Diagnosis: Sporotrichosis
A 55-year-old avid gardener presenting with a nodular lesion on the right hand with proximal lymphangitic spread along the forearm following a rose thorn injury.
Primary chancre-like ulcerated nodule on the dorsal right hand at the site of a prior rose thorn puncture. Linear succession of erythematous, firm subcutaneous nodules ascending along the lymphatic channels of the forearm (sporotrichoid spread). Some nodules have ulcerated.
Injury from rose thorn while gardening 5 weeks ago. Initial papule appeared at the inoculation site 2 weeks later, followed by progressive nodular eruption along the arm. No fever or systemic symptoms. Tissue culture grew Sporothrix schenckii.
Itraconazole 200mg daily for 3-6 months until 2-4 weeks after all lesions have resolved. Baseline liver function testing obtained. Wound care for ulcerated nodules. Gardening with protective gloves advised.
• Mycobacterial infection (M. marinum, M. kansasii) • Nocardiosis • Leishmaniasis • Tularemia • Cat scratch disease • Foreign body granuloma • Cutaneous lymphoma
• Caused by dimorphic fungus Sporothrix schenckii — classic zoonosis from soil/plant material • Classic lymphocutaneous pattern: inoculation chancriform nodule → linear nodules along lymphatic drainage • "Rose gardener's disease" — classic exposure history • Mnemonic for sporotrichoid spread: "five L's" — Leishmaniasis, Leprosy, Lupus vulgaris (TB), Lymphoma, and fungi (Sporothrix, NTM) • Culture on Sabouraud agar at 25°C: star-shaped colonies • Itraconazole is the treatment of choice for cutaneous/lymphocutaneous disease • Saturated solution of potassium iodide (SSKI) is a historical alternative treatment
Tags: fungal, deep mycosis, lymphocutaneous, occupational, itraconazole