Osteoarticular Sporotrichosis in a Brazilian Endemic Setting: Associated Factors and Outcomes

BACKGROUND: Osteoarticular infection is an emerging complication of sporotrichosis, often leading to a significant increase in morbidity and longer treatment. METHODS: We conducted a retrospective cohort study of osteoarticular sporotrichosis (OS) in southeastern Brazil (2014-2024) using clinical, epidemiological, and molecular data. RESULTS: Among 252 patients, 20 (7.9%) had OS, including 10 (4%) with osteomyelitis. The median age of patients with OS was 58 years (IQR 39-64; range 18-83) and 55% were male. Hypertension (45%), diabetes (40%), alcohol use (40%), smoking (40%), and HIV infection (15%) were the most frequent conditions identified. Cutaneous lesions occurred in 95% of cases, and 90% of patients presented with arthralgia and edema. Multifocal OS was observed in 50% of cases, most commonly affecting the knees, fingers, and wrists. The mean time to diagnosis was 14.2 months. Most patients were treated with itraconazole combined with amphotericin B; 13 required surgical intervention, including 2 amputations. The mean treatment duration was 21 months. Multisystem involvement due to sporotrichosis was observed in 45% of cases, including pulmonary involvement. Mortality was 15%. Diabetes (OR = 4.11; 95% CI, 1.50-11.38; p = 0.006) was independently associated with OS. CONCLUSIONS: OS is associated with substantial morbidity and prolonged treatment. Diabetes may increase the risk of OS, while delayed diagnosis jeopardizes outcomes, underscoring the need for early management.