Case Report

Sporothrix schenckii: A Rare Fungal Lesion Mimicking Common Granulomas a Case Report

Niranjanakesav¹, Sathiya Bama^2*, Radhakrishnan¹ and Arbind Kumar^3
1Department of Pathology, Virchow Biopsy Centre, India
²Department of Pathology, IRT Perundurai Medical College and Hospitals (IRT-MPCH), India
³Department of Pharmacology, IRT Perundurai Medical College and Hospitals (IRT-MPCH), India

^*Corresponding author: Sathiya Bama, Department of Pathology, IRT Perundurai Medical College and Hospitals (IRT-MPCH), Perundurai, 638053, Tamil Nadu, India

Published: 27 Jun, 2018
Cite this article as: Niranjanakesav, Sathiya Bama, Radhakrishnan, Kumar A. Sporothrix schenckii: A Rare Fungal Lesion Mimicking Common Granulomas a Case Report. Ann Clin Case Rep. 2018; 3: 1527.

Abstract

The patient, a 35year old lady, reported for a deeply fixed skin swelling in the leg. The proper diagnosis is likely to be missed if attention is concentrated only on the granulomas. Though diagnosis is possible through Hand E stains, accurate identification of the characteristic morphological features of this fungus is essential for proper diagnosis and treatment. Contrary to the usually held view, in this patient, unusually large number of fungal elements with varying morphology is noticed in Hand E sections.
Keywords: Sporothrix; Fungal granuloma; Microabscesses

Introduction

Sporothrix schenckii is a rare dimorphic fungus; transmitted by direct inoculation as in gardeners handling rose plants, or farmers hauling hay etc or veterinarians treating pet animals [1]. It starts as a small indurated lesion which ulcerated later and becomes discolored with extensive crusting and boils. Though reported also as disseminated disease, systemic involvement is rare. If extensive, due to much destruction locally it mimics a tumour as in the case under discussion [2]. As it is likely to be mistaken clinically and pathologically, for many varied lesions with granulomatous features, it is imperative to diagnose it accurately and treat it effectively by simple means.

Case Presentation

The complaint for which this 35yr old woman sought consultation was for discolored nodular swelling of skin over the medial aspect of her left leg. According to her, it was chronic and slowly increasing in size, on examination, the margins are ill defined and the swelling was surrounded by oedematous discolored skin.
When it was excised surgically it measured 2.5 cm × 3.0 cm × 2.0 cm in dimension. The lesion was soft, the upper margin was well defined while lower margin was deep seated and extended into underlying fat. The entire dermis was replaced by nodules of granulomas: many of which were coalascent. Necrotic abscesses were seen more deeply. Giant cells; a dominating feature in these nodules are large in size; larger than those seen in giant cell tumors. Epithelioid aggregates were minimal. They were encircled by diffuse infiltrates of chronic inflammatory cells including many eosinophils. In the abscesses, as well as in giant cells numerous rounded spores, 2 μ to 5 μ in size could be seen; many of which exhibiting also budding forms or tear drop forms. Fractured asteroid bodies were noticed in a diffuse manner. Microabscesses were distributed as a part of granuloma or separately; Spores could be identified well in Hand E sections unusually and are confirmed by G.M.S. fungal stains.

Discussion

The first clue as to the nature of this tumour is its granulomatous nature; mixed with microabscesses occurring as part of granulomas or separately as abscesses with necrosis. According to Laura Lamps [3] granulomatous inflammation can be divided into; (a) epithelioid granulomas with or without necrosis. (b) lipogranulomas, (c) microgranulomas, (d) fibrin ring granulomas as in Q fever (e) foamy macrophagic aggregated as in whipples (f) granulomas with prominent suppurative inflammation, (g) stelate abscesses associated with Palisading granulomas. It is obvious that in this patient the granulomas belong to (f) category as listed above and as emphasized by Chandler fulfilling all the essential features encountered in this fungal lesion [4]. There is no lymphatic spread as in 25% of reported cases 5 G.M.S fungal stain confirms the diagnosis; as it reveals the round

Figure 1

Figure 2

References

1. Milner, Percora, Solomon, Soong. Infectious diseases (Diagnostic pathology series). Elsevier. 2015; 56-59.
2. Zhang Y, Pyla V. Cancer like lesions in a patient with sporotrichosis. Int J Dermatol. 2014;53(4):311-2.
3. Laura Lamps: Hepatic granulomas, with an emphasis on infectious causes. Adv Anat Path. 2008; 15(6): 309-18.
4. Chandler, Kaplan, Ajello: Histopathology of mycotic diseases, Wolfe Medical Publications Ltd, 1980; 112-115.
5. Binford CH, Dooley,T.R: sporotrichosis. In CH.Binford and DH. Connor. Pathology of Tropical and Extraordinary diseases, Armed Forces of Institute of Pathology, 1976; p 574-577.