An Uncommon Rash in the Emergency Department: Sporothrix schenckii

Abstract

The authors present a case of Sporothrix schenckii diagnosed in the emergency department, based on a thorough history. The patient presented with skin nodules that had spread proximally up the arm in various stages of healing. He reported minimal pain for the unhealed ulcer and no pain for the healing ulcers, and no other concerning symptoms. The history of a thorn prick followed by the initial red nodule on the forearm has led to the diagnosis -as it was consistent with the classic presentation of lymphocutaneous sporotrichosis. A high index of suspicion and carefully noting occupational history is required for a diagnosis of sporotrichosis. Clinicians should recommend long sleeves and gloves to their patients when they are handling soil.

Epidemiology of Clinical Sporotrichosis in the Americas in the Last Ten Years

“…A total of 48 publications related to sporotrichosis were found in North America [ 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 ]. There were 1460 patients in total associated with infection caused by species of the genus Sporothrix .…”

“…According to the previous classification, it was found that in Canada, only two case reports were found, one from Ontario and the other from Toronto [ 5 , 6 ]. In the US, 27 reports containing 1 clinical case were found (81.5% S. schenckii , 18.5% Sporothrix spp., S. schenckii complex, and S. schenckii sensu lato ) [ 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ]. Of these, seven cases came from California, three from Oklahoma, two cases from Kansas, Texas, Arizona, Minnesota, and Florida, one case from Michigan, Nebraska, Oregon, Pennsylvania, and finally, one case without a specific city or region.…”

“…In the US, it was reported that Sporothrix spp. (85.19%) and S. schenckii (14.81%) were responsible for this pathology [ 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ]. Finally, in Mexico, 85.05% were due to Sporothrix spp., 14.33% S. schenckii , 0.55% S. globosa, and 0.07% S. mexicana [ 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 ].…”

“…The most frequent variety reported was lymphocutaneous with 956 cases, followed by fixed cutaneous with 388 cases, and the disseminated form with 83 [ 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 ]. A lymphocutaneous presentation evolved into a disseminated after 10 months.…”

“…The most common reported etiological agent with the new taxonomical classification was Sporothrix spp. with 85.00% (1241/1460), followed by S. schenckii with 14.38% (210/1460), S. globosa with 0.54% (8/1460), and S. mexicana with 0.068% (1/1460) [ 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 ].…”