Primary ocular sporotrichosis with granulomatous conjunctivitis
Keywords:ocular sporotrichosis, sporotrichosis, sporothrix, schenckii, granulomatous conjunctivitis, caseating granulomatous inflammation, Parinaud syndrome, zoonotic transmission of sporotrichosis
Sporotrichosis is an infection which is caused by the dimorphic fungus Sporothrix schenckii. Primary ocular sporotrichosis is uncommon in non-endemic areas and may be easily misdiagnosed, leading to a delay in initiation of treatment. In this case report, a 15-year-old girl, who is a post renal transplant patient presented with left eye swelling and localized redness at the medial canthal region. She was initially treated with topical antibiotics but there was no improvement. The addition of topical steroids led to the development of multiple nodules with central ulceration. Examination of the left eye showed granulomatous conjunctivitis. The features were suggestive of sporotrichosis and she was empirically started on oral itraconazole. A biopsy of the lesion showed caseating granulomatous inflammation and fungal PCR tested positive for Sporothrix schenckii. Her symptoms and clinical findings completely resolved after 3 weeks on itraconazole; however, her liver function deteriorated, and patient opted to discontinue the medication.
Chakrabarti A, Bonifaz A, Gutierrez-Galhardo MC, et al. Global epidemiology of sporotrichosis. Medical Mycology 2015; 53(1): 3–14.
Marimon R, Cano J, Gene J, Sutton DA. Sporothrix species of clinical interest. Journal of Clinical Microbiology 2007; 45(10): 3198–206.
Queiroz-Telles F, Buccheri R, Benard G. Sporotrichosis In Immunocompromised Hosts. Journal of Fungi 2019; (5): 1–23.
World Health Organization (WHO). Report of the tenth meeting of the WHO strategic and technical advisory group for neglected tropical diseases. WHO. Geneva, 2017.
Soto MCR. Sporotrichosis in the ocular adnexa: 21 cases in an endemic area in Peru and review of the literature. American Journal of Ophthalmology 2016; 162: 173–9.
Yamagata M, Rudolph FB, Clara M, et al. Ocular sporotrichosis: a frequently misdiagnosed cause of granulomatous conjunctivitis in epidemic areas. American Journal of Ophthalmology Case Reports 2017; 8: 35–8.
Conceição-Silva F, Nazaré Morgado F. Immunopathogenesis of human sporotrichosis: what we already know. Journal of Fungi 2018; 4(3): 22–32.
Arinelli A, Luisa A, Aleixo C, et al. Ocular sporotrichosis: 26 cases with bulbar involvement in a hyperendemic area of zoonotic transmission. Ocular Immunology and Inflammation 2019; 28(5): 764-71.
Orofino-Costa R. Sporotrichosis: an update on epidemiology, etiopathogenesis, laboratory and clinical therapeutics. Brazilian Annals of Dermatology 2017; 92(5): 606–20.
Ling JLL, Koh KL, Tai E, et al. A case of acute granulomatous conjunctivitis caused by cat-transmitted Sporothrix schenckii. Cureus 2018; 10(10): 8–12.
Filho AML, Cavalcante CM, da Silva AB, et al. High-virulence cat-transmitted ocular sporotrichosis. Mycopathologia 2019; 184: 547-9.
Ferreira TA, Sodr T. Primary conjunctival sporotrichosis: An atypical presentation of the disease. JAAD Case Reports 2018; 4: 497–9.
Carlos A, Valle F, De R. Zoonotic sporotrichosis in Rio de Janeiro, Brazil: a protracted epidemic yet to be curbed. Clinical Infectious Diseases 2010; 50(3): 453.
Queiroz-Telles F, Fahal AH, Falci DR, et al. Neglected endemic mycoses. Lancet Infectious Diseases 2017; 3099(17): 1–11.
Kano R, Okubo M, Siew HH, et al. Molecular typing of Sporothrix schenckii isolates from cats in Malaysia. Mycoses 2015; 58: 220–4.
Rodrigues AM, Teixeira MDM, de Hoog GS, et al. Phylogenetic analysis reveals a high prevalence of Sporothrix brasiliensis in feline sporotrichosis outbreaks. PLoS Neglected Tropical Diseases 2013; 7(6): e2281.
Almeida-Paes R, Marques M, de Oliveira E, et al. Sporotrichosis in Rio de Janeiro, Brazil: Sporothrix brasiliensis is associated with atypical clinical presentations. PLoS Neglected Tropical Diseases 2014; 8(9): e3094.
Kashima T, Honma R, Kishi S. Bulbar conjunctival sporotrichosis presenting as a salmon-pink tumor. Cornea 2010; 29(5): 573–6.
Kauffman CA, Bustamante B, Chapman SW, Pappas PG. Clinical practice guidelines for the management of sporotrichosis: 2007 update by the Infectious Diseases Society of America. Clinical Infectious Diseases 2007; 45: 1255–65.
Mahajan VK. Sporotrichosis: an overview and therapeutic options. Dermatology Research and Practice 2014; 2014: 272376.
An Open Access Publication is one that meets the following two conditions:
1. The author(s) and copyright holder(s) grant(s) to all users a free, irrevocable, worldwide, perpetual right of access to, and a license to copy, use, distribute, transmit and display the work publicly and to make and distribute derivative works, in any digital medium for any responsible purpose, subject to proper attribution of authorship, as well as the right to make small numbers of printed copies for their personal use.
2. A complete version of the work and all supplemental materials, including a copy of the permission as stated above, in a suitable standard electronic format is deposited immediately upon initial publication in at least one online repository that is supported by an academic institution, scholarly society, government agency, or other well-established organization that seeks to enable open access, unrestricted distribution, interoperability, and long-term archiving.
Authors who publish with this journal agree to the following terms: 1. Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal. 2. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal. 3. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.