A case of lymphangitic sporotrichosis occurring on both forearms with a published work review of cases of bilateral sporotrichosis in Japan

Abstract

The patient, 56-year-old man who was working as a clerk and a farmer, presented with nodules that had appeared on the dorsa of both his hands 3 months earlier. At the first examination, there were multiple dark-red nodules scattered on the fingers, dorsa and wrists of both hands. The nodules were up to 3 cm in diameter and had crusts in the incenters. The patient was suspected to suffer from prurigo and was subsequently treated with topical steroid, but the nodules did not respond. Therefore, a skin biopsy and fungal culture were performed, and the patient was finally diagnosed as having bilateral multiple sporotrichosis. He was then successfully treated with local thermotherapy and oral potassium iodide. Bilaterally-distributed lymphangitic sporotrichosis is very rare and often difficult to diagnose. Careful attention is required to avoid misdiagnosis.

Atypical presentation of sporotrichosis: report of three cases

“…The crawling exercise in soil with decaying vegetation, performed by our patient 2 prior to the onset of the bilateral lymphocutaneous lesions, suggests that there has been simultaneous multiple inoculations of the fungus into the dermis through microtrauma by plant material, since this is the natural habitat of Sporothrix sp., similar to that reported by other authors 7,8 . The bilateral presentation of sporotrichosis is described as atypical and rare, although it have already been reported in children by zoonotic transmission 9 or by trauma with plants in adults 7,8 . Differential diagnosis of this clinical presentation of sporotrichosis include cutaneous tuberculosis, atypical mycobacterial infection, prurigo, nocardiosis, and cutaneous leishmaniasis in its sporothrichosis-like clinical form 1,7 .…”

“…However, the difficulty of diagnosis of atypical sporotrichosis described in this study are also frequently reported in the literature, either in bilateral case of sporotrichosis 7,9 or in the osteoarticular involvement 3,4 , especially given the numerous other causes more commonly associated with, which are raised as the main diagnostic hypotheses 2,4 . In this scenario, it is common the occurrence of a late diagnosis, and, especially in relation to osteoarticular involvement, the delay in identifying the etiology of the injury can lead to unfavorable prognosis and may result in loss of function of the affected area 4,5 , similar to that observed in our patient that showed signs of muscle atrophy by disuse as a consequence of chronic difficulty in walking.…”

“…The bilateral presentation of sporotrichosis is described as atypical and rare, although it have already been reported in children by zoonotic transmission 9 or by trauma with plants in adults 7,8 . Differential diagnosis of this clinical presentation of sporotrichosis include cutaneous tuberculosis, atypical mycobacterial infection, prurigo, nocardiosis, and cutaneous leishmaniasis in its sporothrichosis-like clinical form 1,7 . Hypersensitivity reactions to infection by Sporothrix sp.…”

“…According to the majority of reported cases of bilateral sporotrichosis, this presentation may occur by self-inoculation, multiple inoculations or re-infection 7 . The crawling exercise in soil with decaying vegetation, performed by our patient 2 prior to the onset of the bilateral lymphocutaneous lesions, suggests that there has been simultaneous multiple inoculations of the fungus into the dermis through microtrauma by plant material, since this is the natural habitat of Sporothrix sp., similar to that reported by other authors 7,8 .…”

Thermotherapy in dermatologic infections

“…Clinicians subsequently experimented-at times, with significant success-with the use of local heat therapy to treat sporotrichosis. [4][5][6][7][8][9][10][11][12][13] Several other infections, to be outlined in this paper, have proven sensitive to induced local hyperthermia or thermotherapy. Although thermotherapy typically implies the use of heat, we will also discuss the use of cold therapy, in the form of cryotherapy, in select infections for Abbreviations used:…”