Lymphocutaneous sporotrichosis complicated by pseudoepitheliomatous hyperplasia: A case report

A 63-year-old Thai woman, owner of 14 cats, presented with chronic skin lesions initially misdiagnosed as cellulitis. Further investigation revealed lymphocutaneous sporotrichosis caused by Sporothrix schenckii. Histopathology of one lesion unexpectedly demonstrated pseudoepitheliomatous hyperplasia (PEH), a reactive epidermal proliferation that can clinically and histopathologically mimic squamous cell carcinoma (SCC). The patient was treated with itraconazole for the fungal infection, and surgical debridement was performed due to suspicion of malignancy. Diagnostic tools included fungal culture and detailed histopathology, emphasizing the importance of thorough evaluation of persistent cutaneous lesions, especially in individuals with animal exposure. This case highlights the rarity of hyperplastic or verrucous variants in chronic fungal infections and underscores the need to distinguish benign PEH from true malignancy. Timely intervention with antifungal therapy and appropriate surgical management resulted in a favorable outcome.