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Patient Case: Sporotrichosis

Patient Case: Sporotrichosis

Discussion

Chief Complaint: “A sore on my hand isn’t healing, and now I have more bumps along my arm.”

History of Present Illness:
A 35-year-old male landscaper presents with a non-healing ulcer on his right hand, which started as a small red bump three weeks ago after he pricked his finger while handling rose bushes. Over time, the lesion enlarged, ulcerated, and became mildly painful. He now notices new, smaller nodules forming in a line up his forearm. He denies fever, chills, or systemic symptoms.

Past Medical History:

  • No history of immunosuppression
  • No recent travel or animal bites

Physical Examination:

  • Skin: A painless ulcer with raised borders on the dorsum of the right hand. Multiple firm, erythematous nodules in a linear pattern extending up the forearm. No pus or deep tissue involvement.
  • Lymph nodes: Non-tender, no significant lymphadenopathy
  • Lungs & Abdomen: Normal

Diagnosis:
The patient’s history of gardening, combined with a slowly progressing ulcer and nodular lymphangitic spread, strongly suggests sporotrichosis, caused by Sporothrix schenckii, a dimorphic fungus found in soil and plant matter.

Diagnostic Tests:

  • Fungal culture from ulcer exudate → Growth of Sporothrix schenckii
  • Histopathology → Granulomatous inflammation with cigar-shaped yeast
  • Chest X-ray → Normal (to rule out systemic involvement)

Management Plan:

  • First-line treatment: Oral itraconazole for 3–6 months
  • For severe cases or immunocompromised patients: IV amphotericin B
  • Wound care: Keep the ulcer clean and avoid re-exposure to contaminated soil
  • Patient counseling: Educate about wearing gloves when handling plants or soil to prevent reinfection

The patient is reassured that sporotrichosis is a localized infection in most cases and has a good prognosis with antifungal treatment.

Questions
  1. What is the most likely cause of this patient’s skin infection?
    a) Sporothrix schenckii
    b) Staphylococcus aureus
    c) Mycobacterium leprae
    d) Leishmania braziliensis
  2. Which of the following best describes the typical spread of cutaneous sporotrichosis?
    a) Hematogenous dissemination with multiple abscesses
    b) Direct contiguous spread from the initial wound
    c) Lymphangitic spread with nodular lesions along the lymphatic channels
    d) Rapid necrotizing infection with tissue destruction
  3. What is the first-line treatment for mild to moderate cutaneous sporotrichosis?
    a) Oral fluconazole
    b) IV amphotericin B
    c) Oral itraconazole
    d) Oral doxycycline
  4. Which activity most likely led to this patient’s infection?
    a) Swimming in freshwater lakes
    b) Gardening and handling rose bushes
    c) Working in a pet store with exotic animals
    d) Consuming contaminated seafood
Reveal answers

Answers

  1. (a) Sporothrix schenckii – This dimorphic fungus is the causative agent of sporotrichosis, a subcutaneous fungal infection often associated with trauma from plants or soil exposure.
  2. (c) Lymphangitic spread with nodular lesions along the lymphatic channels – Sporotrichosis is known for its characteristic lymphocutaneous pattern, where new nodules form along the draining lymphatics, often appearing as a “sporotrichoid” spread.
  3. (c) Oral itraconazole – This is the first-line treatment for mild to moderate sporotrichosis. Severe cases (or immunocompromised patients) may require IV amphotericin B.
  4. (b) Gardening and handling rose bushes – Sporothrix schenckii is found in soil, decaying vegetation, and plant materials. It often enters the body through skin trauma caused by thorn pricks, splinters, or plant handling, making gardening a major risk factor.

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