Lymphoscintigraphic analysis in chromoblastomycosis

• Published in: International Journal of Dermatology Vol. 42; no. 8; pp. 622 - 625
• Main Authors: Ogawa, Marília M., Alchorne, Maurício M. A., Barbieri, Antonio, Castiglioni, Mário L. V., Penna, Adriana Porto Benatti, Tomimori-Yamashita, Jane
• Format: Conference Proceeding Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01-08-2003; Blackwell Science
• Subjects: Adult; Aged; Antifungal Agents - therapeutic use; Biological and medical sciences; Chromoblastomycoses; Chromoblastomycosis - complications; Chromoblastomycosis - diagnostic imaging; Chromoblastomycosis - therapy; Cryotherapy; Female; Human mycoses; Humans; Infectious diseases; Itraconazole - therapeutic use; Leg Dermatoses - diagnostic imaging; Leg Dermatoses - therapy; Lymphedema - diagnostic imaging; Lymphedema - etiology; Lymphedema - therapy; Lymphoscintigraphy; Male; Medical sciences; Middle Aged; Mycoses; Reproducibility of Results; Treatment Outcome; Tropical medicine; Tropical mycoses; South America; Brazil; America; Radionuclide study; Human; Skin disease; Lymphatic system; Mycosis; Cardiovascular disease; Chromoblastomycosis; Scintigraphy; Lymphatic vessel disease; Infection; Lymphedema; Medical imagery; Diagnosis
• DOI: 10.1046/j.1365-4362.2003.01814.x
• EISSN: 1365-4632
• ISSN: 0011-9059

Background One of the main complications of chromoblastomycosis is lymphedema. The purpose of this study was to evaluate the lymphatic system of the limbs of patients with chromoblastomycosis using lymphoscintigraphy. It is a reliable, objective and noninvasive means of supporting the diagnosis of lymphedema.
Methods Lymphoscintigraphy was performed in seven patients with chromoblastomycosis, six with lesions in the lower limb and one in the upper limb. Tc‐99 m dextran was injected into the interdigital spaces of the upper or lower extremities. The qualitative parameters analyzed were the visibilization of the lymph vessels and the lymph nodes, dermal backflow, and existence of collateral vessels. All patients were treated with the association of itraconazole and cryotherapy with liquid nitrogen.
Results Three out of the 14 extremities examined had lymphedema clinically, and the lymphoscintigraphy showed abnormalities in the qualitative parameters; whereas these parameters were normal in the extremities without lymphedema. During the treatment of chromoblastomycosis, a second lymphoscintigraphy exam was performed on 10 limbs and did not show any improvement of the previous lymphoscintigraphic alterations.
Conclusions The qualitative lymphoscintigraphy was a reliable method to show the morphology of the lymph vessels and confirm objectively the diagnosis of lymphedema secondary to chromoblastomycosis. The association of oral itraconazol and cryotherapy did not modify the lymphatic alterations in chromoblastomycosis.