Disseminated Sporothrix brasiliensis infection with endocardial and ocular involvement in an HIV-infected patient

Abstract

Disseminated sporotrichosis occurs in individuals with impaired cellular immunity, such as in cases of neoplasia, transplantation, diabetes, and especially, acquired immunodeficiency syndrome. This report presents a 32-year-old Brazilian human immunodeficiency virus (HIV)-infected patient who developed a protracted condition of disseminated sporotrichosis with endocarditis, bilateral endophthalmitis, and lymphatic involvement. He needed cardiac surgery to replace the mitral valve. Sporothrix brasiliensis isolates were recovered from cultures of subcutaneous nodules and mitral valve fragments. Species identification was based on classical and molecular methods. The patient received amphotericin B for 52 days and subsequently, oral itraconazole. He remains asymptomatic, and he is on maintenance therapy with itraconazole. Despite his positive clinical outcome, he developed bilateral blindness. To our knowledge, this case is the first report of endocarditis and endophthalmitis caused by S. brasiliensis.

Figure 1.

Echocardiographic assessment showing increased diameter of the left atrium and lesioned mitral valve with aneurysmatic formation and regurgitation. (A, B, and E) Transversal view showing mitral valve vegetation. (C and F) Apical view showing mitral valve vegetation. (D) M-mode echocardiogram showing mitral valve lesion. IVS = interventricular sept; LA = left atrium; LV = left ventricle; MV = mitral valve; RA = right atrium; RV = right ventricle.

Figure 2.

Micromorphology of the simpodial and sessil conidia of the S. brasiliensis strain Ss 265 developed on CMA media after 10 days of incubation at 25°C. Hyaline conidia simpodially arranged in a bouquet-like fashion at the ends of the conidiophores are shown in A. Globose dark pigmented sessile conidia are shown in details. (Scale bar: 3 μm).