A Case of Disseminated Cutaneous Sporotrichosis Mimicking Sarcoidosis, that Required Four Biopsies to Diagnose.

A 69-year-old Japanese woman visited Tokai University Oiso hospital with cutaneous ulcers on her left upper arm that appeared in January 2013, and on her right nose that appeared in December of 2013. Neither the two biopsies and tissue culture from the arm lesion nor the biopsy and tissue culture from the nose lesion detected any organism. In December of 2013, she was diagnosed as cutaneous sarcoidosis at Oiso hospital and treated with oral prednisolone for six months, however, did not show improvement. In June of 2014, third skin biopsy and culture from her left upper arm was done at our hospital, and also could not detect any organism. After six months of continuing treatment with oral steroids and steroid injections, the cutaneous ulcers became enlarged, with purulent exudate, requiring a fourth skin biopsy and culture from left upper arm, which finally detected Sporotrichosis. After one-month administration of itraconazole, in January of 2015, cutaneous ulcers of both the arm and nose shrunk. Sporotrichosis mimics sarcoidosis as well as other skin conditions clinically and histologically, therefore recognizing the importance of carrying out multiple skin biopsies and cultures are imperative to prevent misdiagnosis and improper treatments and possible dissemination.