Trichosporon inkin subcutaneous infection in a rheumatoid
- Hyun Jeong Song; Sang Lip Chung; Kyu Suk Lee
- Publication Year
- A 74-year-old woman presented with painful ulcerative nodules on the left forearm. She had
received systemic steroid therapy for rheumatoid arthritis for several years. On physical
examination, there were four hemorrhagic ulcerative nodules with a linear distribution on the left
forearm (Fig. 1A). These nodules had developed over the course of 2 months, and the number
of lesions had increased despite systemic antibiotic therapy. There was no sign of systemic
dissemination of the disease.
Biopsy of a nodule demonstrated suppurative granulomatous inﬁltration (Fig. 1B); the
hyphae stained positive with periodic acid–Schiff (data is not shown) and Gomori–methenamine
silver stains in the dermis (Fig. 1C). The biopsy specimen was cultured in Sabouraud’s dextrose
agar supplemented with cycloheximide with incubation at 26
C. A yeast-like creamy colony
grew in 1 week. The colony became yellowish gray in color and the surface folded radially after
4 weeks of incubation (Fig. 2A). Microscopic examination revealed arthroconidia and
blastoconidia (Fig. 2B), and urease activity was positive. The fungus was identiﬁed as
by yeast biochemical card (YBC, Biomerieux Vitek, Inc., Hazelwood,
MO, USA). The sequences of rDNA obtained from the colony were ampliﬁed using
polymerase chain reaction (PCR) primer, analyzing the sequences of the 5.8S and 28S rDNA
regions for the genetic identiﬁcation of the
species. The sequences of the PCR
product matched the corresponding sequences of the
strain with 99% accuracy (Fig. 2C).
The patient was given oral itraconazole for 8 weeks with good clinical results.
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