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We report the case of a 54-year-old woman with poorly controlled type 2 diabetes mellitus, dyslipidaemia, hypertension and a 3-month history of fixed cutaneous sporotrichosis treated with itraconazole 200 mg once daily. She subsequently presented with progressive enlarging nodular lesions on her left forearm, wrist and right forehead, with right ankle pain. Imaging revealed multifocal osseous involvement, including small lucent lesions in the right frontal bone and left distal radius and aggressive lesions in the right ankle and left radius. MRI of the right ankle showed an enhancing lesion in the distal fibula with cortical destruction. A biopsy showed chronic suppurative granulomatous inflammation, and a fungal culture grew Sporothrix spp. The patient underwent surgical debridement of the ankle and was continued on itraconazole for 1 year. She had complete resolution of all her lesions, resulting in no residual functional disabilities observed during follow-up.

Three months earlier, she had visited a private hospital for multiple lumps on her left upper limb, along with weight loss and decreased appetite. Blood tests showed a white cell count (WCC) of 8.9x10°/L (reference range: 4.0-10.0x10°/L) but raised inflammatory markers, with a C-reactive protein (CRP) level of 7.6 mg/L (reference range: <3.0 mg/L) and an erythrocyte sedimentation rate (ESR) of 63 mm/h (reference range: <30 mm/h). The fracture was managed conservatively, with daily wound dressings applied to the surgical site throughout the hospital admission. The most frequently involved bones include the tibia, small bones of the hands, radius, ulna, knee and ankle?' Patients with sporotrichosis or other fungal joint infections often experience significant, progressive pain, swelling and decreased range of motion in the affected joint.