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Trichosporon inkin subcutaneous infection in a rheumatoid arthritis patient

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Author(s)
Hyun Jeong SongSang Lip ChungKyu Suk Lee
Publication Year
2007
Abstract
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

Trichosporon beigelii

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

Trichosporon

species. The sequences of the PCR
product matched the corresponding sequences of the

T. inkin

strain with 99% accuracy (Fig. 2C).
The patient was given oral itraconazole for 8 weeks with good clinical results.
Department
Dept. of Dermatology (피부과학)
Publisher
School of Medicine
Citation
International Journal of Dermatology, Vol.46(3) : 282-283, 2007
Type
Article
ISSN
0011-9059
URI
http://kumel.medlib.dsmc.or.kr/handle/2015.oak/35924
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