An 82-year-old man with hypothyroidism presented with an ulcerated nodule on the dorsum of his left hand (Figure 1). The lesion had been present for about 3 months. Similar lesions were present along the lymphatic distribution of the dorsum of his left forearm, proximal to the first lesion, as well as the dorsum of his right forearm. Laboratory findings were normal. Immune complexes, complement 3, and complement 4 were negative. A biopsy from an ulcerated nodule was taken for both histologic examination and culture. Hematoxylin and eosin sections showed a nonspecific chronic granulomatous reaction. No fungi were detected by periodic acid-Schiff stain and methenamine silver stain. Culture of tissue obtained from a skin biopsy of 1 lesion placed directly on Sabouraud agar produced colonies of Sporothrix schenckii (Figure 2). The diagnosis of lymphocutaneous sporotrichosis was confirmed.
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