the diagnosis was delayed. This is the first case of
PPC reported in Venezuela since 1996.
Key words: coccodioidomycosis, primary cutaneous coccidioidomycosis.
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