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This case illustrates the challenges and complexities of managing disseminated sporotrichosis with CNS involvement in a patient with advanced HIV.

March 17, 2026Open Access

Disseminated Sporotrichosis With Neurological Involvement in a Person Living With Hiv: Case Report

Puntos clave

This case illustrates the challenges and complexities of managing disseminated sporotrichosis with CNS involvement in a patient with advanced HIV.
Case report of a 51-year-old woman with HIV and diabetes diagnosed with disseminated sporotrichosis.
Skin biopsy, bone marrow aspirate, and cerebrospinal fluid confirmed Sporothrix sp.
Resection of an intracranial lesion and initiation of antifungal therapy with liposomal amphotericin B.
Management of complications including renal failure and infections during treatment.
The patient demonstrated persistent infection in CNS despite treatment.
Frequent CSF monitoring was necessary due to complications.
Antifungal therapy was complicated by electrolyte disturbances and additional infections.

Resumen

Sporotrichosis is a mycosis caused by fungi of the Sporothrix genus, typically limited to the skin, but it may progress to severe disseminated forms in people living with HIV (PLHIV), particularly with central nervous system (CNS) involvement, a rare and highly lethal presentation. We report a case of a 51-year-old woman with diabetes, diagnosed with HIV in May 2024 during evaluation for disseminated sporotrichosis (CD4 count: 19 cells/mm³). She had extensive cutaneous ulcers, with Sporothrix sp. confirmed in skin biopsy, bone marrow aspirate, and cerebrospinal fluid (CSF). In July 2024, she underwent resection of an intracranial lesion, also positive for the fungus. Liposomal amphotericin B was started (May 30 to August 27, 2024), followed by maintenance therapy thrice weekly for 12 months, with serial lumbar punctures. Readmitted due to acute renal failure and electrolyte disturbances (hypokalemia, hypomagnesemia) attributed to the antifungal therapy. Because of persistent Sporothrix in the cerebrospinal fluid (01/31/25) and unavailability of the liposomal formulation, daily lipid complex amphotericin B was resumed on 02/06/25 for six weeks. She developed Klebsiella pneumoniae KPC bloodstream infection, treated with ceftazidime–avibactam, and Clostridioides difficile colitis, treated with oral vancomycin. After discharge in February 2025, she was readmitted in May 2025 for a possible reactivation of neurological sporotrichosis, with cerebrospinal fluid showing significant proteinorrachia. She remains hospitalized to date. Disseminated sporotrichosis in PLHIV is rare and associated with high morbidity. Severe immunosuppression, malnutrition, and delayed diagnosis worsen prognosis. CNS involvement requires prolonged amphotericin therapy, frequent CSF monitoring, and management of drug toxicities. This case highlights the severity and therapeutic complexity of CNS sporotrichosis in PLHIV, emphasizing the need for vigilance for opportunistic infections and integrated multidisciplinary care.

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Cite This Study

Borda et al. (Sun,) studied this question.

synapsesocial.com/papers/69b8ef6ddeb47d591b8c5822 https://doi.org/https://doi.org/10.1016/j.bjid.2026.104792

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