Disseminated sporotrichosis in a person with human immunodeficiency virus disease

Abstract

Introduction: Disseminated sporotrichosis is an incapacitating infection caused by the dimorphic fungus Sporothrix schenckii. Because this condition may mimic the presentation of tuberculosis, syphilis and other bacterial infections, the diagnosis may be missed or delayed.

Case presentation: We describe a case of disseminated sporotrichosis in a patient with poorly controlled human immunodeficiency virus infection. The patient was initially treated for bacterial skin infections. The differential diagnosis also included tuberculosis and syphilis. Only after appropriate specimens had been sent for microbiological and histopathological investigations was the diagnosis of disseminated sporotrichosis made and appropriate treatment started. The patient showed a good clinical response to itraconazole.

Conclusion: This report highlights the importance of having a high index of suspicion of endemic mycoses when managing immunocompromised patients. The report also demonstrates that a delay in the diagnosis of sporotrichosis increases morbidity and results in unnecessary and inappropriate treatment with associated costs and adverse effects.

Keywords: Sporothrix schenkii; disseminated sporotrichosis; human immunodeficiency virus; sporotrichosis.

Fig. 1.

Disseminated ulcerative lesions.

Fig. 2.

Right ear ulcerating lesions.

Fig. 3.

S. schenckii colonies on Sabouraud’s dextrose agar at 25 °C (front).

Fig. 4.

S. schenckii colonies on Sabouraud’s dextrose agar at 25 °C (reverse).

Fig. 5.

S. schenckii lactophenol cotton blue stain microscopy at 1000× magnification showing thin, 1–2 µm in diameter, septate, branching hyphae that give rise to delicate conidiophores and pyriform conidia that are arranged in a daisy flower like pattern on tiny denticles at the apex of the conidiophore.