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Disseminated sporotrichosis caused by Sporothrix brasiliensis with testicular involvement

Summary

This case report describes a rare fungal infection caused by Sporothrix brasiliensis in a 35-year-old man living with HIV/AIDS. The infection spread throughout his body, affecting his skin, lungs, brain, and testicles. Doctors initially thought the testicular involvement was cancer and removed the testicle, but lab tests confirmed it was a fungal infection. The patient was successfully treated with antifungal medications and remains disease-free one year later.

Background

Sporotrichosis is a neglected mycotic disease with increasing prevalence, particularly in Brazil and neighboring countries. Sporothrix brasiliensis has emerged as a significant pathogen causing large outbreaks with atypical manifestations. Disseminated sporotrichosis with testicular involvement remains exceptionally rare, with only four previously reported cases in the literature.

Objective

To report and analyze a case of disseminated sporotrichosis caused by Sporothrix brasiliensis involving the meninges, lungs, and testicles in an immunocompromised patient. The study aimed to highlight the rarity of testicular involvement and the potential for misdiagnosis as malignancy.

Results

A 35-year-old HIV-positive homeless man presented with disseminated sporotrichosis affecting skin, mucosa, meninges, lungs, and testicles. Sporothrix brasiliensis was confirmed through fungal culture and molecular identification. The testicular nodule was initially misdiagnosed as malignancy and treated with orchiectomy, but histopathology revealed necrotizing granulomatous inflammation with Sporothrix yeasts. All isolates were wild-type for antifungal susceptibility and belonged to a clonal clade from southern Brazil. The patient achieved clinical cure with combined amphotericin B and itraconazole therapy.

Conclusion

This is the first reported case of disseminated sporotrichosis with testicular involvement caused by Sporothrix brasiliensis. The case underscores the importance of considering sporotrichosis in the differential diagnosis of testicular masses in immunocompromised patients in endemic areas, as misdiagnosis led to unnecessary orchiectomy. Laboratory confirmation through fungal culture and molecular identification is essential for accurate diagnosis and appropriate antifungal therapy.
  • Published in:Medical Mycology Case Reports,
  • Study Type:Clinical Case Report,
  • Source: PMID: 40677965, DOI: 10.1016/j.mmcr.2025.100716
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