Infection by a Dimorphic Fungus Sporothrix schenckii in an Immunocompromised Patient

Abstract

Infections caused by dimorphic fungi, rarely observed in a temperate climate, may cause chronic infections in immunocompromised patients. We describe a case of sporotrichosis in a 50-year-old woman, who underwent mastectomy due to breast carcinoma, followed by radiation and chemotherapy. She developed skin lesions, localized along the lymphatics. Discharge samples repeatedly yielded a characteristic growth of the dimorphic fungus Sporothrix schenckii. The isolate was resistant to all commonly used antifungal agents, except for itraconazole. Therapy with this antifungal agent resulted in disappearance of the clinical symptoms.

Clinical Practice Guidelines for the Management of Sporotrichosis: 2007 Update by the Infectious Diseases Society of America

“…Disseminated infection with S. schenckii is unusual and is most likely to occur in immunosuppressed patients, including patients with AIDS who have low CD4 + cell counts, transplant recipients, and those who are receiving chemotherapy, corticosteroids, or TNF antagonists [24][25][26][27][28]. In immunosuppressed patients, sporotrichosis is an opportunistic mycosis and may present with a variety of clinical forms, including disseminated cutaneous disease, fungemia, and disseminated visceral disease.…”

Sporothrix schenckii complex biology: environment and fungal pathogenicity

“…schenckii causes a localized lymphocutaneous disease in the immunocompetent host, while it frequently results in disseminated disease in the immunocompromised patient. Disseminated sporotrichosis occurs in individuals with impaired cellular immunity, such as in cases of neoplasia, transplantation, diabetes, and especially AIDS (Wroblewska et al , 2005; Freitas et al , 2012; Silva-Vergara et al , 2012). The extracutaneous forms of sporotrichosis without skin manifestations and with no previous history of traumatic injuries have been described in renal transplant recipients not treated with antifungal prophylaxis (Gewehr et al , 2013).…”