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The lower leg of a 37-year-old man who injured it while gardening. Two weeks later, a small ulcer appeared at the injury site andslowly expanded during the next month. The lesion did not improve with antibiotic therapy.
A dermatologist saw this patient initially and diagnosed pyoderma gangrenosum. But he only examined the lower leg. Had heexamined the entire leg, he might have noticed the telltale nodular lymphangitis in the right thigh (image below) — a further clue to sporotrichosis in thisgardener. Culture of the lesion subsequently grew Sporothrix schencki .
Other organisms that commonly cause nodular lymphangitis after cutaneous inoculation include Nocardia brasiliensis, Mycobacterium marinum, Leishmania brasiliensis, and Francisella tularensis .
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