Disseminated Osteoarticular Sporotrichosis
We report a case of multiple skin lesions, lymphadenopathy, and osteoarticular sporotrichosis in a man infected with human immunodeficiency virus (HIV). He subsequently died of tuberculosis after successful treatment for osteoarticular sporotrichosis with amphotericin B. We describe the unusual histopathology in disseminated sporotrichosis with acquired immunodeficiency syndrome (AIDS) and compare it with that seen in patients without AIDS. Although the optimal treatment of osteoarticular sporotrichosis in patients with AIDS is unknown, use of amphotericin B in our patient appeared successful. Culture and histologic stains of all tissues taken at autopsy were negative for sporotrichosis. Recent studies of similar cases have shown initial treatment with amphotericin B followed by long-term maintenance with itraconazole to be beneficial.
Sporotrichosis is an ubiquitous fungal infection caused by the dimorphic organism Sporothrix schenckii. Typically, it gains entrance into the skin by inoculation from contaminated plants or soil. Lymphocutaneous sporotrichosis is classically characterized by subcutaneous nodules distributed along lymphatic vessels. Pulmonary sporotrichosis is a rare but well-recognized opportunistic fungal infection, usually occurring in patients with alcohol abuse; long-term, high-dose corticosteroid treatment; or diabetes mellitus. Disseminated sporotrichosis is an uncommon manifestation and has been reported as the initial infection of AIDS. Although sporotrichosis is not commonly seen in patients with AIDS, the numbers are increasing. We report the case of a man infected with HIV who initially had osteoarticular sporotrichosis and later had disseminated disease to skin and lymph nodes. The patient was treated successfully with amphotericin B.
We report a case of multiple skin lesions, lymphadenopathy, and osteoarticular sporotrichosis in a man infected with human immunodeficiency virus (HIV). He subsequently died of tuberculosis after successful treatment for osteoarticular sporotrichosis with amphotericin B. We describe the unusual histopathology in disseminated sporotrichosis with acquired immunodeficiency syndrome (AIDS) and compare it with that seen in patients without AIDS. Although the optimal treatment of osteoarticular sporotrichosis in patients with AIDS is unknown, use of amphotericin B in our patient appeared successful. Culture and histologic stains of all tissues taken at autopsy were negative for sporotrichosis. Recent studies of similar cases have shown initial treatment with amphotericin B followed by long-term maintenance with itraconazole to be beneficial.
Sporotrichosis is an ubiquitous fungal infection caused by the dimorphic organism Sporothrix schenckii. Typically, it gains entrance into the skin by inoculation from contaminated plants or soil. Lymphocutaneous sporotrichosis is classically characterized by subcutaneous nodules distributed along lymphatic vessels. Pulmonary sporotrichosis is a rare but well-recognized opportunistic fungal infection, usually occurring in patients with alcohol abuse; long-term, high-dose corticosteroid treatment; or diabetes mellitus. Disseminated sporotrichosis is an uncommon manifestation and has been reported as the initial infection of AIDS. Although sporotrichosis is not commonly seen in patients with AIDS, the numbers are increasing. We report the case of a man infected with HIV who initially had osteoarticular sporotrichosis and later had disseminated disease to skin and lymph nodes. The patient was treated successfully with amphotericin B.
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