An unsuspected and unusual case of zoonotic sporotrichosis.

Sporotrichosis is an infection caused by a thermally dimorphic fungus, Sporothrix schenckii which is commonly reported in the tropics and subtropics. Infection usually occurs as a consequence of traumatic inoculation into the skin. A previously healthy 33-year-old Malay woman presented with a scratch wound over the lateral aspect of her left thigh for 2 months after being scratched by her pet cat. Inspection of the wound revealed a granulomatous plaque measuring 3cm x 2cm with hyperkeratotic scales, fissures and multiple blackish pigments. There was a tender, palpable left inguinal lymph node measuring 1cm x 1cm but the overlying skin looked normal. She was prescribed two courses of antibiotics empirically, without any clinical improvement seen. During follow up and further history taking, the patient informed that her pet cat was diagnosed with sporotrichosis a month before the scratching incident took place, but she claimed that her pet cat had been treated and was cured. She was then empirically started with oral itraconazole 200mg twice a day for two months. Histopathological examination of a skin biopsy showed acute on chronic suppurative granulomatous inflammation but was negative for any fungal elements. However, culture of the skin biopsy isolated Sporothrix schenckii. A final diagnosis of localised cutaneous sporotrichosis was made and the oral itraconazole was continued for another two months. The wound improved dramatically since itraconazole started.