{"id":46322,"date":"2018-03-09T11:19:36","date_gmt":"2018-03-09T15:49:36","guid":{"rendered":"https:\/\/piel-l.org\/blog\/?p=46322"},"modified":"2018-03-23T15:49:25","modified_gmt":"2018-03-23T20:19:25","slug":"caso-clinico-no-76-dermatofitosis-en-pubis","status":"publish","type":"post","link":"https:\/\/piel-l.org\/blog\/46322","title":{"rendered":"Caso cl\u00ednico N\u00ba 76. Dermatofitosis en pubis"},"content":{"rendered":"<p><strong>Dra. Luz Marina Aular, <em>MSc<\/em>. Fernando G\u00f3mez-Daza.<br \/>\n<\/strong>Cl\u00ednica el Vi\u00f1edo. Valencia. Venezuela.<\/p>\n<p><strong>Paciente:<\/strong> A.A.<br \/>\n<strong>Tipo de piel:<\/strong> IV\/VI Fitzpatrick.<br \/>\n<strong>Motivo de consulta: <\/strong>\u00a8Picaz\u00f3n\u00a8 en regi\u00f3n genital.<\/p>\n<p><strong>Enfermedad actual:<\/strong> Paciente femenino de 26 a\u00f1os de edad, abogada, natural y procedente de Valencia, Edo. Carabobo, Venezuela, con enfermedad actual de seis semanas de evoluci\u00f3n cuando inicia p\u00e1pulas y peque\u00f1as placas circulares a nivel de la s\u00ednfisis del pubis y tercio inferior del abdomen con intenso prurito. Acudi\u00f3 a facultativo donde indicaron cremas con corticoides mejorando alguna de las lesiones, se automedica cremas con Clotrimazol asociada con corticoides, en vista de no presentar mejor\u00eda acude a consulta.<\/p>\n<p><strong>Antecedentes personales:<\/strong> Habito de rasurado de vello p\u00fabico de forma semanal. Tiene mascota la cual con frecuencia duerme con ella.<\/p>\n<p style=\"text-align: center;\"><a href=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2018\/03\/ed422-micopiel-01.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter size-large wp-image-46323\" src=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2018\/03\/ed422-micopiel-01-1024x902.jpg\" alt=\"\" width=\"618\" height=\"544\" srcset=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2018\/03\/ed422-micopiel-01-1024x902.jpg 1024w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2018\/03\/ed422-micopiel-01-390x344.jpg 390w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2018\/03\/ed422-micopiel-01-768x677.jpg 768w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2018\/03\/ed422-micopiel-01.jpg 1162w\" sizes=\"auto, (max-width: 618px) 100vw, 618px\" \/><\/a>Fig. 1<\/p>\n<p style=\"text-align: center;\"><a href=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2018\/03\/ed422-micopiel-02.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter size-large wp-image-46324\" src=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2018\/03\/ed422-micopiel-02-1024x768.jpg\" alt=\"\" width=\"618\" height=\"464\" srcset=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2018\/03\/ed422-micopiel-02-1024x768.jpg 1024w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2018\/03\/ed422-micopiel-02-390x293.jpg 390w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2018\/03\/ed422-micopiel-02-768x576.jpg 768w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2018\/03\/ed422-micopiel-02.jpg 1280w\" sizes=\"auto, (max-width: 618px) 100vw, 618px\" \/><\/a>Fig. 2<\/p>\n<p style=\"text-align: center;\"><a href=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2018\/03\/ed422-micopiel-03.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter size-large wp-image-46325\" src=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2018\/03\/ed422-micopiel-03-1024x768.jpg\" alt=\"\" width=\"618\" height=\"464\" srcset=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2018\/03\/ed422-micopiel-03-1024x768.jpg 1024w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2018\/03\/ed422-micopiel-03-390x293.jpg 390w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2018\/03\/ed422-micopiel-03-768x576.jpg 768w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2018\/03\/ed422-micopiel-03.jpg 1280w\" sizes=\"auto, (max-width: 618px) 100vw, 618px\" \/><\/a>Fig. 3<\/p>\n<p style=\"text-align: center;\"><a href=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2018\/03\/ed422-micopiel-04.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter size-large wp-image-46326\" src=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2018\/03\/ed422-micopiel-04-1024x693.jpg\" alt=\"\" width=\"618\" height=\"418\" srcset=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2018\/03\/ed422-micopiel-04-1024x693.jpg 1024w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2018\/03\/ed422-micopiel-04-390x264.jpg 390w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2018\/03\/ed422-micopiel-04-768x520.jpg 768w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2018\/03\/ed422-micopiel-04-110x75.jpg 110w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2018\/03\/ed422-micopiel-04.jpg 1280w\" sizes=\"auto, (max-width: 618px) 100vw, 618px\" \/><\/a>Fig. 4<\/p>\n<p>Caso presentado previo consentimiento informado del paciente.