SynopsisCodesLook ForDiagnostic PearlsDifferential Diagnosis & PitfallsBest TestsManagement PearlsTherapyDrug Reaction DataReferences

View all Images (64)

Sporotrichosis in Adult
See also in: Cellulitis DDx
Other Resources UpToDate PubMed

Sporotrichosis in Adult

See also in: Cellulitis DDx
Contributors: Sruthi Renati MD, Tara Mahar MD, Susan Burgin MD
Other Resources UpToDate PubMed


Sporotrichosis is caused by the dimorphic fungus Sporothrix schenckii, found worldwide, but more commonly in tropical and subtropical climates. The organism resides in decaying vegetation, plants, and soil. Cutaneous infection usually results from traumatic inoculation. Sporotrichosis is the most common and least severe of the deep mycoses.

The lesions of sporotrichosis may present in 3 different patterns.
  • Lymphocutaneous or sporotrichoid pattern – 75% of cases
  • Fixed cutaneous – no lymphatic dissemination; may be more likely to develop in patients previously sensitized to S schenckii
  • Disseminated cutaneous – occurs with systemic involvement; rare and usually in the context of immunosuppression such as oral prednisone therapy, other immunosuppressive medications, alcohol use disorder, diabetes mellitus, hematologic malignancies, and AIDS
Extracutaneous disease is rare but manifests with osteoarticular involvement in immunocompetent individuals, whereas immunocompromised patients typically present with multisystem involvement. Pulmonary sporotrichosis is associated with alcohol use disorder, tuberculosis, diabetes mellitus, sarcoidosis, and steroid use.

Thorny plants, such as barberry and rose bushes, are the most common source of cutaneous inoculation of sporotrichosis. Other plant exposures include sphagnum moss, straw, hay, soil, and mine timbers. Occupational exposures include farmers, florists, gardeners, and forestry workers. Zoonotic transmission from scratch injury or bites of infected cats, rodents, or armadillos has been reported but is a less common mode of transmission.

Untreated cutaneous sporotrichosis usually waxes and wanes over months to years without systemic manifestations.


B42.9 – Sporotrichosis, unspecified

42094007 – Sporotrichosis

Look For

Subscription Required

Diagnostic Pearls

Subscription Required

Differential Diagnosis & Pitfalls

  • Mycobacterium marinum infection also causes a lymphangitic pattern on the extremity and has a similar pattern of red nodules.
  • Cellulitis or Erysipelas
  • Orf
  • The typical pattern of lymphangitic spread can suggest herpes virus infections (Herpes simplex virus and Herpes zoster).
  • Cat-scratch disease
  • Furunculosis
  • Superficial thrombophlebitis
  • Blastomycosis
  • Coccidioidomycosis
  • Other infections such as Cutaneous nocardiosis, Tularemia, Cutaneous tuberculosis, Cutaneous leishmaniasis, and Actinomycosis may have a similar lymphangitic spread from cutaneous inoculation. Exposure and travel history are key for diagnosis.
  • Sarcoidosis rarely ulcerates or spreads along lymphatics.
  • Mycetoma
  • Cutaneous Lymphoma may have associated fevers and weight loss.
  • Skin bacterial abscess has an acute onset.
  • Pyoderma gangrenosum bleeds easily and appears vascular.
  • Vasculitis does not usually have an exophytic growth pattern.
  • Foreign body reaction to Sea urchin sting or barnacles
  • Halogenoderma (Bromoderma, Iododerma)
  • Cutaneous anthrax

Best Tests

Subscription Required

Management Pearls

Subscription Required


Subscription Required

Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

Subscription Required


Subscription Required

Last Reviewed:10/01/2018
Last Updated:07/17/2023
Copyright © 2024 VisualDx®. All rights reserved.
Sporotrichosis in Adult
See also in: Cellulitis DDx
A medical illustration showing key findings of Sporotrichosis (Lymphocutaneous) : Forearm, Lymphangitic distribution, Plaque with ulcer, Regional lymphadenopathy, Smooth nodule
Clinical image of Sporotrichosis - imageId=117226. Click to open in gallery.  caption: 'Crusted and scaly erythematous nodules in a curvilinear configuration (following lymphatics) on the hand and arm.'
Crusted and scaly erythematous nodules in a curvilinear configuration (following lymphatics) on the hand and arm.
Copyright © 2024 VisualDx®. All rights reserved.