Prototheca wickerhamii hand infection successfully treated by itraconazole and voriconazole
2006
Infections in human beings are usually caused by bacteria, viruses, protozoa, or fungi. It is extremely uncommon for clinicians to encounter infections caused by other pathogens. Prototheca is an alga that reproduces by endosporulation and rarely causes infections in humans; most cases are reported among immunocompromised patients. 1 Protothecosis usually involves the skin but may also cause systemic infection. 2 During the past two decades, infections caused by Prototheca have been increasingly recognized, and about 100 cases have been reported worldwide. 3 Herein, we present the case of a hand infection caused by Prototheca wickerhamii , possibly acquired in the Red sea.
A 60‐year‐old diabetic, amateur gardener (orchid grower) presented with a 3‐month history of painful swelling of his right hand. Two months before the swelling began, he underwent a release of “trigger finger” of the third finger. The incision had almost healed completely but was reopened by trauma, while the patient was diving in the Red sea (Sharm‐El‐Sheik). The patient noted that a considerable amount of sea water had entered his wound during each dive.
Upon examination, his hand looked edematous, with a red‐purplish hue. Discrete, somewhat tender, nodules were noted over the involved finger (Figure 1). Temperature at presentation was 36°C. The white cell count was 8,240/ μ L, with a normal differential. C‐reactive protein was …
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