An 8-year-old female patient presented with pain and right peripalpebral edema with a 30-day evolution. She denied fever, ophthalmoplegia, or pain with ocular movement. Clinical worsening occurred with the appearance of micro-nodules and purulent discharge from the right eye. She sought ophthalmologic emergency care and was diagnosed with complicated hordeolum with microabscesses, preseptal cellulitis, and dacryocystitis. Amoxicillin-clavulanate was prescribed for 15 days, along with corticosteroid eye drops and warm compresses. Due to persistence of symptoms, she returned for reevaluation. Physical examination revealed hyperemia and edema of the right lower eyelid (2+/4+), purulent secretion, and microabscesses in the inferior tarsal conjunctiva, with no corneal, iris, or bulbar conjunctival abnormalities. Cranial CT scan was normal. She was hospitalized and started on intravenous ceftriaxone and clindamycin, and the hospital infectious disease team was consulted. A detailed history revealed that the family had two cats that had run away and later returned ill. Ocular sporotrichosis was suspected. Peripalpebral lesion scraping was performed for direct fungal examination and culture. Direct examination identified Sporothrix schenckii , and itraconazole was immediately initiated. The patient showed significant clinical improvement within five days and was discharged for outpatient follow-up with ophthalmology and infectious diseases, without further antibiotic use. Household contacts were screened, and the patient’s 5-year-old brother was diagnosed with the same fungus from a nodular erythematous lesion on the right ear. Approximately ten days later, the mother also developed erythematous plaque lesions on her back and was diagnosed by direct examination and initiated treatment.
Souza et al. (Sun,) studied this question.