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Disseminated sporotrichosis caused by Sporothrix brasiliensis with testicular involvement

Summary

A 35-year-old homeless man with HIV developed a serious fungal infection caused by Sporothrix brasiliensis that spread throughout his body, including to his brain and testicles. A testicle lump was initially thought to be cancer and surgically removed, but it was actually a fungal infection. This is only the fifth case ever reported of this fungus infecting testicles. The patient was successfully treated with antifungal medications and remains healthy one year later.

Background

Sporotrichosis is a neglected mycotic disease with increasing prevalence due to Sporothrix brasiliensis outbreaks in Brazil and neighboring countries. Disseminated sporotrichosis accounts for approximately 4% of cases and is typically associated with immunocompromised conditions. Testicular involvement in sporotrichosis is exceptionally rare, with only four previous cases reported in the literature.

Objective

To report a case of disseminated sporotrichosis caused by S. brasiliensis with meningeal, pulmonary, and testicular involvement in an HIV-positive patient. To describe the clinical presentation, diagnostic findings, and management of this atypical manifestation and review the literature on testicular sporotrichosis.

Results

A 35-year-old homeless HIV-positive patient presented with disseminated S. brasiliensis infection involving skin, mucosa, meninges, lungs, and testicles. Direct examination and fungal cultures confirmed sporotrichosis; molecular identification identified S. brasiliensis. Testicular involvement was initially misdiagnosed as malignancy leading to orchiectomy, confirmed by histopathology as Sporothrix infection. Treatment with amphotericin B followed by itraconazole resulted in clinical improvement.

Conclusion

This is the first reported case of disseminated sporotrichosis with testicular involvement caused by S. brasiliensis. The case emphasizes the importance of considering sporotrichosis in the differential diagnosis of testicular masses in immunocompromised patients in endemic areas, as misdiagnosis can lead to unnecessary surgical interventions. Early 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:Case Report,
  • Source: PMID: 40677965
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