Childhood sporotrichosis: a case report

Abstract

Background: Sporotrichosis is an endemic disease caused by the thermally dimorphic fungal genus Sporothrix spp., and is the most prevalent of implantation or subcutaneous fungal infections. The disease can be chronic, and involves lymphatic vessels, fascia, muscles, cartilage and bones. Patients with sporotrichosis usually have implantation mycoses, caused by transcutaneous trauma, through which fungal conidia occur in the host.

Aim: To report a single case of infantile sporotrichosis treated at our Hospital. Method: This is a single case report of a patient attended at the Pediatrics of the Hospital Universitário São Francisco na Providência de Deus – HUSF, located in the city of Bragança Paulista – SP, Brazil.

Case Report: It was a female patient, 11 years old, with a history of a cat scratch on her right hand without improvement with previous antibiotic therapy. In the tolerated one, they suffered an ulcerous lesion at the base of the finger, in addition to enlarged lymph nodes on the wrist and forearm that extended to the axillary region, without other signs or symptoms of the persistent lesion. After collecting material for laboratory tests, including serology to investigate the cause of the lesion, a new antibiotic therapy with clindamycin, gentamicin and azithromycin was started. After 11 days of hospitalization, it was discovered that the family cat had sporotrichosis, which led to the diagnostic suspicion of lymphocutaneous sporotrichosis in the patient in question. A fungal culture was performed, and the treatment was then changed to itraconazole and doxycycline, with one patient showing improvement in the lesion after starting the new therapy. After 23 days of hospitalization, the diagnosis of lymphocutaneous sporotrichosis with growth of the fungus Sporothrix brasiliensis in the collected samples was confirmed. At the time of discharge, the wounds had already healed and there were no signs of lymph node enlargement. The patient continues treatment with itraconazole, and had follow-up tests to monitor her liver and kidney health, which showed no changes.

Conclusion: In many cases, in the presence of cats in the patients' homes, the fungal infection caused by Sporothrix spp., especially Sporothrix brasiliensis, can be confused with cat scratch disease, which in turn is caused by the bacterium Bartonella henselae. Such confusion can lead to the prescription of antibiotics, which ends up allowing the evolution of the infection. The crucial factor for the correct diagnosis and treatment is the identification of the fungal agent, and the beginning of the treatment with antifungals, including itraconazole, usually brings good results and total remission of the infection.