Beyond the Usual Suspects: A Challenging Case of Disseminated Sporotrichosis Masquerading as Suppurative Lymphadenitis in a Dialysis-Dependent Chronic Kidney Disease Patient With Lupus.

Abstract

Sporotrichosis, a subcutaneous mycosis, can manifest as severe disseminated disease in immunocompromised hosts. This report describes a challenging case of extracutaneous sporotrichosis in a 28-year-old female with systemic lupus erythematosus (SLE) on immunosuppressive therapy, who also faced significant socioeconomic constraints. The patient initially presented to the emergency department with a painful right inguinal mass. Physical examination revealed a hemorrhagic lesion, and aspiration of the material was performed for culture, which returned negative. She was discharged but returned 2 months later with worsening symptoms and widespread lesions. During this second admission, a detailed history finally revealed contact with cats. The patient was readmitted for an inguinal lymph node biopsy. Histopathological analysis revealed granulomatous lymphadenitis with stellate necrosis, and the diagnosis was ultimately confirmed by culture, identifying Sporothrix schenckii complex. Treatment with itraconazole was initiated but later switched to liposomal amphotericin B due to hepatotoxicity. The patient completed a 1-year course of liposomal amphotericin B with an excellent clinical response. This case highlights the diagnostic complexity of sporotrichosis in patients with SLE, its potential for severe dissemination, and the impact of socioeconomic barriers on timely diagnosis and disease management.