Citation: Magalhães, V.C.R.; Colombo, S.A.; Freitas, G.J.C.; Moura, A.S.; Vieira, F.C.L.; Lyon, A.C.; Azevedo, M.I.; Peres, N.T.d.A.; Santos, D.A. Late Diagnosis of Disseminated Sporothrix brasiliensis Infection with Bone Marrow Involvement in an HIV-Negative Patient. Pathogens 2022, 11, 1516. https://doi.org/10.3390/ pathogens11121516 Academic Editors: María Guadalupe Frías-De-León and María del Rocío Reyes Montes Received: 17 November 2022 Accepted: 8 December 2022 Published: 10 December 2022 Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affil- iations. Copyright: © 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/). pathogens Case Report Late Diagnosis of Disseminated Sporothrix brasiliensis Infection with Bone Marrow Involvement in an HIV-Negative Patient Vanessa Caroline Randi Magalhães 1,2 , Salene Angelini Colombo 3 , Gustavo José Cota Freitas 1 , Alexandre Sampaio Moura 2 , Flávia Cardoso Lopez Vieira 2 , Ana Cláudia Lyon 2 , Maria Isabel Azevedo 3 , Nalu Teixeira de Aguiar Peres 1, * and Daniel Assis Santos 1, * 1 Department of Microbiology, Institute of Biological Sciences, Universidade Federal de Minas Gerais, Av. Antônio Carlos, 6627, Belo Horizonte 31270-901, Brazil 2 Hospital Eduardo de Menezes, Fundação Hospitalar do Estado de Minas Gerais (FHEMIG), R. Dr. Cristiano Rezende, 2213, Belo Horizonte 30622-020, Brazil 3 Department of Preventive Veterinary Medicine, School of Veterinary, Universidade Federal de Minas Gerais, Av. Antônio Carlos, 6627, Belo Horizonte 31270-901, Brazil * Correspondence: naluperes@gmail.com (N.T.d.A.P.); dasufmg@gmail.com (D.A.S.); Tel.: +55-31-3409-2760 (N.T.d.A.P.); +55-31-3409-2758 (D.A.S.); Fax: +55-31-3409-2733 (N.T.d.A.P.); +55-31-3409-2733 (D.A.S.) Abstract: 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. Keywords: systemic sporotrichosis; pyoderma gangrenosum; hemophagocytic syndrome 1. Introduction Sporothrix brasiliensis is the leading agent of human and animal sporotrichosis in Brazil. The disease occurs after fungal inoculation on the host’s skin after being bitten or scratched by infected animals, mainly domestic cats [1]. On the other hand, Sporothrix species may also reach human patients through the traumatic implantation of the skin with fungal conidia from soil, plants, and decaying organic matter [2–4]. Sporotrichosis is also caused by other species, such as Sporothrix schenckii, Sporothrix globosa, and Sporothrix luriei [4,5]. However, S. brasiliensis is the most prevalent in Brazil, particularly in the south, southeast, and northeast [4,5]. The disease usually manifests as a chronic skin and subcutaneous infection with local lymph node involvement [3]. However, severe systemic organ manifestations have been observed in Brazil, mainly in immunocompromised individuals [6,7]. Low levels of CD4 + T cells in HIV patients predispose these individuals to the systemic dissemination of sporotrichosis. Other conditions such as diabetes, alcoholism, granulomatous diseases, cirrhosis, kidney transplantation, and chronic use of corticosteroids are also described to be associated with sporotrichosis [2,6]. In a recent systematic review of cases of sporotrichosis in Brazil carried out by Rabello et al. (2022) [5], the lymphocutaneous clinical form was predominant in 56.1% of the cases, followed by 27.1% of fixed cutaneous and 14.3% of systemic sporotrichosis. In that study, 16.9% of the patients were co-infected with HIV, 13.4% were diabetic, 6.1% were alcoholics, and 2.3% were smokers [5]. Despite its increasing incidence, severe sporotri- chosis remains a diagnostic challenge, mainly due to its resemblance to other diseases. Pathogens 2022, 11, 1516. https://doi.org/10.3390/pathogens11121516 https://www.mdpi.com/journal/pathogens