Ocular and Osseous Sporotrichosis in an Immunocompromised Patient: A Case Report

Brazil is a hyperendemic region for zoonotic sporotrichosis. Disseminated forms are uncommon and often occur in immunosuppressed individuals. This case highlights a rare presentation of fungal endophthalmitis in disseminated sporotrichosis. A 53-year-old man from Rio de Janeiro with a history of chronic alcoholism presented with weight loss and multiple disseminated nodulocystic and ulcerative skin lesions in mid-2022. Culture of exudate from one of the skin lesions revealed Sporothrix sp., and multiple osteolytic lesions were identified. He was prescribed oral itraconazole with improvement of skin lesions. He was hospitalized twice for courses of intravenous amphotericin B lipid complex, with partial improvement, and was maintained on oral itraconazole 400 mg/day. In May 2024, he experienced sudden worsening of visual acuity in the right eye and new hardened subcutaneous nodular lesions. Ophthalmologic examination diagnosed uveitis and endophthalmitis. Culture of an aqueous humor aspirate revealed Sporothrix sp. He was hospitalized and diagnosed with monoclonal gammopathy. Intravenous liposomal amphotericin B was initiated, along with intracameral and intravitreal amphotericin B injections and dexamethasone eye drops. After treatment, he showed partial clinical improvement of both skin and ocular lesions. He was discharged on oral posaconazole (800 mg/day) and continued intravitreal and intracameral amphotericin B therapy. He remains under ongoing follow-up for sporotrichosis and gammopathy. Ocular adnexal manifestations of sporotrichosis are not uncommon in hyperendemic areas of zoonotic sporotrichosis in Brazil and include granulomatous conjunctivitis, dacryocystitis, Parinaud oculoglandular syndrome, and bulbar conjunctivitis. In this patient, uveitis and endophthalmitis—rare manifestations of intraocular sporotrichosis—were observed. Immunosuppression, mainly due to chronic alcoholism (which had ceased for two years without clinical improvement), and the recent diagnosis of monoclonal gammopathy may have contributed to dissemination and persistence of the infection. The patient’s osteolytic lesions were attributed to disseminated sporotrichosis, complicating the overall clinical course. It is essential to recognize disseminated sporotrichosis and to screen these patients for conditions that cause immunosuppression, with special attention to early detection of uncommon extracutaneous manifestations of the disease.