Caráter oportunista da esporotricose em coinfecção com HIV: relato de caso e revisão de literatura

Abstract

Sporotrichosis is an endemic zoonosis in Brazil, caused by the dimorphic fungus of the genus Sporothrix. Traumatic inoculation occurs through contaminatedorganic material or scratches/ bites from sick animals. The cutaneous presentation of sporotrichosis is the most prevalent and is subdivided into lymphocutaneous, fixed cutaneous and multiple inoculation. Disseminated disease occurs by hematogenous dissemination and is more frequent in immunosuppressed patients, especially those with the human immunodeficiency virus (HIV) and low CD4+ T cell counts. The gold standard for diagnosis is culture with isolation and identification of Sporothirix spp. in samples from lesions. The treatment of sporotrichosis is based on the use of antifungals, with itraconazole being the drug of choice for the treatment of localized cutaneous forms and amphotericin for disseminated and severe cases. The report describes the case of a 31-year-old male patient with disseminated sporotrichosis as a clinical manifestation of AIDS. He was treated with a first course of amphotericin B deoxycholate with a total cumulative dose of 750 mg in 14 days and, after several weeks, another 12,600 mg of amphotericin lipid complex in 42 days, followed by the use of itraconazole for 8 months until abandonment. Disseminated opportunistic sporotrichosis in patients living with HIV presents a therapeutic challenge and its favorable outcomes depend on a rapid diagnosis and appropriate therapy.