Disseminated Sporotrichosis With Neurological Involvement in a Person Living With Hiv: Case Report

Sporotrichosis is a mycosis caused by fungi of the Sporothrix genus, typically limited to the skin, but it may progress to severe disseminated forms in people living with HIV (PLHIV), particularly with central nervous system (CNS) involvement, a rare and highly lethal presentation. We report a case of a 51-year-old woman with diabetes, diagnosed with HIV in May 2024 during evaluation for disseminated sporotrichosis (CD4 count: 19 cells/mm³). She had extensive cutaneous ulcers, with Sporothrix sp. confirmed in skin biopsy, bone marrow aspirate, and cerebrospinal fluid (CSF). In July 2024, she underwent resection of an intracranial lesion, also positive for the fungus. Liposomal amphotericin B was started (May 30 to August 27, 2024), followed by maintenance therapy thrice weekly for 12 months, with serial lumbar punctures. Readmitted due to acute renal failure and electrolyte disturbances (hypokalemia, hypomagnesemia) attributed to the antifungal therapy. Because of persistent Sporothrix in the cerebrospinal fluid (01/31/25) and unavailability of the liposomal formulation, daily lipid complex amphotericin B was resumed on 02/06/25 for six weeks. She developed Klebsiella pneumoniae KPC bloodstream infection, treated with ceftazidime–avibactam, and Clostridioides difficile colitis, treated with oral vancomycin. After discharge in February 2025, she was readmitted in May 2025 for a possible reactivation of neurological sporotrichosis, with cerebrospinal fluid showing significant proteinorrachia. She remains hospitalized to date. Disseminated sporotrichosis in PLHIV is rare and associated with high morbidity. Severe immunosuppression, malnutrition, and delayed diagnosis worsen prognosis. CNS involvement requires prolonged amphotericin therapy, frequent CSF monitoring, and management of drug toxicities. This case highlights the severity and therapeutic complexity of CNS sporotrichosis in PLHIV, emphasizing the need for vigilance for opportunistic infections and integrated multidisciplinary care.