Sporotrichosis is a cutaneous mycosis caused by Sporothrix spp., mainly S. schenckii and S. brasiliensis . Human infection occurs primarily through traumatic inoculation and, in Brazil, zoonotic transmission through contact with infected cats has become the main route of infection. The main clinical forms are fixed cutaneous and lymphocutaneous. Disseminated forms also occur, more commonly in immunocompromised individuals. A 21-year-old previously healthy male sought dermatological care in July 2024 due to pustules, nodules, and erythema on the scalp associated with regional lymphadenopathy and left-sided chest pain with a two-month history. Sporotrichosis was diagnosed after skin biopsy with positive culture for S. schenckii . Treatment with itraconazole was initiated, leading to improvement of scalp lesions; however, left chest pain persisted and erythematous nodules developed in the region. Complementary investigation revealed chest CT showing an osteolytic lesion with bone sequestration in the 7th left costal arch, as well as soft tissue swelling extending to the cutaneous region. The patient was referred to thoracic surgery, and in May 2025, resection of the left 7th costal arch was performed due to significant tissue destruction. Culture of the surgical material showed growth of S. aureus and S. schenckii . Based on these findings, initial intravenous treatment with oxacillin and lipid complex amphotericin B was administered for 7 days, followed by oral levofloxacin and itraconazole. The patient was discharged in good condition and maintained improvement without recurrence until the last outpatient follow-up. Sporotrichosis rarely presents as a disseminated disease in immunocompetent patients. Osteoarticular involvement is among the most commonly affected sites, usually occurring by contiguity with cutaneous lesions. In this case, the mechanism of dissemination is questioned, whether hematogenous spread or local infiltration through the skin. Additionally, coinfection with a classic bacterial agent further increased the complexity of the case. Sporotrichosis is an expanding zoonosis that can present with diverse clinical manifestations even in healthy individuals, requiring increasing awareness among healthcare professionals.
Silva et al. (Sun,) studied this question.