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A 50-year-old black man with constitutional symptoms, cutaneous nodules, and bilateral hilar adenopathy was found to have non-caseating granulomata on bronchial biopsy. He was treated with corticosteroids for sarcoidosis. Within five months he was found to have disseminated sporotrichosis. Electron microscopy revealed mycelial forms of S. schenckii in superficial lesions and yeast forms from deep tissue sites: no novel forms were seen. Blood mononuclear cell studies revealed hyperactive suppressor cells with respect to non-specific T cell targets and the antigen specific target. Examination of the initial biopsy material after digestion with diastase before PAS staining revealed budding yeast consistent with S. schenckii. This case emphasizes the need for careful histopathologic examination of clinical material before a diagnosis of sarcoidosis is made, and reveals an immunologic abnormality which may account for the patient's anergic state and susceptibility to S. schenckii infection.
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