Oculoglandular Syndrome of Parinaud Caused by Sporothrix Schenckii in Maranhão: A Case Report

Sporotrichosis is an implantation fungal infection caused by the Sporothrix spp. complex. Parinaud’s oculoglandular syndrome is an ocular condition that, although uncommon, has been reported in several regions of Brazil and has shown relevance in areas of high endemicity. A 26-year-old female biologist, responsible for collecting samples from decomposing animals, presented with edema and erythema of the right upper eyelid for three weeks, associated with mild pruritus. She initially received antibiotic treatment in an ophthalmology service. Due to worsening symptoms, including palpebral edema, erythematous nodular formation, intense pruritus, purulent discharge, and conjunctival hyperemia, aerobic bacterial culture of ocular secretion was performed, isolating Pseudomonas montelli , sensitive to polymyxin B, which was initiated topically every 3 hours. She was referred to an infectious disease specialist with suspicion of ocular sporotrichosis; fungal cultures were collected and itraconazole 200 mg/day was initiated based on clinical-epidemiological suspicion. On follow-up, the lesion improved, with no pain or pruritus, although occasional discharge persisted. Three weeks later, fungal culture results were positive for Sporothrix schenckii and Candida parapsilosis , in addition to Pseudomonas monteillii . Treatment with itraconazole and polymyxin B was maintained. The patient showed progressive improvement, with only a small residual eyelid nodule and mild conjunctival hyperemia. She was discharged from outpatient care after complete healing and resolution of nodulation and conjunctival hyperemia following five months of itraconazole therapy (200 mg/day). This case illustrates that the increase in sporotrichosis cases has been accompanied by a broader range of clinical presentations and lesions. Itraconazole, alone or in combination, remains a cornerstone of treatment. Nonetheless, sporotrichosis management remains challenging due to low diagnostic suspicion and prolonged treatment duration.