FIRE Logo Harvard Medical School Logo

Sporotrichosis

Kitt Shaffer, MD, PhD
Darrell Smith, MD

3/13/01

Presentation

This 70 year old woman avid gardener had a long history of productive cough and chronic fatigue, recent weight loss and malaise. She had no fevers or night sweats. Look at the chest film first and decide what terms you would use to describe the findings to someone over the phone. Think about what the abnormality suggests about the chronicity of the findings, and what the top three diagnoses would be.

Imaging Technique

PA and lateral chest radiographs were obtained, as well as a chest CT without use of IV contrast. Slice thickness of the study was 10 mm.

Imaging Findings

PA chest radiograph
chest CT slice near apex
chest CT slice in base

The chest film shows bilateral large irregular cavities in the right and left upper lobes. There is a lot of distortion of the surrounding parenchyma, and upward retraction of both hila. Changes like these take quite some time to develop, suggesting that this process has been going on for a while. The CT shows even more disease extending into the lung base. While you can't tell from these two images, there was minimal right hilar adenopathy but no other abnormality. When you see apical chronic scarring, retraction, and formation of large cystic spaces, one of the first things you should consider is TB. Other possibilities would include a cavitary tumor such as a squamous cell carcinoma. Other infections that could look like this and be relatively chronic would include a variety of fungal infections. Given her history of gardening, one fungus that should be considered is sporotrichosis, which is a dimorphic fungus found in the soil, and often transmitted via skin breaks through contact with thorns. This was what was found at bronchoscopy in this patient.

Differential Diagnosis

1. tuberculosis 2. fungal infections 3. cavitary tumor

Diagnosis

sporotrichosis

Discussion

Sporotrichosis most often causes a skin infection, often from a skin break and exposure to soil or horticultural materials. It is a particular risk in gardeners and florists. Systemic spread is rather rare, but the lung is one of the sites that can be involved. The skin infection occurs in non-immune compromised hosts, although the systemic forms are slightly more common in mildly immune-compromised hosts, such as alcoholics. Imaging findings are essentially identical to post-primary tuberculosis, with upper lobe scarring retraction, and frequently hilar and mediastinal adenopathy.

References

Fraser and Pare's Diagnosis of Diseases of the Chest, 4th edition, W.B. Saunders, 1999, pg 149.

To Visitors: Nothing on this website should be considered medical advice. Only your own doctor can help you make decisions about your medical care and it is not s Hospital, Dana-Farber Cancer Institute, or Harvard Medical School to offer consultation via the web at eduational sites such as these. s Hospital toll-free physician referral line at 1-800-294-9999.

Contact DNSMITH@PARTNERS.ORG for additional information about this site.