Sporotrichosis is a fungal disease that causes symptoms similar to those of other infectious and non-infectious diseases, making diagnosis difficult and challenging. Here, we report a case of an HIV-negative patient presenting disseminated sporotrichosis with widespread cutaneous lesions mimicking pyoderma gangrenosum, with bone marrow infection, pancytopenia, and hemophagocytic syndrome. However, all the clinical manifestations and a bacterial coinfection delayed the request for a fungal diagnosis. Therefore, sporotrichosis should always be investigated in patients from endemic areas presenting with widespread cutaneous lesions associated with pancytopenia.

Sporotrichosis is a globally distributed subcutaneous mycosis caused by fungi of the Sporothrix complex, and is associated with worse outcomes in immunocompromised individuals, including those with diabetes mellitus. The impact of diabetes mellitus on the clinical presentation and outcomes of sporotrichosis remains poorly characterized. We conducted a systematic review of individual participant data to assess this association. Eight databases (Cochrane Library, Embase, LILACS, MEDLINE/PubMed, Scopus, Global Index Medicus/WHO, SciELO, and Web of Science) were searched without restrictions on publication date, country, language, sex, or age. The retrieved case data were divided into two groups: (1) localized disease and (2) systemic disease. We identified 122 cases of sporotrichosis in patients with diabetes mellitus from 64 articles and from 28 unpublished cases from Brazil and Mexico. Most patients were male (62.3%), with a mean age of 56.6 years, and 73% were from hyperendemic countries. Among cutaneous presentations, lymphocutaneous and fixed cutaneous forms were most frequent (41%), while osteoarticular multifocal disease was the leading extracutaneous manifestation (22.1%). Alcohol use disorder was independently associated with systemic disease (adjusted OR 4.76, 95% CI 1.45–18.05; P = .014). Compared with localized disease, systemic disease more commonly presented with joint symptoms (40.6% vs. 13.5%; P < .001), lesions with lower limb involvement (80% vs. 20%; P < .001), head involvement (81.3% vs. 18.8%; P < .001), and trunk involvement (84.6% vs. 15.4%; P < .001). Itraconazole monotherapy was the main treatment (45.9%), followed by amphotericin B-based regimens (33.6%). There were better outcomes for patients with localized disease than for those with systemic disease (cure rate 86.6% vs. 56.4%; P < .001). Systemic disease carried a 20% mortality rate in this population. These findings underscore the challenges posed by sporotrichosis in patients with diabetes mellitus and highlight the need for further research on risk factors for systemic disease and optimal treatment strategies for this population.

Background: Osteoarticular infection is an emerging complication of sporotrichosis, often leading to a significant increase in morbidity and longer treatment. Methods: We conducted a retrospective cohort study of osteoarticular sporotrichosis (OS) in southeastern Brazil (2014–2024) using clinical, epidemiological, and molecular data. Results: Among 252 patients, 20 (7.9%) had OS, including 10 (4%) with osteomyelitis. The median age of patients with OS was 58 years (IQR 39–64; range 18–83) and 55% were male. Hypertension (45%), diabetes (40%), alcohol use (40%), smoking (40%), and HIV infection (15%) were the most frequent conditions identified. Cutaneous lesions occurred in 95% of cases, and 90% of patients presented with arthralgia and edema. Multifocal OS was observed in 50% of cases, most commonly affecting the knees, fingers, and wrists. The mean time to diagnosis was 14.2 months. Most patients were treated with itraconazole combined with amphotericin B; 13 required surgical intervention, including 2 amputations. The mean treatment duration was 21 months. Multisystem involvement due to sporotrichosis was observed in 45% of cases, including pulmonary involvement. Mortality was 15%. Diabetes (OR = 4.11; 95% CI, 1.50–11.38; p = 0.006) was independently associated with OS. Conclusions: OS is associated with substantial morbidity and prolonged treatment. Diabetes may increase the risk of OS, while delayed diagnosis jeopardizes outcomes, underscoring the need for early management.

INTRODUÇÃO: A esporotricose é uma micose subcutânea causada pelo fungo do gênero Sporothrix com distribuição mundial. Tradicionalmente, a transmissão ocorre por meio da inoculação traumática de propágulos de Sporothrix spp. em tecidos da pele, os quais encontram-se presentes no meio ambiente. No entanto, casos de esporotricose zoonótica por meio do contato com felinos têm sido reportados no Brasil. Além disso, manifestações atípicas e com maior gravidade já foram observadas em micoses por Sporothrix brasiliensis. OBJETIVO: Traçar o perfil epidemiológico e clínico de pacientes diagnosticados com esporotricose em um hospital terciário em Belo Horizonte, Brasil. MÉTODOS: Foram incluídos 106 pacientes diagnosticados com esporotricose, entre 2014 a 2022. Os dados coletados foram resumidos por meio de estatística descritiva simples. RESULTADOS: Cinquenta e sete (53,8%) pacientes eram do sexo feminino. Os pacientes tinham entre 4 e 83 anos, 66,4% relataram contato prévio com gatos e a maioria dos casos (46,2%) ocorreu em Belo Horizonte. Encontramos opredomínio da forma linfocutânea 37 (34,9%), seguida pela forma extracutânea 34 (32,1%). Osistema osteoarticular foi o mais acometido com 24,5%, seguido pelo pulmonar 12,3%, ocular 9,4%e meníngeo 7,6%. Nesta coorte tivemos 12 (11,3%) óbitos por esporotricose. CONCLUSÃO: Nossoestudo confirma a emergência e expansão progressiva da esporotricose zoonótica no Estado de MG.Além disso, demonstra o grande potencial do desenvolvimento de formas sistêmicas de esporotricose,com destaque para o acometimento osteoarticular.