Subcutaneous bilateral sporotrichosis : A rare presentation Sydney Hartz Alves 1,2 , Pedro Lucas Aure´lio 3 , Mateus Z. Tecchio 2 , Augusto Zuchetto 3 , Re´gis Schirmer 3 & Janio M. Santurio 1 1 Department of Microbiology and Parasitology, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil; 2 Hospital Universita ´rio de Santa Maria, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil; 3 Laborato ´rio Enzilab, Cachoeira do Sul, RS, Brazil Received 27 January 2004; accepted in revised form 16 June 2004 Abstract Sporotrichosis is the most common subcutaneous mycosis observed in Brazil as well as in different regions of the world. We report a rare case of sporotrichosis in a Caucasian male agricultural worker whose lesions occurred bilaterally and simultaneously on the upper limbs. Key words: bilateral sporotrichosis, sporotrichosis, Sporothrix schenckii Introduction Sporotrichosis is a subcutaneous fungal infection caused by the traumatic implantation of the dimorphic pathogenic fungus, Sporothrix sche- nckii, representing the most common subcutane- ous fungal infection in the general population of Brazil [1, 2]. The occupational and recreational circumstances of infection, as well as the clinical manifestations in immunocompetent patients, have been well established [3, 4]. This study reports an unusual case of lymphangitic sporotrichosis with symmetric bilateral distribution on the upper limbs which was successfully treated with oral potassium iodide. Case report A 30-year-old Caucasian male, an agricultural worker living in the rural area of Cachoeira do Sul (state of Rio Grande do Sul, Brazil), had been frequently cutting down wildwood. He had developed lesions in the external region of both wrists and upper arms 6 months before clinical examination and reported frequent small injuries to his arms due to wood splinters. During clinical examination (September, 2002) he presented cancroid lesions about 3 cm in size on his wrists (Figure 1). He also presented two sup- purative nodules about 2 cm in size on both upper arms and bilateral lymphadenopathy in the ax- illary region. The clinical hypothesis required examination for the detection of fungi. A KOH direct mycological examination of pus, exudates and scrapings from lesions and culture on Mycobi- otic agar (Difco) were included in routine labo- ratory tests. The direct examination was negative. The culture was incubated at 25 °C and after 8 days it showed a creamy, wrinkled sur- face colony with a brownish color in the center. A slide culture with corn meal agar revealed numerous oval-shaped spores showing sympodial growth, which suggested Sporothrix schenckii. The identification of the aetiological agent was confirmed by the microscopic appearance of the fungus after conversion to the yeast form at 37 °C. The patient was treated with oral potassium iodide, 1.5 g three times a day after his meals, for 3 months. The post-treatment therapeutic re- sponse has been satisfactory, with no relapse after 1 year follow-up. Mycopathologia 158: 285–287, 2004. Ó 2004 Kluwer Academic Publishers. Printed in the Netherlands. 285