CASE REPORT: SPOROTRICHOSIS WITH PARINAUD OCULOGLANDULAR SYNDROME

Abstract

Introduction: Sporotrichosis is a subcutaneous mycosis caused by fungi of the Sporothrix schenckii complex, transmitted through traumatic inoculation or contact with infected animals. The lymphocutaneous form is the most common clinical presentation. However, atypical manifestations may occur, such as Parinaud oculoglandular syndrome, characterized by granulomatous conjunctivitis accompanied by ipsilateral preauricular or cervical lymphadenopathy. Case description: We report the case of a previously healthy 46-year-old woman who had contact with a stray cat with lesions compatible with sporotrichosis. She reported that, during the rescue, the animal sneezed near her face. Approximately two months after the initial contact, she developed a left infraorbital nodule, purulent ocular discharge, and conjunctival hyperemia. In the following weeks, she developed painful lymphadenopathy in the cervical, submandibular, and forearm regions, as well as painless nodules on the lower limbs. She denied fever or other complaints. Physical examination showed a firm and painful left infraorbital nodule measuring approximately 0.5 cm; conjunctival hypertrophy with granulomatous lesions; lymphadenopathy in the left anterior cervical and submandibular chains; and diffuse, painless, erythematous cutaneous nodules on the right forearm and bilaterally on the lower limbs, approximately 1 cm in diameter. A cervical lymph node biopsy revealed granulomatous lymphadenitis with necrosis and suppuration, with negative fungal investigation. She was treated with itraconazole 200 mg/day for six months, with complete resolution of symptoms. Comments: Ocular sporotrichosis is rare and usually results from direct inoculation of the yeast into mucosal surfaces. Parinaud syndrome is more commonly described with etiologies such as Bartonella henselae, but there are increasing reports involving Sporothrix spp. The absence of fungi on histology does not rule out the diagnosis, which should be based on clinical and epidemiological features. Disseminated cutaneous disease with multiple nodules in immunocompetent individuals, as in this case, is uncommon; however, it may occur with a high fungal burden or multiple inoculation sites. Early diagnosis and prompt initiation of antifungal therapy are essential to prevent ocular sequelae and systemic dissemination. This case highlights the importance of evaluation in atypical conjunctivitis associated with lymphadenopathy, especially in patients with a history of contact with sick animals.