LAUSR

A n 89-year-old Laotian immigrant with a past medical history of diet-controlled diabetes mellitus presented with a 4month history of fevers and skin lesions that persisted despite two courses of oral antibiotics. He also complained of dysphagia and odynophagia. He denied recent travel or gardening, but reported exposure to outdoor-dwelling cats. Physical examination revealed abscesses in various stages of healing involving the chin, trunk and elbows, but were most pronounced on the fingers, hands (Fig. 1) and feet. X-rays of both lower extremities (performed to assess for osteomyelitis) revealed multiple cortical tibial lucencies consistent with disseminated mycosis (Fig. 2). Wound swab and bone cultures grew Sporothrix schenckii. Biopsies of the left false vocal cord showed granulomatous inflammation consistent with sporotrichosis. HIV testing returned negative results. Sporotrichosis is caused by infection with the dimorphic fungus Sporothrix schenckii, and is classically transmitted via soil and plantmaterial such as sphagnummoss; zoonotic transmission has also been reported, most commonly from cats. The most common form of sporotrichosis is cutaneous, occurring on the hand or arm inoculated by a contaminated rose thorn or cat’s claw puncture. Disseminated sporotrichosis occurs most commonly in immunocompromised hosts, but this patient’s likely risk factors for dissemination were his diabetes and age.