, Volume 25, Issue 3-4, pp 373-380

Enfermedad de Jorge Lobo

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Sumario

Se presenta el segundo caso colombiano de Enfermedad de Lobo o Blastimicosis queloidiana, en un agricultor de 46 años de edad, procedente del departamento del Chocó. Presentaba lesión nodular de tipo queloidiano, exulcerada localizada en el dorso del pie derecho, de un año de evolución, sin compromiso del estado general, sin adenopatía satélite y sin compromiso pulmonar. Se hace la descripcíon de las lesiones histopatológicas producidas por el hongo y la descripción de la morfología del parásito en fresco y teñido por diversos métodos. Cultivos e inoculaciones a cobayos y ratones fueron negativos.

Se hace énfasis en las diferencias clínicas, histológicas, micológicas y experimentales que existen entre la Paracoccidioidomicosis o Blastomicosis suramericana y la Enfermedad de Lobo y se concluye que la Enfermedad de Lobo o Blastomicosis queloidiana es una enfermedad autónoma y completamente diferente a la Blastomicosis suramericana y producida por un hongo diferente alP. brasiliensis.

Summary

The second known case of keloid Blastomycosis or Lobo's disease in Colombia is reported. The patient, a 46 year old male farmer from the State of Chocó (northwest region of Colombia), had been suffering for a year from a keloid-like ex-ulcerated, lobulated lesion located on the dorsal aspect of the right foot. Neither regional adenopathy nor lesions were found.

The histopathological changes were studied by means of serial sections taken from the surgical specimen. The epidermis was atrophic, and had neither pseudo-epitheliomatous hyperplasia nor intra-epidermal abscesses. The dermis showed a marked keloid like fibrosis with abundant collagenous bands, there were many foreign body type granulomas without necrosis, with histiocytes and abundant giant cells which contained many parasites. In the H-E stain, the fungus cells were poorly stained, nevertheless they were readily recognized due to the refracting capsule and to the central slightly basophilic protoplasmic material. There were also many free parasites intermingled with the collagenous tissue. With the P.A.S. technique the fungi were intensely stained, showing a pink capsule and a dark red protoplasmic material. With the Grocott technique the fungus capsule, but not the protoplasmic mass, was very sharply stained; we consider this method the best to study the external morphology of the fungus.

The fungus cells were very uniform in size (8–10µ), neither dwarf nor giant forms were seen; they were generally rounded but occasionaly pear-shaped (Fig. 6), and semilunar cells (Figs. 6, 7) were present. Chains of buds were commonly observed and multiple budding forms were also abundant (Figs. 3, 4, 8). The daughter cells were attached to the mother one by an easily visible bridge (Fig. 8).

The differences from South American blastomycosis are discussed and a brief review of the literature concerning keloid blastomycosis is made.

The conclusion is that keloid blastomycosis is an autonomous disease and not a clinical form of South American blastomycosis and the etiologic agent is different fromP. brasiliensis.