<\/p>\n<p><strong>Diagn\u00f3sticos presuntivos:<\/strong><\/p>\n<ol>\n<li>Dermatofitosis inflamatoria.<\/li>\n<li>Liquen simple cr\u00f3nico.<\/li>\n<li>Liquen plano.<\/li>\n<\/ol>\n<p><strong>Plan de trabajo:<\/strong> Iconograf\u00eda, estudio micol\u00f3gico.<\/p>\n<p><strong>Estudios paracl\u00ednicos:<\/strong><\/p>\n<ul>\n<li><strong>Laboratorio:<\/strong><\/li>\n<li><strong>Estudio micol\u00f3gico:<\/strong><\/li>\n<\/ul>\n<p style=\"text-align: center;\"><a href=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2018\/03\/ed422-micopiel-05.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter size-large wp-image-46327\" src=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2018\/03\/ed422-micopiel-05-1024x766.jpg\" alt=\"\" width=\"618\" height=\"462\" srcset=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2018\/03\/ed422-micopiel-05-1024x766.jpg 1024w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2018\/03\/ed422-micopiel-05-390x292.jpg 390w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2018\/03\/ed422-micopiel-05-768x575.jpg 768w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2018\/03\/ed422-micopiel-05.jpg 1280w\" sizes=\"auto, (max-width: 618px) 100vw, 618px\" \/><\/a>Fig. 5: Luz de Wood evidenci\u00e1ndose la fluorescencia verde brillante en los fol\u00edculos pilosos parasitados por el dermatofito.<\/p>\n<p style=\"text-align: center;\"><a href=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2018\/03\/ed422-micopiel-06.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter size-large wp-image-46328\" src=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2018\/03\/ed422-micopiel-06-1024x768.jpg\" alt=\"\" width=\"618\" height=\"464\" srcset=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2018\/03\/ed422-micopiel-06-1024x768.jpg 1024w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2018\/03\/ed422-micopiel-06-390x293.jpg 390w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2018\/03\/ed422-micopiel-06-768x576.jpg 768w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2018\/03\/ed422-micopiel-06.jpg 1280w\" sizes=\"auto, (max-width: 618px) 100vw, 618px\" \/><\/a>Fig. 6: Examen directo con KOH 20% y negro amido observ\u00e1ndose abundantes artroconidios tipo ect\u00f3thrix (objetivo 40x).<\/p>\n<p style=\"text-align: center;\"><a href=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2018\/03\/ed422-micopiel-07.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter size-large wp-image-46329\" src=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2018\/03\/ed422-micopiel-07-1024x768.jpg\" alt=\"\" width=\"618\" height=\"464\" srcset=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2018\/03\/ed422-micopiel-07-1024x768.jpg 1024w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2018\/03\/ed422-micopiel-07-390x293.jpg 390w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2018\/03\/ed422-micopiel-07-768x576.jpg 768w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2018\/03\/ed422-micopiel-07.jpg 1280w\" sizes=\"auto, (max-width: 618px) 100vw, 618px\" \/><\/a>Fig. 7: Examen directo con KOH 20% y negro amido, en algunos tallos pilosos se observaron solo hifas hialinas segmentadas (objetivo 40x y zoom digital).<\/p>\n<p style=\"text-align: center;\"><a href=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2018\/03\/ed422-micopiel-08.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter size-large wp-image-46330\" src=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2018\/03\/ed422-micopiel-08-1024x768.jpg\" alt=\"\" width=\"618\" height=\"464\" srcset=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2018\/03\/ed422-micopiel-08-1024x768.jpg 1024w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2018\/03\/ed422-micopiel-08-390x293.jpg 390w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2018\/03\/ed422-micopiel-08-768x576.jpg 768w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2018\/03\/ed422-micopiel-08.jpg 1280w\" sizes=\"auto, (max-width: 618px) 100vw, 618px\" \/><\/a>Fig. 8: Examen directo con KOH 20% y negro amido, en otros campos se observaron ac\u00famulos de artroconidios (objetivo 40x y zoom digital).<\/p>\n<p style=\"text-align: center;\"><a href=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2018\/03\/ed422-micopiel-09.