Tumor-like periungual cutaneous sporotrichosis in an endemic area^☆

Dear Editor,

Sporotrichosis is the most prevalent subcutaneous myco-sis in tropical and subtropical areas, caused by fungi of the genus Sporothrix,¹ whose transmission occurs predom-inantly through bites or scratches from infected animals in urban areas of endemic regions,² such as the Amazon region.³

The clinical forms of cutaneous sporotrichosis are divided into: lymphocutaneous, fixed cutaneous, and disseminated. The lymphocutaneous form is the most common, characte-rized by ulcers, classically accompanied by lymphangitis. It usually affects the upper limbs of adult patients and the face in children.¹,⁴ In forms without lymphangitis, such as the fixed cutaneous form, the diagnosis may be less remembered.⁵

This report describes a patient with localized cutaneous sporotrichosis with an exuberant and atypical tumor presen-tation, diagnosed in an endemic area.

The patient is a 44-year-old female, a florist for 15 years, residing in Manaus, Amazonas, who was previously healthy. For two weeks, she presented with a painful, progressively growing lesion on the second finger of her left hand, follow-ing trauma from a plant thorn. The patient denied contact with sick animals. On physical examination, an ulcerated, purplish, friable tumor was observed, covered by fibrinous material and involving the entire distal extremity, associ-ated with microvesicles at the base of the lesion, without lymphangitis (Fig. 1). She had received cephalexin 500 mg every 6 hours for seven days, without clinical improvement. An incisional biopsy was performed, and fragments were sent for culture and histopathology. The histological examination revealed a suppurative granulomatous process (Fig. 2), with no fungi detected by PAS. The bacterial culture was negative, while the fungal culture isolated Sporothrix spp (Fig. 3). Real-time polymerase chain reaction from culture material revealed Sporothrix brasiliensis. Itracona-zole, 200 mg/day, was started, with significant improvement in pain and significant lesion regression in three weeks of use. After four months of treatment, there was complete resolution of the tumor (Fig. 4).

Fig. 1
A purplish, ulcerated, friable, and vegetating nodule covered by fibrinous exudate in the periungual region.

Fig. 2
Epidermal hyperplasia and granulomatous infiltrate with neutrophils (left. Hematoxylin & eosin, ×4). Infiltrate of epithelioid cells (upper right. Hematoxylin & eosin, ×40). Neutrophil microabscess in the dermis (lower right. Hematoxylin & eosin, ×40).

Fig. 3
Culture for Sporothrix sp. at 25^◦, after 6 weeks.

Fig. 4
Patient clinical improvement after three weeks of itra-conazole (left). Complete lesion resolution after four months (right).

The presence of a painful tumor-like lesion in the peri-ungual region suggests neoplastic diseases such as glomus tumor, squamous cell carcinoma, and melanoma, as well as other diseases such as verruca vulgaris, chronic parony-chia, and subungual exostosis.⁵,⁶ The classic presentation of cutaneous sporotrichosis consists of a nodular lesion at the inoculation site, which may evolve into ulceration and lym-phocutaneous dissemination, most frequently affecting the upper limbs and occasionally involving the fingers and peri-ungual regions. Chronic, slow-healing ulcers on the thumb and periungual region have been described, especially after minimal trauma, with subsequent development of pro-gressive erythema, edema, and persistent pain.⁷ Rarely, sporotrichosis can induce pseudoepitheliomatous hyperplasia, resulting in a hyperplastic or tumor-like lesion.⁸

Between 2021 and 2022, there was a 304% increase in the number of cases of zoonotic sporotrichosis in Manaus. Between 2022 and 2023, this increase was 349%. The main animal involved in transmission is the cat. As in other endemic areas, the main etiological agent is Sporothrix brasiliensis.³,⁹

