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Attritional extensor tendon rupture in a patient with Phialophora verrucosa tenosynovitis: case report
Michael Sorkin1, Theodore A Kung1, Kevin C Chung1
1Section of Plastic Surgery, Department of Surgery, University of Michigan Health Systems, Ann Arbor, MI 48109 USA.
Abstract:
Deep tissue fungal infections of the hand are exceedingly uncommon. We present a case of fungal tenosynovitis caused by Phialophora verrucosa that led to extensor tendon rupture in a patient who was on chronic immunosuppressive therapy. Indolent fungal cysts can elude clinical diagnosis until excision is performed with definitive pathologic examination. In immunocompromised patients, antifungal therapy may be warranted after cyst excision even in the absence of acute infection to prevent subsequent progression to tenosynovitis.
Insights
Deep tissue fungal infections are rare. Phialophora verrucosa caused tenosynovitis and tendon rupture in an immunosuppressed patient, highlighting the need for antifungal therapy post-excision.
Area of Science:
- Medical Mycology
- Hand Surgery
- Immunocompromised Host Research
Background:
- Deep tissue fungal infections of the hand are rare.
- Phialophora verrucosa is a fungus that can cause infections.
- Immunosuppressive therapy increases susceptibility to fungal infections.
Purpose of the Study:
- To report a rare case of fungal tenosynovitis caused by Phialophora verrucosa.
- To highlight the potential for extensor tendon rupture in such cases.
- To discuss the management of indolent fungal cysts in immunocompromised patients.
Main Methods:
- Case presentation of a patient with fungal tenosynovitis.
- Pathologic examination of excised fungal cyst.
- Review of clinical presentation and treatment.
Main Results:
- Phialophora verrucosa identified as the causative agent.
- Extensor tendon rupture occurred due to fungal tenosynovitis.
- Indolent fungal cysts can present without acute infection.
Conclusions:
- Fungal tenosynovitis of the hand is uncommon but can lead to severe complications like tendon rupture.
- Early diagnosis and treatment are crucial, especially in immunocompromised individuals.
- Antifungal therapy may be necessary after cyst excision to prevent disease progression.
