#JAMAClinicalCase - Sporotrichosis: A Micaceous Plaque on th
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An older adult presented with a history of a mildly pruritic plaque on the elbow at the site of a prior injury. The medical history was unremarkable, and findings of a review of systems were negative. The patient had been treated in the past with topical steroids without improvement, and the size of the lesion had continued to grow slowly. Physical examination findings revealed a solitary, well-circumscribed pink plaque with overlying yellow-white micaceous scale with interspersed punctate hemorrhagic crusts. Because of a drug interaction with itraconazole, the patient was prescribed terbinafine, 250 mg daily.

Tissue culture results confirmed infection by Sporothrix schenckii, and the patient was diagnosed with fixed cutaneous disease- Sporotrichosis. It is a deep fungal infection caused by thermal dimorphic fungi. Sporotrichosis can also induce an immunoreactive state manifesting as erythema nodosum, reactive arthritis, Sweet syndrome, or erythema multiforme. Itraconazole, 200 mg daily until 2 to 4 weeks after clinical clearance can be used. Terbinafine, Saturated solution of potassium iodide, Amphotericin B has also been shown to be effective and may be used as an alternate therapy. Local treatments shown to have some efficacy in treating cutaneous disease include electrosurgery and cryotherapy.

Sarcoidosis, a clinically protean disease, may histologically display psoriasiform epidermal hyperplasia, however, well-formed epithelioid granulomas are the characteristic histologic finding, in contrast to the suppurative granulomas seen in this patient, the latter of which is highly suggestive of infection. Granulomatosis with polyangiitis is typified by a necrotizing vasculitis that often manifests clinically as purpura or pyoderma gangrenosum–like ulcerations.

source: https://jamanetwork.com/journals/jamadermatology/article-abstract/2767596