Effective treatment using itraconazole combined with terbinafine in the treatment of nasal sporotrichosis: A case report

RATIONALE: Sporotrichosis is a subacute or chronic infection caused by sporothrix schenckii complex. The misdiagnosis rate of sporotrichosis is very high. Fungal microscopic examination and timely culture help us make an accurate diagnosis and treatment. We observed that combined treatments are more effective than monotherapy in treatment of sporotrichosis. PATIENT CONCERNS: A 47-year-old female complained of pustules and scabs on her nose tip that lasted for 1 month at our hospital. She was diagnosed with skin infection and treated with antibiotics for 20 days. Nonetheless, the treatment did not result in any improvement with the lesion. DIAGNOSES: The results on bacterial culture, sensitive test, special stains, and multiple acid-fast cultures were negative. Finally, fungi were observed by KOH. Finally, fungal hyphae were observed by KOH and by fluorescent staining. Taupe filamentous colonies of sporothrix-like species appeared by fungal culture. The diagnosis of sporotrichosis was finally confirmed based on the lesion characteristics and the results of laboratory examination. INTERVENTIONS: The lesions did not alleviate with Itraconazole oral administration for 1 month. Then we treated the patient with the combination therapy of itraconazole (ITR) and terbinafine. At the same time, the compound glycyrrhizin tablet was used for liver protection. OUTCOMES: The patient was free of clinical symptoms of sporotrichosis following the treatment and did not have complications during an 8-month follow-up. LESSONS: We should always be alert to sporotrichosis although it is not a very common disease. It is important to adapt fungi microscopic analysis and culture for an accurate diagnosis. ITR is the first choice for sporotrichosis. However, combination treatment is more effective for stubborn cases.