Periungual sporotrichosis with complete nail regeneration

Sporotrichosis is a subcutaneous mycosis whose periungual involvement is uncommon and may mimic paronychia of different etiologies, particularly bacterial paronychia, potentially delaying the diagnosis. We report a 59-year-old male farmer from the Brazilian Amazon with painful periungual inflammation of the left fourth finger, initially treated with clindamycin without improvement, followed by ascending nodular and ulcerated lesions. Mycological culture confirmed Sporothrix spp. Due to extensive disease and associated arthralgia, osteoarticular involvement was investigated, but imaging showed no bone or deep tissue abnormalities. Itraconazole was initiated at 200 mg/day and increased to 400 mg/day after 30 days. After 9 months of treatment, complete resolution was achieved. Despite extensive initial nail plate loss, a morphologically normal nail completely regrew without residual dystrophy, with no recurrence during 12 months of follow-up. This case highlights sporotrichosis as a differential diagnosis of antibiotic-refractory paronychia and demonstrates the potential for complete nail recovery after severe periungual involvement.