
==== Front
Med Mycol Case Rep
Med Mycol Case Rep
Medical Mycology Case Reports
2211-7539
Elsevier

S2211-7539(24)00041-1
10.1016/j.mmcr.2024.100667
100667
Case Report
Sporotrichosis caused by Sporotrix globosa in an elderly male farmer at the site of a cat scratch
Sakai Yuka a
Norimatsu Yuta norimanorima@gmail.com
a⁎
Akatsuka Taro a
Hamada Toshihisa a
Gomi Harumi b
Sugaya Makoto a
a Department of Dermatology, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita, Chiba, 286-8520, Japan
b Center for Infectious Diseases, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita, Chiba, 286-8520, Japan
⁎ Corresponding author. norimanorima@gmail.com
06 9 2024
12 2024
06 9 2024
46 1006674 7 2024
29 8 2024
4 9 2024
© 2024 The Author(s)
2024
https://creativecommons.org/licenses/by/4.0/ This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
We report a case of sporotrichosis in an elderly male farmer at the site of a cat scratch scar.

An 84-year-old Japanese farmer was scratched by his cat two months before his visit to our hospital.

A skin biopsy was performed. Tissue culture revealed the presence of Sporothrix globosa.

The patient was treated with oral itraconazole 200 mg/day for 13 months due to a slow healing ulceration, and the symptoms resolved. (71 words).

Keywords

Sporotrichosis
Farmer
Cat scratch scar
Sporothrix schenckii
Sporothrix globosa
Handling editor: Dr Adilia Warris
==== Body
pmc1 Introduction

The disease sporotrichosis, caused by dimorphic fungi from the Sporothrix schenckii complex, is widespread in tropical and subtropical regions [1]. This infection is usually caused by percutaneous trauma in which the fungus invades the host. Such infections may progress to chronic cutaneous, subcutaneous and/or deep infections involving lymphatics, fascia, muscle, cartilage and bone. Sporotrichosis, however, rarely results in death. The pathogen thrives in soil and decaying vegetation such as dead wood, water moss, corn stalks, and hay. Humans are usually infected by traumatic inoculation with the fungus during outdoor activities such as farming, gardening, and animal husbandry. Sporotrichosis is also known as a zoonosis. In particular, cat owners are at risk for developing cat-transmitted sporotrichosis [1]. Recent genetic analysis has shown that there are at least six species of Sporothrix [2]. These fungi are known to be distributed geographically, and Sporothrix globosa is reported to be the main causative agent in Japan [3].

To the best of our knowledge, there have been no reports of human sporotrichosis transmitted from cats in Japan, although there have been reports of sporotrichosis in cats [4,5].

We report a case of sporotrichosis in the area of a cat scratch scar in an 84-year-old Japanese farmer.

2 Case presentation

An 84-year-old Japanese male farmer was scratched by his cat two months before his visit to our hospital. Skin ulcers and nodules had developed and he was treated with gentamicin ointment by the local doctor. As the symptoms did not improve, he was referred to our hospital (day 0). His medical history included hypertension, diabetes mellitus, and benign prostatic hyperplasia.

His medical history included diabetes mellitus and psoriasis vulgaris. He was taking furosemide, febuxostat, doxazosin, nifedipine, empagliflozin, candesartan, vonoprazan, dabigatran etexilate methanesulfonate, and donepezil.

On the dorsum of his right hand were multiple red nodules with ulceration visible (Fig. 1a).Fig. 1 Clinical image of the back of the hand at initial examination and at day 553 (10 months after discontinuation of treatment).

Fig. 1

Blood tests at the first visit showed slightly raised C-reactive protein 0.35mg/dL (normal range 0mg/dL-0.3mg/dL), normal white blood cell counts 6180/μL (normal range 3300/μL-8600/μL), and no increased level of β-D glucan (<0.5pg/mL; normal range 0 pg/mL-20 pg/mL). Skin biopsy was performed to differentiate nontuberculous mycobacterial infection and fungal infection (day 0).

Pathologically, hematoxylin and eosin staining showed a diffuse cellular infiltrate spreading into the dermis. Granuloma formation with multinucleated giant cell infiltration was also observed. (Fig. 2a and b).Fig. 2 Pathological findings (a) Hematoxin eosin staining showed a diffuse cellular infiltrate spreading into the dermis. (b) Granuloma formation with multinucleated giant cell infiltration was also observed.

Fig. 2

Grocott staining and Periodic acid-Schiff stain showed numerous fungi (Fig. 3).Fig. 3 Periodic acid-Schiff stain and Grocott staining

Periodic acid-Schiff stain (a) and Grocott staining (b) showed numerous fungi (see arrows).

Fig. 3

Sequence analysis (amplification of spacer region (ITS1) between 18S rRNA and 5.8S rRNA) led to a diagnosis of infection by Sporothrix globosa [6] (Fig. 4).Fig. 4 Tissue culture and genetic testing

Tissue culture (Sabouraud agar) (a) and sequence analysis (amplification of spacer region (ITS1) between 18S rRNA and 5.8S rRNA) (b) led to a diagnosis of infection by Sporothrix globosa.

