Retrospective Analysis of Patients with Cutaneous Sporotrichosis: Unusual Cause of Non-Healing Ulcers

Abstract

Background: Sporotrichosis (most reported subcutaneous mycosis) is caused by sporothrix schenckii species complex, a common saprophyte of soil, decaying wood, hay, and sphagnum moss caused by agent's inoculation on the skin or mucous membrane by trauma with contaminated soil and plant material. Aim and Objective: To study the clinico-epidemiological profile and unusual presentations in an area of high endemicity. Material and Methods: Retrospective analysis of 96 consecutive, diagnosed patients of sporotrichosis attending the Dermatology outpatient clinic between July 2015 to May 2018 was done. Clinical details regarding age, gender, occupation, onset, duration and progression of lesion, sites involved, history of trauma and various clinical patterns were recorded. Results: Of the 96 patients, 36(37.5%) were males and 60(62.5%) females (ratio 1:1.6). Seventy two (75%) patients were between the age group of 20-79 years with majority that is 56 (58.3%) between 20-59 years, these being the most active years of life. History of trauma was reported by 44% patients however 56% denied any such history. Clinically, 63 patients were of FCS and 33 were of LCS. Histopathology was consistent with sporotricosis in 42% patients, was suggestive of granuloma in 8%, deep fungal infections in 3%, results were awaited in 2% and not consistent in 45% patients. Conclusion:This study ascertains the clinico-epidemiological profile in the area as it was conducted in the endemic area of sporotrichosis and various unusual presentations were noted. The non-healing ulcer although is a rare presentation but the diagnosis could not be overlooked and the clinical suspicion is the key to diagnosis. Timely initiation of an effective treatment is imperative to prevent chronicity and morbidity. Culture remains gold standard; however, histology provides support to the diagnosis.