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Images of Memorable Cases: Case 109

Module by: Herbert L. Fred, MD, Hendrik A. van Dijk. E-mail the authorsEdited By: Frederick Moody

http://rup.rice.edu/memcases-button.jpg

Case_109-pres1-1.jpg

The lower leg of a 37-year-old man who injured it while gardening. Two weeks later, a small ulcer appeared at the injury site and slowly expanded during the next month. The lesion did not improve with antibiotic therapy.

A dermatologist saw this patient initially and diagnosed pyoderma gangrenosum. But he only examined the lower leg. Had he examined the entire leg, he might have noticed the telltale nodular lymphangitis in the right thigh (image below) — a further clue to sporotrichosis in this gardener. Culture of the lesion subsequently grew Sporothrix schencki.

Case_109-diag1-1.jpg

Other organisms that commonly cause nodular lymphangitis after cutaneous inoculation include Nocardia brasiliensis, Mycobacterium marinum, Leishmania brasiliensis, and Francisella tularensis.

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