Jorge Lobo‟s disease (JLD) or lacaziosis is a chronic, granulomatous skin and subcutaneous tissue infection caused by the fungus Lacazia loboi. Clinical lesions are generally polymorphous, often presenting with a keloid-like aspect, and most often involving ears or limbs. Histopathology remains the “gold standard” exam to reach diagnosis. Few clinical-pathological correlation studies on this disease are available to date. Our goal was to systematically review cases of JLD diagnosed at the dermatopathology laboratory of the Dermatology Service of the Federal University of Pará, Brazil, from 1967 to 2009. After a thorough chart review, we could retrieve demographic and clinical data, as well as histopathological features from each case studied. 59 biopsies from 45 patients were evaluated. The sample consisted of 37 men and eight women, with a mean age of 50 years. Most patients were agricultural workers (55%), of which 93% were males. Fifty-nine percent of the lesions showed a keloid-like appearance. Verrucous (8%), plaque (3%), gummatous (1%), and hyperchromatic macular (1%) lesions were less frequently observed. Most skin lesions occurred on the lower limbs (56%). Histopathologically, the stratum corneum showed hyperkeratosis in 71% of the biopsies, associated with parakeratosis in 37% and with orthokeratosis in 50%. Transepidermal elimination of parasites (TEP) was present in 36% of the cases in association with hyperkeratosis in 95% (p=0.0121) and with parakeratosis in 90% (p<0.0001). The epidermis showed a hyperplastic appearance in 58% of the specimens, was atrophic in 29%, normal in 12%, and ulcerated in 8% of them. There was a hyperplastic epidermis (86%, p=0.0054) in sites where TEP took place. We could also observe the presence of parasites in the epidermis in 30% of the biopsies, in which an association with TEP occurred in 89% (p<0.0001). There was no statistically significant relationship between the occurrence of TEP and the clinical aspect of the lesion (p=0.4231). Lymphocytes, macrophages and giant cells of the foreign-body type were predominant in the infiltrate, being observed in 100% of the cases. Plasma cells were seen in 35%, neutrophils in 15%, and eosinophils in 11% of the cases. There was a statistically significant relationship between the occurrence of TEP and the presence of neutrophil infiltration (p=0.0016). An exudative reaction pattern was present in 10% of the biopsies, and 11% exhibited focal areas of necrosis. Langhans giant cells were observed in 59% of the biopsies, and asteroid bodies in 5%. Pseudo-Gaucher cells were present in 69% of the cases, and fibrosis in 96%. The infiltrate showed extension to the reticular dermis in all cases, and to the deep dermis in 88%. A subcutaneous spread of the infiltrate occurred in 10% of the cases, with identification of parasites within the fat tissue in one of them. As for age distribution, sex and profession of the patients, the data overlapped those of the literature. The results allowed us to evaluate epidemiological, clinical and histopathological profiles of the disease, which in certain respects differed from the classically described ones of the literature, especially concerning characteristics of the epidermis, inflammatory cell infiltrate, and location of lesions.
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