Pulmonary cavitation and skin lesions mimicking tuberculosis in a HIV negative patient caused by Sporothrix brasiliensis

Abstract

A 32-year-old HIV negative male presented with multiple pulmonary cavitation and skin abscesses up to 15 cm in diameter mimicking tuberculosis. Sporothrix brasiliensis was isolated and patient responded well to amphotericin B followed by itraconazole, except the skin lesions that had to be surgical drained to obtain cure.

Keywords: Amphotericin B; Genotyping; Pulmonary sporotrichosis; Serology; Sporothrix brasiliensis.

Fig. 1

Cutaneous ulcers on the chest, abdomen and back of a patient with pulmonary sporotrichosis (A and B). Cutaneous biopsy scar is visible in Fig. 1A.

Fig. 2

Numerous deep ulcerated nodules on the legs and thighs in the same patient (A, B, C and D).

Fig. 3

Large cutaneous abscesses on the arms (A) and thighs (B and C) due to S. brasiliensis infection.

Fig. 4

Pretreatment x-ray (A) showing numerous cavitary nodules spread in both lungs due to S. brasiliensis infection; 3 months post-treatment image (B); Pretreatment CT of the same patient (C) and 4 months post-treatment CT (D).

Fig. 5

Phylogenetic tree generated by Maximum Likelihood and Neighbour-Joining methods revealing the placement of the isolates HUPE 117310 and HUPE 117298 (●) in the S. brasiliensis clade (dashed clade). The percentage of replicate trees in which isolates clustered together in the bootstrap test (1000 replicates) are shown in the branches in both methods used.

Fig. 6

Lymph node fistula on the neck mimicking scrofuloderma: images before (A) and after systemic therapy (B).

Fig. 7

Surgical treatment of an abscess on the left wrist: pretreatment (A) and post-treatment (B) images.

Fig. 8

Surgical approach of intercommunicating skin abscesses on the right arm: images before surgery (A); with the drain (B) and post-treatment (C).

Fig. 9

Surgical treatment of a large cutaneous abscess on the left thigh: images before surgery (A); with the drain (B) and post-treatment (C).