Ocular adnexal sporotrichosis: case series from a hyperendemic region in southern Brazil

Sporotrichosis is an emerging subcutaneous disease that occurs in outbreaks in Brazil and other South American countries. Reports of extracutaneous cases caused by Sporothrix brasiliensis have been increasing in the literature. This study describes the first case series of ocular adnexal sporotrichosis in the state of Rio Grande do Sul (RS), southern Brazil. A retrospective analysis was conducted including cases diagnosed over a three-year period at a specialized reference service in RS, Brazil. Ocular sporotrichosis accounted for 25 cases, with a marked increase observed during the last two years of the study (2024-2025), reaching the highest proportion of approximately 16 cases per 100 appointments among all sporotrichosis cases. All patients presented with ocular adnexal involvement, including granulomatous conjunctivitis (56%; 14/25), Parinaud oculoglandular syndrome (40%; 10/25), and eyelid lesions with dacryocystitis in one case (4%). All cases were associated with zoonotic transmission of S. brasiliensis. Clinical cure was achieved using itraconazole (200 mg/day) for a mean treatment duration of 120 days. Our findings highlight the emergence of ocular sporotrichosis in southern Brazil, predominantly affecting adnexal structures, and emphasize the importance of early diagnosis, continuous educational efforts, and increased awareness of extracutaneous manifestations in hyperendemic areas.