Fig. 4

The patient was treated with itraconazole 200 mg/day for 13 months, e.g. until 4 weeks after the skin laesion was healed and the symptoms resolved. We followed the patient up until day 553, and no recurrences were observed (Fig. 1b).

3 Discussion

We present a highly likely cat-transmitted case of sporotrichosis which developed after a cat scratch in an 84-year-old Japanese farmer.

Unfortunately, we were unable to culture any specimen from the cat.

Potassium iodide, itraconazole, and terbinafine are the main drugs used to treat sporotrichosis [1,7,8]. Itraconazole, in particular, is considered the first-line drug for the treatment of sporotrichosis, so it was also used in this case [7]. The patient was treated with itraconazole for a prolonged period for time (13 months) due to a very slow healing ulcer [9,10]. The reason for the slow healing of the skin laesions is most likely related to his poor glycemic control.

Sporothrix globosa is also known to be occasionally resistant to itraconazole [[11], [12]], although was not considered in our case as regression of the laesion was observed albeit in a slow manner. No recurrence was noted during the follow-up visit ten months after the discontinuations of the treatment (day 553).

Conflict of interest

None.

Ethical form

This study received no funding, and there are no potential conflicts of interest to declare. We obtained written and signed consent to publish the case report from the patient. We have also received permission from the Ethics Committee to report this case. (22-Nr-018).

CRediT authorship contribution statement

Yuka Sakai: Writing – review & editing, Writing – original draft, Visualization, Resources, Investigation, Data curation. Yuta Norimatsu: Writing – review & editing, Writing – original draft, Visualization, Validation, Supervision, Software, Resources, Project administration, Methodology, Investigation, Formal analysis, Data curation, Conceptualization. Taro Akatsuka: Writing – review & editing, Visualization, Resources, Data curation. Toshihisa Hamada: Writing – review & editing, Visualization, Resources, Methodology, Data curation. Harumi Gomi: Writing – review & editing, Validation, Supervision, Resources, Methodology, Investigation, Formal analysis, Conceptualization. Makoto Sugaya: Writing – review & editing, Supervision, Software, Resources, Project administration, Methodology, Conceptualization.

Appendix A Supplementary data

The following is the Supplementary data to this article:Multimedia component 1

Multimedia component 1

Acknowledgements

None.

Appendix A Supplementary data to this article can be found online at https://doi.org/10.1016/j.mmcr.2024.100667.
==== Refs
References

1 Barros M.B. de Almeida Paes R. Schubach A.O. Sporothrix schenckii and sporotrichosis Clin. Microbiol. Rev. 24 2011 633 654 21976602
2 Marimon R. Gene J. Cano J. Molecular phylogeny of Sporothrix schenckii J. Clin. Microbiol. 44 2006 3251 3256 16954256
3 Chakrabarti A. Bonifaz A. Gutierrez-Galhardo M.C. Mochizuki T. Li S. Global epidemiology of sporotrichosis Med. Mycol. 53 2015 3 14 25526781
4 Hirano M. Watanabe K. Murakami M. Kano R. Yanai T. Yamazoe K. Fukata T. Kudo T. A case of feline sporotrichosis J. Vet. Med. Sci. 68 2006 283 284 16598175
5 Nakamura Y. Sato H. Watanabe S. Takahashi H. Koide K. Hasegawa A. Sporothrix schenckii isolated from a cat in Japan Mycoses 39 1996 125 128 8767006
6 The Japanese Pharmacopoeia 15th edition Rapid Identification of Microoganisms Based on Molecular Biological Method vol. 285 2006 1741 1742
7 Kauffman C.A. Bustamante B. Chapman S.W. Pappas P.G. Clinical practice guidelines for the management of sporotrichosis: 2007 update by the Infectious Diseases Society of America Clin. Infect. Dis. 45 2007 1255 1265 17968818
8 Francesconi G. Francesconi do Valle A.C. Comparative study of 250 mg/day terbinafine and 100 mg/day itraconazole for the treatment of cutaneous sporotrichosis Mycopathologia 171 2011 349 354 21103938
9 Sharkey-Mathis P.K. Kauffman C.A. Graybill J.R. Stevens D.A. Hostetler J.S. Cloud G. Dismukes WE. Treatment of sporotrichosis with itraconazole. NIAID mycoses study group Am. J. Med. 95 3 1993 279 285 8396321
10 de Lima Barros MB. Schubach A.O. de Vasconcellos Carvalhaes de Oliveira R. Martins E.B. Teixeira J.L. Wanke B. Treatment of cutaneous sporotrichosis with itraconazole--study of 645 patients Clin. Infect. Dis. 52 12 2011 e200 e206 21628477
11 Fischman Gompertz O. Rodrigues A.M. Fernandes G.F. Bentubo H.D. de Camargo Z.P. Petri V. Atypical clinical presentation of sporotrichosis caused by Sporothrix globosa resistant to itraconazole Am. J. Trop. Med. Hyg. 94 2016 1218 1222 27114300
12 Suzuki R. Yikelamu A. Tanaka R. Igawa K. Yokozeki H. Yaguchi T. Studies in phylogeny, development of rapid IdentificationMethods, antifungal susceptibility, and growth rates of clinical strains of Sporothrix schenckii complex in Japan Med. Mycol. J 57 2016 E47 E57 27581775
