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Serbian Journal of Dermatology and Venereology

The Journal of Serbian Association of Dermatovenereologists (SAD)

4 Issues per year

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2406-0631
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Cutaneous Manifestations of Toxoplasmosis: a Case Report

Kutane manifestacije toksoplazmoze − prikaz slučaja

Sonya Marina / Valja Broshtilova / Ivo Botev / Dimitrina Guleva / Maria Hadzhiivancheva / Assia Nikolova / Jana Kazandjieva
Published Online: 2015-04-04 | DOI: https://doi.org/10.2478/sjdv-2014-0010

Abstract

Although toxoplasmosis is one of the most widely spread infections in the world, types that involve the skin are extremely rare. However, skin lesions are not specific; moreover, they are quite diverse, which makes the diagnosis of cutaneous toxoplasmosis rather difficult. Thus, differential diagnosis should include a number of other diseases. We present a case of a 43-year-old immunocompetent man with multiple livid erythematous papules and nodules with yellowish discharge that involved the skin of the body and the extremities. By using electro-chemiluminescence immunoassay, immunoglobulin G antibodies to Toxoplasma gondii were detected in the serum, confirming the diagnosis of toxoplasmosis. The treatment with pyrimethamine and trimethoprim-sulfamethoxazole led to complete resolution of skin lesions. In conclusion, although rare in the dermatological practice, cutaneous toxoplasmosis should be considered in all patients presenting with lymphadenopathy, non-specific skin eruptions, especially nodular and colliquative, blood eosinophilia and histological findigs revealing abundant eosinophilic inflitrations.

Sažetak

Uvod. Iako toksoplazmoza predstavlja jednu od najrasprostranjenijih infekcija u svetu, varijante koje zahvataju kožu su ekstremno retke. Manifestacije na koži nemaju spefičan izgled, mogu biti raznolike, što svakako otežava dijagnozu i čini diferencijalnu dijagnozu veoma složenom.

Prikaz slučaja. U ovom radu prikazujemo slučaj četrdesetrogodišnjeg muškarca sa promenama na koži u vidu multiplih papula i nodula iz kojih se spontano i na pritisak cedio žućkast eksudat. Promene su bile diseminovane po trupu i ekstremitetima, najizraženije na dorzumima oba stopala, potkolenicama i natkolenicama; nije bilo promene opšteg stanja niti febrilnosti. Promene su počele da se javljaju tri godine ranije; u početku su bile lokalizovane na donjim ekstremitetima u vidu tamnoljubičastih mrlja i čvorova, da bi se kasnje počele širiti i zahvatati i ostale delove tela.

Relevantne laboratorijske i ostale analize bile su u granicama fizioloških vrednosti, jedino je u krvnoj slici postojala leukocitoza sa eozinofilijom. Patohistološka analiza isečka obolele kože je pokazala hiperkeratozu, hipergranulozu i akantozu u epidermisu; u dermisu, naročito u njegovom dubokom delu kao i u susednim delovima hipodermisa, uočavao se gust infiltrat sačinjen od brojnih eozinofilnih granulocita, limfocita, histiocita, plazma ćelija i džinovskih ćelija tipa oko stranog tela; kolagen je bio fibroziran, ožiljast, vlakna su bila umnožena, grube, neravne zadebljale strukture. Pomoću elektro-hemiluminiscentnog imunoeseja, u serumu je utvrđen značajno povišen nivo imunoglobulina klase G protiv Toxoplasma Gondii, na osnovu čega je postavljena dijagnoza toksoplazmoze. Nakon oralnog lečenja sa pirimetaminom i trimetoprim-sulfametoksazolom, došlo je do potpune regresije promena.

Zaključak. Iako je toksoplazmoza veoma retka u svakodnevnoj dermatološkoj praksi, na nju uvek treba misliti kod pacijenata sa limfadenopatijom, nespecifičnim, najčešće nodularno-kolikvativnim promenama na koži, kod kojih se u perifernoj krvi i u kožnim lezijama može dokazati povišen broj eozinofilnih granulocita.

Key words: Toxoplasmosis; Signs and Symptoms; Skin Manifestations; Pyrimethamine; Trimethoprim-Sulfamethoxazole Combination; Treatment Outcome

Ključne reči: Toksoplazmoza; Znaci i simptomi; Kožne manifestacije; Pirimetamin; Trimetoprim-sulfometoksazol kombinacija; Ishod terapije

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About the article

Published Online: 2015-04-04

Published in Print: 2014-09-01


Citation Information: Serbian Journal of Dermatology and Venereology, Volume 6, Issue 3, Pages 113–119, ISSN (Online) 2406-0631, ISSN (Print) 1821-0902, DOI: https://doi.org/10.2478/sjdv-2014-0010.

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© Sonya MARINA et al.. This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License. BY-NC-ND 3.0

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