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Sporotrichum schenckii

- See: Anti-Fungal Agents

- Discussion:
    - is a fungus that may be introduced into the extremity thru abrasions caused by splinters or thorns (rose bushes);
    - incubation period is 1-12 weeks;
    - may start as a red papular lesion and then develops into an abscess and spreads to the regional lymphatics, resulting in multiple granulomas, which occur along the course of the lymphatics, and ulcerate as the area is ruptured;
          - subcutaneous inoculation with the ubiquitous fungus sporothrix schenckii leads to chronic granulomatous infection that involves skin and subQ tissues.
    - sporotrichosis should be considered in the differential diagnosis of chronic inflammatory monoarticular arthritis and tenosynovitis, especially where there is a risk of inoculation with spores.

- Histological Exam:
    - look for a pyogranulomatous inflammatory response;
    - neutrophils surrounded by multinucleated giant cells, epithelioid cells, and lymphocytes;
    - typically there are only a few yeasts visualized;
    - use periodic acid-Schiff and Gomori-methenamine silver (difficult to see on hematoxylin and eosin staining);
    - Splendore-Hoeppli phenomenon:
          - eosinophilic halo
          - may result from a central fungus surrounded by products of disintegrated host cells and other debris; and possibly antigen-antibody complexes as well.

- Treatment:
    - supersaturated potassium iodide is the drug of choice;
          - lymphocutaneous disease generally can be treated orally with saturated potassium iodine solution, while those with pulmonary or deep infection require amphotericin or ketoconazole;
          - toxic effects of the iodide include excessive lacrimation, lacrimal-gland and parotid-gland enlargement

Sporotrichosis of the Upper Extremity.

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