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| Fig. 32.1 Sporotrichosis. A, Linear lesions secondary to a cat scratch. B, Erythematous, crusted, ulcerated nodule in a lymphocutaneous pattern. (Courtesy of James E. Fitzpatrick, MD.) |
Cutaneous sporotrichosis is more common than systemic sporotrichosis. Cutaneous sporotrichosis can be further divided into two forms: lymphangitic or lymphocutaneous disease, and fixed infection. The lymphocutaneous form accounts for approximately 80% of the cases. This classic form of sporotrichosis begins at the site of inoculation (most commonly, upper extremity) as a painless pink papule, pustule, or dermal nodule, which rapidly enlarges and ulcerates (Fig. 32-1A). Without treatment, the infection ascends along the lymphatics, producing secondary nodules and regional lymphadenopathy that may ulcerate (Fig. 32-1B). The fixed cutaneous variant (20%) is confined to the site of inoculation. The organism may rarely disseminate hematogenously to the joints, bone, meninges, or eye. Disseminated disease is most common in immunosuppressed patients, especially those with impaired cellular immunity (acquired immune deficiency syndrome [AIDS] patients). Pulmonary disease is usually due to inhalation and generally occurs in alcoholics, immunocompromised or debilitated patients. Both erythema nodosum and erythema multiforme have been reported as reactive eruptions to sporotrichosis.
Ramos-e-Silva M, Vasconcelos C, Carneiro S, Cestari T: Sporotrichosis,
Clin Dermatol 25(2):181–187, 2007.