In the present case, the occurrence of cutaneous infec-tion by S. brasiliensis without a history of contact with sick animals is epidemiologically plausible and clinically relevant. The patient is a florist, with daily handling of flow-ers, branches, thorns, mosses and soil, a circumstance that implies repeated microtraumas by organic material and, therefore, potential non-zoonotic inoculation. In endemic scenarios, the high fungal load resulting from the epidemic in felines favors the environmental dissemination of the agent (soil, plant matter and objects), which increases the probability of traumatic implantation from contaminated material and explains autochthonous cases in individuals without direct exposure to cats.¹⁰

In endemic regions, especially in the Amazon region, the possibility of sporotrichosis should always be consid-ered in the differential diagnosis of exuberant, painful, or tumor-like skin lesions in the periungual region, even in the absence of contact with sick animals, especially when there is a history of trauma with organic material. The atyp-ical clinical presentation, such as the tumor-like form, can mimic neoplasms or other infectious and inflammatory der-matoses, requiring a high degree of clinical suspicion and mycological confirmation. Early recognition and appropriate treatment are fundamental to avoiding local complications and ensuring complete resolution of the condition. This report reinforces the importance of clinical surveillance in areas of active transmission, as well as the integration between dermatology and mycology services in the iden-tification and management of unusual cases of cutaneous sporotrichosis.

• ☆
  Study conducted at the Fundação Hospitalar de Dermatologia Tropical e Venereologia ‘‘Alfredo da Matta’’, Manaus, AM, Brazil.
• Financial support
  None declared.

Research data availability

Does not apply.

References

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• ² Rennó Rocha de Oliveira L, Souza INTC, Souza MS, Pires CAA, dos Santos MAL, et al. Sporotrichosis in Amazon: series of 46 cases with emphasis on zoonotic transmission. An Bras Derma-tol. 2025;100:501171.
• ³ Mesquita VA, Talhari S, Leturiondo AL, de Souza GC, de Brito EM, de Andrade SL, et al. Zoonotic Sporotrichosis outbreak: Emerg-ing public health threat in the Amazon State, Brazil. PLoS Negl Trop Dis. 2024;18:e0012328.
• ⁴ Orofino-Costa R, Freitas DFS, Bernardes-Engemann AR, Rodrigues AM, Talhari C, Ferraz CE, et al. Human sporotri-chosis: recommendations from the Brazilian Society of Dermatology for the clinical, diagnostic and therapeutic management. An Bras Dermatol. 2022;97:757-77.
• ⁵ Hattori M, Yoshiike T, Sonoda T, Hiruma M. A case of lympho-cutaneous sporotrichosis occurring at the nail bed. Mycoses. 2011;54:e663-5.
• ⁶ Martins CPS, Nakamura R, Schechtman RC, Leverone A. Peri-ungual sporotrichosis: a diagnostic challenge. Int J Dermatol. 2017;56:209-11.
• ⁷ Milby AH, Pappas ND, O’Donnell J, Bozentka DJ. Sporotrichosis of the upper extremity. Orthopedics. 2010;33:273-5.
• ⁸ Kamalapirat T, Apichonbancha S, Tonaree W. Lymphocutaneous sporotrichosis complicated by pseudoepitheliomatous hyperpla-sia: A case report. Diagn Microbiol Infect Dis. 2025;112:116791.
• ⁹ de Souza GC, de Brito EM, de Lima Fernandes DC, Frota MZM, de Araújo Santos FJ, de Oliveira Ferreira C, et al. Sporothrix brasiliensis as the major causative species of the zoonotic out-break of human sporotrichosis in the Brazilian Amazon. Trop Med Int Health. 2025;30:65-9.
• ¹⁰ Rodrigues AM, Della Terra PP, Gremião ID, Pereira SA, Orofino-Costa R, de Camargo ZP. The threat of emerging and re-emerging pathogenic Sporothrix species. Mycopathologia. 2020;185:813-42.

Edited by

• Editor
  Sílvio Alencar Marques

Publication Dates

• Publication in this collection
  24 Aug 2026
• Date of issue
  2026

History

• Received
  29 Oct 2025
• Accepted
  06 Jan 2026
• Published
  01 July 2026