Sporotrichosis is a subcutaneous mycosis caused by fungi of the genus Sporothrix . In immunocompetent individuals, the disease usually presents with benign manifestations limited to the skin and adjacent lymphatic vessels. Atypical forms, with multiple lesions or extracutaneous manifestations (pulmonary, osteoarticular, disseminated), are rare and occur mainly in immunosuppressed patients or in hyperendemic areas. We report the case of a 59-year-old female, retired, living in a rural area of Santa Catarina, with a 25-year history of psoriasis and psoriatic arthritis for one year. After refractoriness to methotrexate and disease-modifying drugs, she started anti-TNF immunobiologic therapy (adalimumab) three years earlier. She presented to the outpatient clinic with nasal obstruction, hyperemia, and edema in the maxillary and nasal regions, progressing to an ulcerative lesion on the nasal columella. She had undergone three cycles of antibiotics without improvement and was admitted for investigation and treatment. In addition to cutaneous findings, she complained of chronic cough, and CT scan showed a 6 cm cavitary mass in the right lung, with “tree-in-bud” pattern opacities. She reported prior contact with a cat suspected of sporotrichosis. Skin biopsy revealed fungal structures, and culture confirmed Sporothrix schenckii complex. Bronchoalveolar lavage was negative for mycobacteria, histoplasmosis, aspergillosis, and paracoccidioidomycosis, raising suspicion of pulmonary involvement by Sporothrix . She was treated with lipid complex amphotericin B for four weeks, with significant clinical improvement, and was discharged on outpatient itraconazole 400 mg/day. Sporotrichosis in immunocompromised hosts may be associated with more severe clinical courses, higher fungal burden, and longer durations of systemic antifungal therapy. Extracutaneous forms, such as pulmonary disease, may occur alone or as part of disseminated disease. Anti-TNF agents, although essential for the treatment of several autoimmune diseases, increase the risk of infections such as sporotrichosis. Diagnosis can be challenging due to atypical clinical and radiological presentations. In Brazil, sporotrichosis represents a growing public health problem, with expansion in communities and increasing cases of atypical and disseminated disease in immunosuppressed patients, posing greater diagnostic and therapeutic challenges.
Diaz et al. (Sun,) studied this question.