Pulmonary Sporotrichosis Masquerading As Non‐Hodgkin's Lymphoma

1St. Joseph Mercy Hospital, Ann Arbor, MI

Meeting: Hospital Medicine 2011, May 10-13, Dallas, Texas.

Abstract number: 1016

Case Presentation:

A 61‐year‐old female nonsmoker was noted to have small nodular opacities in the right lung on a routine chest roentgenogram (CXR). Subsequently, a chest computerized tomography (CT) revealed multiple nodules with primarily upper zone involvement. She denied hemoptysis, fevers, chills, cough, chest pain, dyspnea, malaise, or weight loss. Routine blood work including a complete blood count, complete metabolic panel, and tuberculin skin test were unremarkable. A chest CT scan performed 6 months later showed increased size and number of the previously visualized pulmonary nodules. She continued to be asymptomatic. Five months later, a bronchoscopy with transbronchial biopsies was performed, and histopathology revealed an atypical lymphoid infiltrate suspicious for low‐grade non‐Hodgkin's lymphoma. A positron emission to‐mography–CT performed 1 week later showed increased multifocal abnormalities in the right lung, with cavitations in some of the nodules and significant progression of variable ill‐defined nodular opacities in the middle lobe compared with the initial study. A right upper lobe vide‐assisted thorascopic wedge biopsy was performed. Histopathology showed necrotizing granulomatous inflammation. Special stains for acid‐fast bacilli and fungi were negative. Two weeks after the biopsy, fungal bronchial washings, grew Sporothrix schenkii. In addition, B‐cell clonality studies by polymerase chain reaction were negative, thus not supporting a diagnosis of lymphoma. The patient was started on itraconazole and had significant improvement.

Discussion:

Pulmonary infection with Sporothrix schenkii is uncommon; when present it is usually secondary to inhalation or aspiration of conidia in susceptible individuals. Fewer than 100 cases of primary pulmonary sporotrichosis have been reported in the literature. Cases predominantly occur in middle‐aged alcoholic men and those with underlying lung disease. The outcome of pulmonary sporotrichosis is usually poor, often because of delay in diagnosis and severe underlying pulmonary disease. With treatment, prognosis is excellent.

Conclusions:

Although pulmonary sporotrichosis remains a rare infection, its prevalence may be greater than previously recognized. Clinicians should be aware of this infection in the differential diagnosis of pulmonary granulomatous diseases, especially in hosts who have relevant environmental exposure to the fungus.

Disclosures:

A. Tiwari ‐ none; A. Malani ‐ none

To cite this abstract:

Tiwari A, Malani A. Pulmonary Sporotrichosis Masquerading As Non‐Hodgkin's Lymphoma. Abstract published at Hospital Medicine 2011, May 10-13, Dallas, Texas. Abstract 1016. Journal of Hospital Medicine. 2011; 6 (suppl 2). https://www.shmabstracts.com/abstract/pulmonary-sporotrichosis-masquerading-as-nonhodgkins-lymphoma/. Accessed September 20, 2019.

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