Actinomycetoma with systemic features: A warning sign for immunosuppression?

A 32-year-old man was referred to our Dermatology Outpatient Unit with the clinical suspicion of sporotrichosis. At the age of 8, he had suffered a penetrating injury to his right foot, which remained as a painless nodule for years. One year before his outpatient appointment, the nodule progressively increased in size and ulcerated, and in the last 6 months, he began to experience night sweats, a low-grade fever, a 12-kg weight loss, and malaise.