A lesion with lymphangitic spread in a gardener

Abstract

A 52-year-old woman presented with a 6-week history of a tender nodule on her right arm (figure 1). Physical examination revealed a crusted, ulcerated, erythematous, 3-cm nodule on the forearm. Proximal to the lesion wereseveral tender, erythematous, 1.5-cm nodules sweeping up the medial aspect of the arm. The patient was an avid gardener who spent many hours caring for her rosebushes. There was no history of trauma to her hand. A 6-mm punch biopsy was performed. Histologic examination revealed a granubmatous infiltrate in the deep dermis (figure 2). Periodic acid-Schiff (PAS) stain revealed budding, pleomorphic, ovoid organisms characteristic of Sporothrix schenckii (figure 3). The patient was treated with 100 mg itraconazole orally twice a day for 6 weeks. The condition resolved during treatment and showed no sign of recurrence 6 months later.