Cutaneous Sporotrichosis

Cutaneous sporotrichosis is a distinctive clinical syndrome, yet the diagnosis is frequently overlooked in individual patients for weeks or even months. A possible explanation for this delay is the relative rarity of this disease in many areas of the United States. The cases to be reported emphasize the distinctive clinical features, laboratory methods of diagnosis, and epidemiology of cutaneous sporotrichosis and reveal a hitherto unrecognized mode of transmission of the disease. Events will be described chronologically in an attempt to preserve the suspense and humor inherent in the investigation of the outbreak. Patient Summaries and Epidemiological Investigation In January an 18-year-old college freshman (patient 1) was referred to Shands Teaching Hospital for excision of a chronic ulcer on the right wrist. He was found to have a shallow necrotic ulcer with rolled edges on the flexor surface of the involved wrist (Figure). The base of the lesion measured 2 to