Lymphocutaneous sporotrichosis :A case from southeastern China

A 53-year-old male in Ningbo, a city of southeastern China. He visited us on 14 October 2021, with the chief complaint of a 5-month history of slowly enlarging, estering wounds that started on his left thumb, extended to his ipsilateral forearm 2 months later and then to his ipsilateral upper-arm.Previous treatments with antibiotics and topical ointments caused no improvement. He had a history of abnormal glucose tolerance and high blood pressure,but no immunodeficiency diseases. He referred an accidental stab by wood chips before the onset of illness.Physical examination showed the ulceration and festering of the three wounds(Figure1A-C). Routine hematological and biochemistry investigations, including the interferon-gamma release assay(IGRA) and immunologic tests, were normal. The imaging studies of heart, lung and stomach were no abnormal. The histopathology of previous hospital showed acute and chronic inflammation associated with epithelial hyperplasia and multinucleate cells reaction. The wounds were received debridement in our ward.For a definitive diagnosis of this pathogen, pus specimens culture and smear were be performed on day1, we also send pus specimens for metagenomic next-generation sequencing(mNGS) test, which was performed by Vision Medicals CO. Ltd (Guangzhou, China). We found yeast-like fungus by immunofluorescence staining (Figure2 A) on day2. On day3, the mNGS detected sporothrix globosa with 2652 high-confidence sequence reads that showed 99.0% identity and covered 0.83% of the sporothrix globosa genome. About 10 days later, the pathogen was identifified as Sporothrix schenckii species complex based on findings of fungi cultured on Sabouraud glucose medium (Figure2 B).