Sporotrichosis - Cellulitis
The lesions of sporotrichosis may or may not spread up lymphatic channels. Three types are described:
- Fixed cutaneous
- Disseminated cutaneous
Systemic symptoms are rare except for extra-cutaneous disease, which includes osteoarticular involvement in immunocompetent individuals and pulmonary, CNS, and urogenital involvement in patients with decreased immunity. Osteoarticular sporotrichosis is the most common extra-cutaneous manifestation. Rarely, a multisystem disease can occur after hematogenous spread, usually in the immunocompromised. Pulmonary sporotrichosis is associated with alcohol use disorder, tuberculosis, diabetes mellitus, sarcoidosis, and steroid use.
The most commonly reported plants harboring the fungus include plants with thorns such as barberry and rose bushes, sphagnum moss, straw, hay, soil, and mine timbers. Occupation exposures include farmers, florists, gardeners, forestry workers, etc. Untreated cutaneous sporotrichosis usually waxes and wanes over many months to years without systemic manifestations.
Nodularity and ulceration are more commonly seen with sporotrichosis than in typical cases of cellulitis. Take a careful history of exposures.
B42.9 – Sporotrichosis, unspecified
42094007 – Sporotrichosis
- Mycobacterium marinum also causes a lymphangitic pattern on the extremity and has a similar pattern of red nodules.
- Cellulitis or erysipelas
- The typical pattern of lymphangitic spread can suggest herpesvirus infections (HSV and zoster).
- Cat-scratch disease
- Superficial thrombophlebitis
- Other infections such as blastomycosis, coccidioidomycosis, nocardiosis, tularemia, cutaneous tuberculosis, leishmaniasis (Old World and New World), and actinomycosis may have a similar lymphangitic spread from cutaneous inoculation. Exposure and travel history are key for diagnosis.
- Sarcoidosis rarely ulcerates or spreads along lymphatics.
- Cutaneous lymphoma may have associated fevers and weight loss.
- Bacterial abscess has an acute onset.
- Pyoderma gangrenosum bleeds easily and appears vascular.
- Vasculitis does not usually have an exophytic growth pattern.
- Foreign body reaction to sea urchin spines or barnacles
- Halogenoderma (bromoderma, iododerma)