Case Report: Osteomyelitis Due to Sporothrix brasiliensis in Two Immunocompetent Patients Requiring Surgical Amputation

Abstract

Sporotrichosis is the most frequent subcutaneous mycosis in Latin America. Sporothrix brasiliensis is the most virulent species, responsible for the majority of human and animal cases in Brazil. Osteomyelitis was described as a potential comorbidity of S. brasiliensis infection; however, surgical amputation resulting from an extracutaneous form is a rare outcome. In such cases, immunodeficiency and alcoholism must be investigated. We present two unusual cases of surgical amputation as a severe morbidity resulting from osteomyelitis by S. brasiliensis in immunocompetent nonalcoholic patients.

Figure 1.

Patient’s lesions as presented at Day 0 in the Human Sporotrichosis Reference Clinic, Niterói, Rio de Janeiro, Brazil. Left fingers and ipsilateral lymph nodes fistulas on the forearms of Case 2 (A and C) and Case 1 (B and D), respectively.

Figure 2.

Image diagnosis. (A) Scintigraphy using (99m) Tc-labeled methylene diphosphonate attested to bone involvement at Day 11 in Case 1 (Left panel: Phase I of the three-phase Bone Scintigraphy - Front Up Member. The thin black arrow indicates the radioactive tracer access point. Right panel: Phase III where the green arrow points to the distribution of the radioactive tracer in the affected bone area by increased radio-label uptake. Blue arrows mark the infectious/inflammatory process of the ascending lesions in soft tissues). (B) X-rays of left hands show an ostial lesion on the medulla region in the thumb distal phalanx of Case 1 on Day 5 (left panel, red arrow) and Case 2 on Day 7 (right panel, green arrow).