Erythema nodosum associated with sporotrichosis

Abstract

Case 1 A 34‐year‐old woman had ulcerated lesion 2 cm in diameter on the right leg of 2 months’ evolution. She also presented painful erythematous nodules on lower limbs accompanied by arthralgia appearing 1 month after the initial lesion (Figure 1a). The patient reported having been scratched on the right leg by a cat with sporotrichosis 15 days before the initial symptoms. Examination of the ulcerated lesion showed growth of Sporothrix schenckii, and histological investigation of one nodule showed a mononuclear inflammatory infiltrate in the hypodermis with a predominantly septal distribution, negative upon culture for fungi (Figure 1b). Radiographic examination of left ankle showed increased soft tissue, while other ancillary tests were normal. The patient was treated with itraconazole 100 mg/day for 4 months, with regression of Erythema nodosum (EN) on day 20. Figure 1  (a) Ulcerated lesions on right calf and erythematous nodules on lower limbs. (b) Histopathology of one lower limbs nodule, displaying small granuloma in the subcutaneous cellular tissue (HE, 4 ×) Case 2 A 25‐year‐old woman presented to our facility for evaluation of an ulcerated lesion measuring 3 cm on her left wrist accompanied of ascending subcutaneous nodules on her lower limbs. She reported having been scratched on the site of a subsequent lesion 10 days previously by a cat with sporotrichosis. Culture of ulcerated lesions produced S. schenckii. The patient was placed on itraconazole 100 mg/day. One week after initiating treatment, she suffered a second scratch, which was followed, 7 days later, by nodular lesions located on the lower limbs accompanied by arthralgia and fever. Histopathology showed a predominantly hypodermic perivascular mononuclear inflammatory infiltrate with a septal distribution, forming small granulomas and producing a negative culture (Figure 2b). Radiography of ankles showed increased soft tissue. The treatment was maintained, with regression of EN after 50 days and total regression of lesions by the third month. 2 (a) Ulcerated lesion with infiltrated borders on left wrist and erythematous nodules on lower limbs. (b) Histopathology of one lower limbs nodule, showing granulomatous tissue reaction in hypodermis (HE, 20 ×) Case 3 A 12‐year‐old boy was admitted,with an ulcerated 2 cm lesion on the left foot with slightly infiltrated borders and secretion, accompanied by painful groin adenomegaly. Physical examination also revealed a recent scar measuring 1.5 cm on the left knee. He denied trauma but reported household contact with 11 cats with sporotrichosis. Upon his return visit 40 days later, the patient presented painful erythematous nodules on his knees and thighs, plus knees and ankles edema with arthralgia (Figure 3a). Culture of ulcerated lesion, by now nearly healed, showed S. schenckii. Histopathological examination of a nodule showed septal and lobular hypodermic infiltrate with formation of granulomas and negative fungal culture (Figure 3b). He was treated with itraconazole 100 ...

Sporotrichosis in Rio de Janeiro, Brazil: Sporothrix brasiliensis Is Associated with Atypical Clinical Presentations

“…However, except for 1 case of disseminated S. schenckii in a patient with AIDS, all of the unusual clinical forms of sporotrichosis were attributed to infection with S. brasiliensis , including disseminated cutaneous sporotrichosis in the absence of an underlying immunosuppressive condition, mucosal involvement affecting nasal cavity or conjunctiva, and hypersensitivity reactions. Regarding the hypersensitivity manifestations, our finding are consistent with the previously reported cases of erythema nodosum and erythema multiforme associated with zoonotic sporotrichosis [24], [25] due to S. brasiliensis . Recently, Sweet syndrome has also described in 3 patients with sporotrichosis [26], and studies are underway to determine, by calmodulin sequencing, the species involved in these cases.…”

Cat‐Transmitted Sporotrichosis Epidemic in Rio de Janeiro, Brazil: Description of a Series of Cases

“…These lesions may be explained by different mechanisms, such as self-inoculation, bloodstream dissemination, or aspiration of conidia and/or yeast forms from cat lesions or sneezes [29]. According to Gutierrez-Galhardo et al [32], cases of erythema nodosum may be due to constant exposure to the cat lesions containing large amounts of fungi, possibly leading to subclinical reinfection, resulting in hypersensitivity of the erythema nodosum type. The same may have occurred in patients presenting with erythema multiforme and arthralgia, symptoms present in ∼30% of patients, without radiologically visible involvement of bones or joints.…”

Sporothrix schenckii and Sporotrichosis

“…Erythema nodosum and erythema multiforme have been reported in cases of sporotrichosis by zoonotic transmission. These conditions appear to be associated with a hypersensitivity reaction, resulting from continuous exposure to large amounts of fungus and subclinical reinfections (86,89).…”