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Disseminated subcutaneous sporotrichosis in an immunocompetent patient: A case report and a systematic literature review

Summary

A 74-year-old man developed multiple infected lumps on his arm, wrist, and finger months after being injured by a tree branch. Doctors identified the infection as sporotrichosis caused by a fungus called Sporothrix schenckii using advanced genetic testing. He was successfully treated with itraconazole tablets for several months and completely recovered. This case is unusual because sporotrichosis typically affects people with weakened immune systems, but this patient had a normal immune system.

Background

Sporotrichosis is a subacute and chronic infectious disease caused by the sporotrichosis complex affecting skin, subcutaneous tissues, and lymphatic vessels. Disseminated subcutaneous sporotrichosis typically occurs in immunocompromised patients but is rare in immunocompetent individuals. Different Sporothrix species show varying virulence and antifungal susceptibility patterns.

Objective

To report a case of disseminated subcutaneous sporotrichosis in an immunocompetent 74-year-old male patient and conduct a systematic literature review of disseminated subcutaneous sporotrichosis cases with species identification to analyze associations between Sporothrix species and clinical presentation.

Results

The patient presented with red masses on the right forearm, wrist, and little finger with local ulceration following tree branch injury. mNGS identified Sporothrix schenckii. Itraconazole treatment resulted in complete healing without scarring at 4-month follow-up. Systematic review identified 22 disseminated cases: 31.8% S. schenckii, 54.5% S. brasiliensis, and 13.6% S. globosa, with cure achieved in 15 patients, recurrence in 5, and 1 death.

Conclusion

Disseminated subcutaneous sporotrichosis can occur in immunocompetent patients and may be related to bacterial strain virulence rather than solely immune status. mNGS provides rapid and accurate species identification to guide antifungal therapy selection. Different Sporothrix species demonstrate varying virulence and drug sensitivity, with S. schenckii associated with higher treatment duration than S. brasiliensis.
  • Published in:Medical Mycology Case Reports,
  • Study Type:Case Report with Systematic Literature Review,
  • Source: PMID: 41079969, DOI: 10.1016/j.mmcr.2025.100739
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