Case study Disseminated infection with Lacazia loboi and immunopathology of the lesional spectrum ☆,☆☆ Francisca Regina Oliveira Carneiro MD, PhD a, ⁎ , Thais Rodrigues da Cunha Fischer MD a , Caroline Martins Brandão MD a , Carla Pagliari MD, PhD b , Maria Irma Seixas Duarte MD, PhD b , Juarez Antonio Simões Quaresma MD, PhD a,c a Centro de Ciencias Biologicas e da Saude, Universidade do Estado do Pará, 66087-670, Belem, PA, Brazil b Departamento de Patologia, Universidade de São Paulo, 01246903, Sao Paulo, SP, Brazil c Nucleo de Medicina Tropical, Universidade Federal do Pará, 66015-070, Belem, PA, Brazil Received 27 May 2013; revised 23 October 2014; accepted 24 October 2014 Keywords: Lacaziosis; Immunopathology; Clinical aspects; Jorge Lobo disease; Lobmycosis Summary The pathogenesis of lacaziosis continues to be obscure, and works have investigated the blood systemic immune response or the dermal immune response in restricted lesions in different body regions. Some authors describe that the inflammatory infiltrate in lacaziosis lesions showed a predominance of macrophages followed by CD45RO + , CD4 + , and CD8 + T cells; CD57 + natural killer cells; S-100 + cells; and CD20 + B lymphocytes. A 54-year-old man and living in the State of Para, Amazon region, Brazil, was seen with a lesion on the left lower limb, which had started as a small nodular area 18 years ago. The lesion showed progressive growth and disseminated to other parts of the body. Our findings showed that dermal immune response differs depending on the type of lesions and clinical presentation, with presence of CD1a + , FXIIIa + , CD45 + , CD4 + , CD8 + , and S-100 + cells and cytokine profile with expression of interleukin 1 β, tumor necrosis factor α, transforming growth factor β, IL-10, and interferon γ. © 2015 Elsevier Inc. All rights reserved. 1. Introduction Jorge Lobo's disease or lacaziosis is a chronic mycosis caused by fungal pathogen Lacazia loboi, an agent phylogenetically closely related to the dimorphic pathogen Paracoccidioides brasiliensis [1,2]. Cases of lacaziosis have been described in various South American countries, but it assumes great importance in the Brazilian Amazon region, where the largest numbers of these cases are found [3-5]. Data regarding the immune response in L loboi infection are still scarce in the literature. Vilani-Moreno et al [6] characterized the inflammatory infiltrate in lacaziosis lesions and showed a predominance of macrophages followed by, in decreasing order of frequency, CD3 + , CD4 + , and CD8 + T cells; CD57 + natural killer cells; CD79 + plasma cells; and CD20 + B lymphocytes. Xavier et al [7] characterized the presence of CD68 cells and intense staining for transforming growth factor β (TGF-β) that is a strong inhibitor of the microbicidal activity of macrophages and induces fibrosis in ☆ Competing interests: The authors have no conflict of interest associated with this manuscript. ☆☆ This work had the financial support of the National Counsel of Technological and Scientific Development (Brasília, Brazil) grant number 481190/2010-4. The authors disclose no role of the sponsors on the study design, analysis, interpretation, writing, and in the decision to submit the article for publication. ⁎ Corresponding author. Ambulatório de Dermatologia, Centro de Ciências Biológicas e da Saúde, Universidade do Estado do Pará, 66087-670, Trav. Perebebui 2623, Marco, Belem, PA, Brazil. E-mail address: reginacarneiro@globo.com (F. R. Oliveira Carneiro). www.elsevier.com/locate/humpath http://dx.doi.org/10.1016/j.humpath.2014.10.016 0046-8177/© 2015 Elsevier Inc. All rights reserved. Human Pathology (2015) 46, 334–338