Cutaneous Sporotrichosis With Suppurative Lymphatic Progression: A Case Report

Sporotrichosis is a subcutaneous mycosis caused by fungi of the Sporothrix complex, usually acquired through traumatic inoculation of contaminated organic material. The lymphocutaneous form is the most common clinical presentation, characterized by nodular and ulcerated lesions distributed along lymphatic vessels. The fixed form may evolve into more severe presentations if not adequately treated. Diagnostic delay may lead to prolonged use of antimicrobials and unnecessary hospitalizations. To report a case of sporotrichosis with progression from localized cutaneous form to suppurative lymphocutaneous disease, highlighting diagnostic and therapeutic challenges. A 62-year-old hypertensive female developed a cutaneous lesion after trauma with wood, with a sensation of a splinter in the distal phalanx of the index finger. Two weeks later, she developed an erythematous ulcer approximately 5 mm in diameter, without purulent exudate, and was treated with cephalexin for seven days. Ten days later, the lesion increased in size (approximately 1 cm), with yellowish exudate and pinpoint hemorrhagic areas. Trimethoprim-sulfamethoxazole was initiated for seven days. Due to progressive worsening and lack of response, she was hospitalized. On admission, she had an extensive ulcer with granulation tissue, necrosis, and purulent exudate. She received oxacillin, cefepime, and linezolid, in addition to surgical debridement. After partial improvement, she was discharged with a deep ulcerated lesion. Approximately two weeks later, she experienced recrudescence and was rehospitalized, receiving cefepime, linezolid, and vancomycin. Five days after readmission, subcutaneous nodules appeared along an ascending trajectory toward the elbow, which suppurated in the following week, characterizing suppurative lymphocutaneous sporotrichosis. Histopathological examination revealed chronic inflammatory infiltrate with poorly formed histiocytic granulomas, and silver staining was positive for yeast-like structures compatible with Sporothrix spp. Itraconazole was initiated, with planned use for up to six months. This case illustrates an uncommon clinical progression of sporotrichosis from fixed cutaneous to suppurative lymphocutaneous form, emphasizing the importance of including subcutaneous mycoses in the differential diagnosis of chronic refractory ulcers, especially after trauma. Early clinical suspicion and histopathological confirmation are essential for appropriate management, avoiding inappropriate antimicrobial use and unnecessary hospitalizations.