Facial Verrucous Sporotricosis: Diagnostic And Treatment Difficulties

Sporotrichosis is a subcutaneous mycosis caused by fungi of the Sporothrix complex, whose clinical and epidemiological relevance has increased in recent decades, especially in Brazil, due to the expansion of zoonotic transmission and the emergence of atypical clinical presentations. Facial involvement, particularly in the verrucous form, represents an important diagnostic challenge, as it mimics other infectious, inflammatory, or neoplastic dermatoses, often resulting in delayed diagnosis and inadequate management. Case report: We describe the case of a 55-year-old female patient with a chronic facial lesion, initially interpreted as cutaneous leishmaniasis and pyoderma gangrenosum, which worsened after corticosteroid therapy. The lesion evolved from papules to an extensive infiltrated and verrucous plaque affecting the nose, chin, and upper lip. Initial investigation revealed nonspecific histopathological findings and negative cultures. Persistent clinical suspicion led to a new biopsy, special stains, immunohistochemistry, and serology, which confirmed the diagnosis of sporotrichosis. The patient denied contact with cats, reporting only sporadic gardening. Treatment with full-dose itraconazole was instituted and maintained for 12 months, with favorable evolution, complete healing of the lesions, and recovery of facial anatomy. Conclusion: This case highlights the diagnostic difficulties of facial verrucous sporotrichosis, especially in the absence of a classic epidemiological link and in the face of initial nonspecific histopathological findings. It reinforces the importance of including sporotrichosis in the differential diagnosis of chronic facial lesions in endemic areas, as well as the clinical-pathological correlation and the use of complementary diagnostic methods to ensure timely and appropriate treatment. Keywords: Sporotrichosis; Facial sporotrichosis; Subcutaneous mycosis; Differential diagnosis; Itraconazole.