Osteomyelitis caused by Sporothrix schenckii in an immunocompetent patient

Sporotrichosis is the most common subcutaneous mycosis in South America and its association with zoonotic transmission remains a relevant public health problem in Rio de Janeiro, Brazil. The disease most commonly presents as subacute or chronic cutaneous lesions, although dissemination to various organs and systems occurs in rare cases, mainly in immunosuppressed individuals. This report describes a case of sporotrichosis with severe bone and subcutaneous damage in an immunocompetent patient who did not exhibit the characteristic skin lesions of sporotrichosis, including ulcers, nodules, and lymphangitis.

Keywords:
Sporotrichosis; Osteomyelitis; Cutaneous fistulae

Authorship

Laura Cunha Ferreira

Serviço de Doenças Infecciosas e Parasitárias, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil. Universidade Federal do Rio de JaneiroBrazilRio de Janeiro, Rio de Janeiro, BrazilServiço de Doenças Infecciosas e Parasitárias, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil.

Paulo Feijo Barroso

Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil. Universidade Federal do Rio de JaneiroBrazilRio de Janeiro, Rio de Janeiro, BrazilDepartamento de Medicina Preventiva, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil.

Elise Tonomura

Serviço de Radiologia, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil. Universidade Federal do Rio de JaneiroBrazilRio de Janeiro, Rio de Janeiro, BrazilServiço de Radiologia, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil.

Tiyomi Akiti

Serviço de Micologia, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil.Universidade Federal do Rio de JaneiroBrazilRio de Janeiro, Rio de Janeiro, BrazilServiço de Micologia, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil.

Káris Maria de Pinho Rodrigues

Corresponding author: Profa. Káris Maria de Pinho Rodrigues. e-mail: karis@cives.ufrj.br

The authors declare that there is no conflict of interest.

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Figures

Figures (3)

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Figure 1
Images of the (A) right leg (B) and ankle before treatment. Edema was observed in the dorsum of the right foot, ankle, and pretibial region from where the purulent material was obtained for culture.

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Figure 2
Magnetic resonance imaging of the right lower extremity before treatment. (A) Sagittal and (B) Axial short tau inversion recovery images of the tibia showed areas of abnormally high signal intensity in the bone marrow, fistula drainage into the posterior adjacent tissue, and abscess formation in the pretibial space. (C) A sagittal proton density image of the ankle showed the abnormal high signal intensity of the talus bone marrow and fluid with varying signals within the articular space and the adjacent soft tissues, indicating a distinct protein content.

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Figure 3
Magnetic resonance imaging of the right lower extremity at 7 months following initiation of Itraconazole therapy. (A) Sagittal and (B) Axial short tau inversion recovery images of the tibia showed areas of abnormally high signal intensity in the bone marrow, with clearing of the soft tissue abscess. (C) A sagittal proton density image of the ankle showed the abnormal high signal intensity of the talus bone marrow and fluid with varying signals within the articular space and the adjacent soft tissues, indicating a distinct protein content.

Figure 1 Images of the (A) right leg (B) and ankle before treatment. Edema was observed in the dorsum of the right foot, ankle, and pretibial region from where the purulent material was obtained for culture.

Figure 2 Magnetic resonance imaging of the right lower extremity before treatment. (A) Sagittal and (B) Axial short tau inversion recovery images of the tibia showed areas of abnormally high signal intensity in the bone marrow, fistula drainage into the posterior adjacent tissue, and abscess formation in the pretibial space. (C) A sagittal proton density image of the ankle showed the abnormal high signal intensity of the talus bone marrow and fluid with varying signals within the articular space and the adjacent soft tissues, indicating a distinct protein content.

Figure 3 Magnetic resonance imaging of the right lower extremity at 7 months following initiation of Itraconazole therapy. (A) Sagittal and (B) Axial short tau inversion recovery images of the tibia showed areas of abnormally high signal intensity in the bone marrow, with clearing of the soft tissue abscess. (C) A sagittal proton density image of the ankle showed the abnormal high signal intensity of the talus bone marrow and fluid with varying signals within the articular space and the adjacent soft tissues, indicating a distinct protein content.

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Osteomyelitis caused by Sporothrix schenckii in an immunocompetent patient

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[1] Corresponding author: Profa. Káris Maria de Pinho Rodrigues. e-mail: karis@cives.ufrj.br