Jorge Lobo first described a skin disorder in South America associated with a fungal infection in 1931.
Synonym: lacaziosis, Jorge Lobo’s disease
The causative fungus is Lacazia loboi, which is related to other deep fungi such as Paracoccidioides and Blastomyces. Confusion about the causative fungus has resulted in confusion in terms used to describe the lesions.
The organisms is believed to be distributed in the environment. Humans may become infected by trauma, insect bite, animal contact or high water pressure.
The organism expresses the cytokine transforming growth factor beta (TGF-beta), which suppresses macrophage activity.
It is endemic in the Amazon but cases have occurred in other parts of the world. It can be found in dolphins.
Clinical features:
(1) The incubation period ranges from 3 months to 4 years.
(2) The patient develops skin nodules and plaques resembling keloid.
(3) Common sites are the earlobes, distal extremities and buttocks.
(4) Some patients develop widespread skin lesions which may become confluent.
(5) Lesions may show a pattern of lymphangitic spread.
(6) Mucous membranes are spared.
Biopsy shows spherical to oval fungal organisms in a dense keloid-like hypertrophic dermal scar.
It is an obligate intracellular pathogen. This means that in vitro cultivation in the lab is often negative.
The organism was resistant to antifungal agents in the past but has been successfully treated with posaconazole. Therapy often must be prolonged to avoid relapse.
