Conjunctival and bulbar sporotrichosis as Parinaud's oculoglandular syndrome acquired by blood inoculation

Abstract

Parinaud's oculoglandular syndrome (POS) is a clinical condition characterized by granulomatous conjunctivitis associated with homolateral neck pain and anterior preauricular lymphadenopathy. Several reports of this condition occurred and some bacterial etiological agents were identified. However, fungal infections have also been associated, especially sporotrichosis. A 40-year-old female patient complained about a "little ball" in the lower eyelid of the left eye. On ocular examination, visual acuity and fundoscopy were normal. The biomicroscopy revealed a granulomatous lesion in the lower eyelid of the left eye associated with yellowish discharge. The patient returned the next day, reporting worsening of the condition accompanied by low fever, malaise, preauricular and submandibular lymphadenomegaly. The examination showed the evolution of conjunctival edema and various conjunctival granulomas in the lower and upper tarsus of the left eye, a clinical picture compatible with POS. In the investigation of the clinical history, the patient remembered an episode of contact with blood of cats. During the investigation, we discarded differential diagnoses such as tuberculosis, toxoplasmosis, CMV, herpes virus and Bartonella. Serology was positive for Sporothrix. Treatment with itraconazole 100 mg once daily was started. By the eighth week, the conjunctival granulomas had disappeared, and the medication was discontinued after 90 days of treatment, after about 2 weeks of total remission. According to the literature, there are no cases of primarily ocular manifestation of blood sporotrichosis transmission. However, in the report, the form of transmission of the disease occurred by inoculation by direct contact with the blood of contaminated cats.