Approach

Lymphocutaneous/cutaneous sporotrichosis causes skin lesions with characteristic proximal nodular lymphangitic spread.[1][2] Because cutaneous nocardiosis, cutaneous non-tuberculous mycobacterial infections, and cutaneous leishmaniasis manifest a similar 'sporotrichoid' skin lesion pattern, the diagnosis of sporotrichosis needs to be established by culture and/or histopathological demonstration of the fungus from aspirated or biopsied skin lesions.

Extracutaneous manifestations of sporotrichosis are more challenging to diagnose because of their non-specific presentation, indolent subacute clinical course, and the lower sensitivity of fungal culture and histopathology in these clinical forms of sporotrichosis. Hence, diagnosis of extracutaneous sporotrichosis is often delayed with reported median times from symptom onset to diagnosis ranging from several months to up to even 2 years depending on the clinical form of sporotrichosis.com.bmj.content.model.Caption@52f66154[Figure caption and citation for the preceding image starts]: Ascending 'sporotrichoid' distribution of skin lesions across the proximal lymphatic channelsFrom the collection of Richard J. Hamill, MD and Edward Septimus, MD, Baylor College of Medicine, Houston, TX [Citation ends].

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