# A Presentation of Necrotizing Disseminated Sporotrichosis

## TL;DR

This paper presents a rare case of severe, widespread sporotrichosis in a healthy man, highlighting the challenges in diagnosis and treatment.

## Contribution

The case highlights an uncommon, rapidly progressive form of sporotrichosis in an immunocompetent individual.

## Key findings

- The patient had necrotizing lesions caused by disseminated Sporothrix schenckii.
- Corticosteroid use may have worsened the fungal infection.
- Early recognition of environmental exposure is critical for diagnosing sporotrichosis.

## Abstract

We report a biopsy-proven case of disseminated sporotrichosis in a 42-year-old immunocompetent male, highlighting an uncommon presentation with rapid clinical deterioration. The patient initially presented with cutaneous lesions involving the face, thorax, and extremities that were suspected to represent a delayed hypersensitivity reaction to trimethoprim-sulfamethoxazole, and he was treated with systemic corticosteroids. He returned 10 days later with worsening necrotic lesions and constitutional symptoms. Otolaryngology and dermatology services obtained multiple skin biopsies, which demonstrated numerous fungal yeast forms across distinct anatomic sites. Subsequent history revealed facial trauma from a tree branch while gardening several weeks before presentation. Plasma next-generation sequencing (Karius Spectrum Test) demonstrated strong molecular evidence of disseminated Sporothrix schenckii. Sporotrichosis is a subcutaneous mycosis typically acquired via traumatic inoculation and most commonly presents as localized disease in immunocompetent hosts; disseminated infection is rare and usually associated with immunosuppression. This case underscores the diagnostic challenge of sporotrichosis, the potential for corticosteroid exposure to exacerbate fungal infections, and the importance of early consideration of endemic mycoses in patients with progressive cutaneous lesions and relevant environmental exposures. The patient required intensive care for septic shock secondary to disseminated sporotrichosis and was treated with broad-spectrum antimicrobial and antifungal therapy.