Systemic Sporotrichosis With Testicular Involvement: Literature Review and Case Report

Sporotrichosis is an endemic fungal infection in Brazil, caused by a dimorphic fungus of the genus Sporothrix. Transmission occurs through traumatic inoculation from soil, contaminated plants, and zoonotic sources, mainly from cats, as well as through inhalation of conidia. It commonly presents as localized, lymphocutaneous, disseminated, or systemic forms. The testicles are among the organs that can be affected, often manifesting as a testicular mass. This work is aimed at analyzing a clinical case along with a bibliographic review on the testicular involvement of sporotrichosis.

A 35-year-old male with positive HIV serology and a history of psychoactive substance use presented with disseminated ulcerated lesions that progressed over 1 month, with a positive blood culture for sporotrichosis. Upon hospitalization, a painless lump in the right testicle was diagnosed upon palpation and peripheral vascularization. An orchiectomy was performed, and anatomopathological analysis revealed the presence of Sporothrix.

Few reports on testicular sporotrichosis were found in the literature. Systemic forms are rare and are often associated with immunosuppression, particularly in cases of HIV and chronic alcoholism. This immunosuppression can favor the prevalence and dissemination of the fungus. The fungus also produces melanin, which aids in evading the immune system. The gold standard for diagnosis is culture. Furthermore, the treatment of choice is prolonged therapy with Amphotericin B, followed by itraconazole.

Given the suspicion of disseminated sporotrichosis and the presence of a testicular nodule, the possibility of testicular sporotrichosis should be evaluated while maintaining attention to the differential diagnosis for neoplasia.