LOBO'S DI S EA S E
No. 1
•
Azulay
41
Fig. 3. Top, mi­
croscopic
picture
of the gland show­
ing a heavy infil­
trate of Glenospo­
loboi
(low
power). Fig. 4. Bot­
tom,
microscopic
picture
of
the
gland showing a
rella
heavy infiltrate of
Glenospore//a lo­
boi (high power).
Case Report
merous round bodies of nodule mem­
A 34-year-old man who was born in
brane, presenting as single or multiple
the Amazon area had a tumor on the left
buds
ear which had been present for the past
(catenular).
3 years. At first, the area was pruritic, but
grown.
gradually a small nodule appeared at the
site.
The
lesion
became
tender
and
eventually developed into a lobulated,
springs,
with
linking
disposition
The organism could not be
Histological study revealed epidermal
atrophy.
In the dermis, there was lym­
phocytic and histiocytic infiltration with
glossy tumor which resembled a keloid.
several Langhans and foreign body giant
At the left postauricular area, there was
cells. Numerous rounded parasites with
a 2 cm lymph node.
Mycological examination revealed nu-
birefringent membranes and central nu­
clei were seen. Some showed a budding
INTERNATIONAL JOURNAL OF DERMATOLOGY
42
picture, and the catenular aspect both
inside and outside the giant cells was
observed.
Microscopic examination of the lymph
node demonstrated a lymphocytic exu­
date with giant cells. Numerous parasites,
both grouped and isolated, were seen.
In
addition,
birefringent
membranes
similar to Glenosporella loboi, inside and
3-(p-Chloroanilino) 1 O-(p-chlorophenyl)-2,
·1 O-dihydro-2-(isopropylimino) phenazine­
Clofazimine
References
1.
conhecimento das granulomatose blasto­
micoiles; o agente etiol6gico da micose de
Jorge Lobo. Med. Cirurg. Brasil. 48:143, 1940.
3.
Azulay, R. D., Andrade, L. C., Silva, D.,
e Carneiro, J. A., Reprodu<;ao experimental
da blastomicose de Jorge Lobo. An. Bras.
4.
Azulay, R.
improvement.
Dermatol. 434:161, 1968.
Discussion
The disease is characterized by iso­
seu
like aspect is rather common.
In addi­
tion, infiltrative, gummatous, ulcerated
and verrucous lesions may be observed.
Isolation of the parasite is difficult.
In
5.
obtained an isolate in an artificial me­
7.
round forms identical to those found in
tissues, using 199 medium. This medium
8.
cultures.
the etiological
agent of
Lobo's disease has behaved as an anthro­
pophile and has not been isolated from
animals or vegetables.
Good
climatic
conditions for its growth are found in
the Brazilian Amazon area and in those
neighboring countries where the average
annual temperature is above 24°C and
the rainfall at least 2.000 mm.
All of the reported patients have been
from such areas except for one from
Costa Rica and another from Panama.9
Inflammatory reactions are not neces­
sari'ly found; however, the lymph nodes
have been involved in 7 of the 98 re­
ported cases.11-1s We can offer no satis­
factory explanation for these variations.
no
1968.
Azulay, R. D., Andrade, L. C., e Carneiro, J.
A., Lobo's blastomycoses: new experiments
L. C., Blastomicose de Jorge Lobo. Con­
tribui<;ao ao estudo da etiologia, inocula­
<;ao experimental, imunologia e patologia
sibility of this, but Carneiro et al.7 have
is one of the few appropriate to tissue
experimental-inocula<;ao
on culture, immunology and inoculation.
Cong. Int. Dermatol. Munich, 1967, pg. 858859.
6. Azulay, R. D., Carneiro, J. A., e Andrade,
fact, some observers question the pos­
Last year, M. Sampaios isolated
estudo
homen e animais de laborat6rio e investi­
ga<;ao imunol6gica. 0 Hospital 73:1167,
glossy, variously sized nodules, of cafe
au lait or burnt ivory color. The keloid­
D., Carneiro, J. A., e Andrade,
L. C., Micose de Jorge Lobo. Contribui<;ao ao
lated or grouped painless, hard, smooth,
Until now,
Lobo, J., Um caso de blastomicose produ­
zido por uma especie nova, encontrada no
recife Rev. Med. Pernambuco 1:763, 1931.
2. Fonseca, F. 0., Leao, A., Contribui<;ao para o
The patient was treated with clofazi­
dium.
Vol. 15
Drug Names
outside the giant cells, were found.
mine 100 mg daily and has shown some
Jan.-Feb. 1976
9.
10.
11.
da doen<;a. An. Bras. Dermato I. 45:47, 1970.
Carneiro, J. A., Azulay, R. D., e Andrade, L.
C., Micose de Jorge Lobo. lsolamento do
parasito em cultura artificial. 0 Hospital 73:
1151, 1968.
Sampaio, M., A note on the cultivation of
the etiological agent of Jorge Lobo's disease
in 199 Tc. Inst. Med. Trap. S.P. 16:121, 1974.
Lobo, Jorge,
Blastomicose
queloidiforme.
J. Bras. Med. 1 1:120, 1966.
Fialho, A., Blastomicose do tipo Jorge Lobo.
0 Hospital 14:903, 1938.
Trejos, Romero (V Cong. Int. Microbiologia,
1950) citado porr Jorge Lobo. J. Bus. Med.
11: 137, 1966.
12.
Guimarraes, F. N., e Macedo, D. G., Con­
tribui<;ao ao estudo das blastomicose na
Amazonia (blastomicose queloidiana e blas­
tomicose Sul-americana) 0 Hospital 38:223,
1950.
13. Correia, P., Colombia, 1958. Citado por Jorge
Lobo (9).
14. Cerruti, H., Zamith, V.) Um caso de blasto­
micose de Jorge Lobo. Rev. Paulista Med.
34:210, 1949.
15. Silverie, C. R., Ravisse, P., Villar, J. P., e
Moulins, C., La blastomycose cheloidienne
on maladie de Jorge Lobo en Guyane Fran­
<;aise. Bull. Societe Pathol. Exotique. 56:29,
1963.