A 32-year-old man worked as a subsistence farmer raising pigs and tending his small garden; he also kept cats and dogs. He reported fever, night sweats, weight loss of 10 kg over 3 months, haemoptysis and skin ulcers (figure 1). Radiography and chest CT scan (figure 2) showed extensive bilateral cavities. An HIV test was negative. Bronchoalveolar lavage and biopsy of the skin lesions displayed Sporothrix schenckii. He was treated with amphotericin B and his lesions slowly healed.

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Figure 1

Cutaneous ulcers in the left thigh with clean edges. This figure is only reproduced in colour in the online version.

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Figure 2

Chest CT scan. Diffuse cavities at anterior and posterior locations in the lungs.

Sporotrichosis is a chronic pyogranulomatous infection caused by a dimorphic fungus that contaminates skin or subcutaneous tissue after trauma with plant materials such as thorns or splinters, or through cat scratches or bites.1–3 The term ‘Rose Gardener's disease’ has been coined following the observation of the disease in gardeners, farmers, forestry and nursery workers, veterinary workers and outdoor labourers.1 ,2 ,4 Primary pulmonary disease is extremely rare, and other diagnosis such as tuberculosis and cryptococcosis should be considered.1 ,4 We believe that this patient's pulmonary cavities are reflective of disease dissemination.