Case history
Case history
A 45-year-old man from Missouri without significant past medical history presented to his primary care physician 3 weeks after a rose thorn abraded the dorsal surface of his right index finger while he was gardening. Two weeks after the injury he developed a nontender nodular lesion that subsequently ulcerated with only scant serous drainage. He was prescribed cephalexin without clinical improvement and returned to his physician 10 days later when he developed 2 nodular nontender lesions on his right forearm. He otherwise felt well and denied fever, chills, or other symptoms. Except for the 1 x 2-cm well demarcated ulcerated lesion overlying the right index proximal interphalangeal joint and two 2 x 2-cm erythematous nontender, nonfluctuant nodular lesions in his right forearm, his physical exam was unremarkable without associated lymphadenopathy or synovitis. His complete blood count and basic metabolic panel values were within normal range.
Other presentations
Besides the most common lymphocutaneous form of sporotrichosis, fixed cutaneous lesions, also called plaque sporotrichosis, without ascending lymphangitic spread can occur. Such lesions are verrucous or plaque-like and may ulcerate.[1][2] In patients with HIV, skin lesions tend to be more extensive and often manifest as atypical punched-out ulcerations.
Extracutaneous sporotrichosis can also occur, usually in patients with underlying medical conditions such as diabetes, COPD, alcohol use disorder, HIV, and hematologic malignancies. Osteoarticular sporotrichosis is the most common extracutaneous manifestation and is seen in normal hosts but also in patients with alcoholism, diabetes, and HIV. It can present as monoarthritis or oligo/polyarthritis involving the knee, hand, wrist, elbow, or ankle with sparing of the hip, shoulders, and spine; tenosynovitis, bursitis, or nerve entrapment syndromes may coexist.[4][5] Pulmonary sporotrichosis develops in patients with COPD or alcoholism as subacute cavitary upper lobe pneumonia mimicking pulmonary tuberculosis.[6] Meningeal sporotrichosis may follow an indolent chronic course in patients with HIV.[7]
Disseminated sporotrichosis presenting with multiple skin lesions and varying visceral involvement occurs in patients with HIV and hematologic malignancies.[8][9] Other less common presentations include laryngeal or ocular sporotrichosis, and fungemia.[1][2]
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