Primary ocular sporotrichosis with granulomatous conjunctivitis

Sporotrichosis is an infection which is caused by the dimorphic fungus Sporothrix schenckii.  Primary ocular sporotrichosis is uncommon in non-endemic areas and may be easily misdiagnosed, leading to a delay in initiation of treatment.  In this case report, a 15-year-old girl, who is a post renal transplant patient presented with left eye swelling and localized redness at the medial canthal region.  She was initially treated with topical antibiotics but there was no improvement.  The addition of topical steroids led to the development of multiple nodules with central ulceration.  Examination of the left eye showed granulomatous conjunctivitis.  The features were suggestive of sporotrichosis and she was empirically started on oral itraconazole.  A biopsy of the lesion showed caseating granulomatous inflammation and fungal PCR tested positive for Sporothrix schenckii. Her symptoms and clinical findings completely resolved after 3 weeks on itraconazole; however, her liver function deteriorated, and patient opted to discontinue the medication