Sporotrichosis
A 65-year-old man who was otherwise healthy presented to the dermatology clinic with a 5-month history of a progressively enlarging annular rash over his right hand and forearm. He worked as a farmer in southern China and noted that the erythema had developed after trauma to his hand from agricultural work. He had treated himself with a topical mixture of juices and fragments from herbs, but there was no improvement in his condition. Physical examination revealed large, nontender, annular areas of erythema over the dorsum of the right hand and forearm with ulceration and crusting (Panel A). A biopsy was performed, and fungal culture grew Sporothrix schenckii (Panel B shows a macroscopic view, and Panel C a microscopic view [lactophenol cotton-blue stain]), a finding confirmed by polymerase chain reaction. Sporotrichosis is a subacute-to-chronic infection caused by the dimorphic fungus S. schenckii complex, which is found worldwide. The infection usually involves the skin and subcutaneous tissue and occurs from inoculation of the fungus from plants and soil through the skin. Persons who are immunocompromised are at higher risk for disseminated disease. The patient was treated with itraconazole and terbinafine and local thermotherapy for 2.5 months. At follow-up 4 months after the completion of treatment, the erythema and crusting had resolved. Jinglin Qin, M.Med. Junmin Zhang, M.D., Ph.D. Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China source: nejm.org