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter size-large wp-image-46331\" src=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2018\/03\/ed422-micopiel-09-766x1024.jpg\" alt=\"\" width=\"618\" height=\"826\" srcset=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2018\/03\/ed422-micopiel-09.jpg 766w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2018\/03\/ed422-micopiel-09-359x480.jpg 359w\" sizes=\"auto, (max-width: 618px) 100vw, 618px\" \/><\/a>Fig. 9: Cultivo en agar Sabouraud y Mycosel\u00ae con adici\u00f3n de leche a temperatura ambiente, 8 d\u00edas de incubaci\u00f3n evidenci\u00e1ndose colonias algodonosas blancas a partir del cuarto d\u00eda con pigmento amarillo naranja que difunde al agar.<\/p>\n<p><a href=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2018\/03\/ed422-micopiel-10.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter size-large wp-image-46332\" src=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2018\/03\/ed422-micopiel-10-1024x768.jpg\" alt=\"\" width=\"618\" height=\"464\" srcset=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2018\/03\/ed422-micopiel-10-1024x768.jpg 1024w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2018\/03\/ed422-micopiel-10-390x293.jpg 390w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2018\/03\/ed422-micopiel-10-768x576.jpg 768w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2018\/03\/ed422-micopiel-10.jpg 1280w\" sizes=\"auto, (max-width: 618px) 100vw, 618px\" \/><\/a>Fig. 10: Impronta con cinta adhesiva trasparente y te\u00f1ida con azul de metileno en el cual se evidencian abundantes macroaleuroconidios multicelulares (macroconidios) fusiformes con esp\u00edculas en su superficie, algunos en etapa de germinaci\u00f3n o desarrollo algo inusitado (objetivo 40x y zoom digital). Se concluye que el hongo aislado es Microsporum canis. Discusi\u00f3n: Se presenta el caso cl\u00ednico por lo infrecuente de la dermatofitosis en pubis y por las siguientes interrogantes al foro.<\/p>\n<p><strong>\u00bfC\u00f3mo clasificar\u00eda cl\u00ednicamente esta dermatofitosis o ti\u00f1a?<br \/>\n\u00bfTi\u00f1a del cuerpo?, \u00bfTi\u00f1a Incognito? \u00bfTinea capitis?, \u00bfQueri\u00f3n de Celso?, \u00bfGranuloma dermatof\u00edtico de Majocchi? <\/strong><\/p>\n<p><strong>Tratamiento y Evoluci\u00f3n:<\/strong> Se presentar\u00e1 la siguiente semana.<\/p>\n<p>&nbsp;<\/p>\n<hr \/>\n<p><a name=\"segunda-parte\"><\/a><\/p>\n<h3><strong>SEGUNDA PARTE<\/strong><\/h3>\n<p class=\"p1\"><span class=\"s1\"><b>Tratamiento: <\/b>Sist\u00e9mico: Itraconazol 100 mg VO OD por 30 d\u00edas. Local: Clotrimazol crema 1% local por 30 d\u00edas.<\/span><\/p>\n<p class=\"p1\"><span class=\"s1\"><b>Evoluci\u00f3n:<\/b><\/span><\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p class=\"p1\" style=\"text-align: center;\"><span class=\"s1\"><a href=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2018\/03\/ed423-micopiel-11.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter size-large wp-image-46419\" src=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2018\/03\/ed423-micopiel-11-1024x768.jpg\" alt=\"\" width=\"618\" height=\"464\" srcset=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2018\/03\/ed423-micopiel-11-1024x768.jpg 1024w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2018\/03\/ed423-micopiel-11-390x293.jpg 390w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2018\/03\/ed423-micopiel-11-768x576.jpg 768w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2018\/03\/ed423-micopiel-11.jpg 1280w\" sizes=\"auto, (max-width: 618px) 100vw, 618px\" \/><\/a>Fig. 11: Imagen tomada a los 10 d\u00edas post-tratamiento con leve mejor\u00eda.<\/span><\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>P\u00e1pulas y peque\u00f1as placas circulares a nivel de la s\u00ednfisis del pubis y tercio inferior del abdomen con intenso prurito<\/p>\n","protected":false},"author":7,"featured_media":46332,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[13],"tags":[],"class_list":["post-46322","post","type-post","status-publish","format-standard","has-post-thumbnail","","category-micopiel"],"_links":{"self":[{"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/posts\/46322","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/users\/7"}],"replies":[{"embeddable":true,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/comments?post=46322"}],"version-history":[{"count":0,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/posts\/46322\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/media\/46332"}],"wp:attachment":[{"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/media?parent=46322"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/categories?post=46322"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/tags?post=46322"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}