Phaeohyphomycotic cyst caused by a recently described species, Phaeoannellomyces elegans

An 81-year-old man presented with a chronic, painful nodule on the palmar surface of the left fourth finger. As a former farm worker, the patient acknowledged frequent soil-contaminated wounds of the left hand 4 to 12 years previously, but he denied any recent trauma. The patient's other medical problems included a history of chronic immunoglobulin A gammopathy and a new pleural mass eroding into adjacent ribs on chest X-ray. The finger nodule was excised and consisted of an intact phaeohyphomycotic cyst which yielded growth of a darkly pigmented fungus. At 25 degrees C, the isolate formed annellidic yeast cells having dark-brown walls consistent with the recently described species Phaeoannellomyces elegans. In vitro antifungal susceptibility tests indicated resistance to amphotericin B and variable susceptibility to imidazoles. The lesion was excised, and the patient received no antifungal therapy. After 9 months of follow-up, the fungal infection shows no signs of recurrence.