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The Phantom Leg

SIR: We report a case of sporotrichosis from the IIlawarra area of New South Wales. The patient, a 66-year-old man, suffered minor trauma to the upper part of the right arm while gardening in May, 1978. A short length of Pittosporum sp. branch penetrated the upper arm just above the elbow on the anteromedial aspect, was subsequently removed by the patient and treated with methylated spirits. When the patient was seen in February, 1979, two ulcerated tumours were present in the vicinity of the right elbow. Treatment with oxytetracycline hydrochloride (Terramycin) ointment, vitamin C (5000 mg) and minocycline (Minomycin) was unsuccessful. Sporotrichosis was considered as a possible diagnosis. Skin scrapings were collected on several occasions, as was exudate from the non-healing ulcers. The initial pathology investigations were unhelpful in confirming a diagnosis of sporotrichosis; however, iodine therapy was commenced on the basis of the clinical appearance of the patient's lesions. After seven weeks of potassium iodide treatment with topical Neocortef 1% ointment and some cryotherapy, some improvement was detected and at this stage the patient was referred to the mycologist at The Wollongong Hospital, where skin scrapings were collected and a biopsy specimen was taken from the periphery of one lesion. Heavy pure growth of Sporotrichum schenckii was obtained from both specimens after five to 10 days incubation and periodic-acid-Schiff-stained and silverstained sections revealed giant cells and budding yeast-like cells consistent with sporotrichosis. Sporotrichosis has been reported rarely in the Australian literature (with the exception of recent Queensland surveys' 2) and most reported cases apparently respond quite well to iodine therapy. The patient whose case is reported here is having difficulty adjusting to the high concentration of iodine. Since this is apparently the first case of sporotrichosis to be reported from the IIlawarra region (although we feel other cases have been encountered in this region) and because of the unexplained early difficulty in confirming the presence of S. scbenckii. we will present a more complete case report and discussion when the success or otherwise of this treatment is fully evaluated.