Primary pulmonary sporotrichosis in an immunocompetent host

Background: Primary pulmonary sporotrichosis in the absence of lymphocutaneous disease is typically an incidental diagnosis. The disease often presents as a cavitary bronchonodular process similar to other granulomatous or neoplastic entities. Therefore, lung parenchymal cavitation in an older patient with a prior smoking history may represent a challenging diagnostic dilemma. Case Report: We present a case of unexpected primary pulmonary sporotrichosis in a patient without dermatological manifestations or obvious sources of infection discovered during a pre-operative evaluation for a cavitary lung lesion presumed to be malignant. After a bronchoalveolar culture unexpectedly demonstrated Sporothrix schenckii, retrospective detailed questioning revealed a remote hobby of restoring old churches. Treatment with oral itraconazole resulted in radiological and clinical improvement and avoidance of planned surgical intervention. Conclusions: This case emphasizes the importance of a detailed history, both recent and remote. While exclusion of lung malignancy in a high risk patient with a cavitary lesion is essential, primary pulmonary sporotrichosis, a rare entity, should be considered in an immunocompetent host with potential exposure to Sporothrix schenckii.