Medicopsis Romeroi infection presenting as disseminated nodules and sinuses in a patient with chronic rheumatoid arthritis.

Medicopsis romeroi, formerly known as Pyrenochaeta romeroi, usually presents as solitary localised subcutaneous cyst in immunocompromised patients. We report an unusual manifestation of the fungal infection in a patient of rheumatoid arthritis. A farmer in 60s presented with multiple painless nodules over legs for the last one year. Patient was a known case of rheumatoid arthritis and was self-medicating with oral prednisolone 20mg/day since last two years. He also complained of dyspnoea for the last 6 months. Cutaneous examination showed 8-10 soft nodules of size 1×1 to 2×2 cm approximately, over both legs, right knee and bilateral gluteal region.