title: Tenosynovitis caused by Scedosporium apiospermum infection misdiagnosed as an Alternaria species: a case report.
abstract: Scedosporium apiospermum, which can usually be isolated from soil, polluted stream water and decaying vegetation, is increasingly recognized as an opportunistic dematiaceous fungus. The mortality rate of infection in immunocompromised hosts is over 50%. S. apiospermum is commonly responsible for dermal and epidermal infections (i.e., mycetoma) after traumatic penetration.
  
  
  
  A 73-year-old woman was admitted to our hospital complaining of painful swelling and tenderness on the dorsum of the proximal left wrist and hand. The symptoms had persisted for approximately 2 months. A physical examination revealed a 4 x 3 cm, poorly defined, erythematous papule, which was fluctuant, with pustules and crusts on the dorsum of the left hand.
  
  
  
  We report a very rare case of tenosynovitis caused by S. apiospermum infection. We identified the infectious agent via molecular DNA sequencing. The infectious agent was initially misidentified as an Alternaria species by microscopic examination with lactophenol cotton blue (LPCB) staining. The infection was successfully treated with debridement and adjuvant fluconazole therapy.
authors.affiliation: Premedical Science, College of Medicine, Chosun University, Gwangju, Republic of Korea.
authors.forename: Choon-Mee
authors.initials: CM
authors.lastname: Kim
authors.affiliation: Department of Pathology, School of Medicine, Chosun University, Gwangju, Republic of Korea.
authors.forename: Sung-Chul
authors.initials: SC
authors.lastname: Lim
authors.affiliation: Department of Internal Medicine, School of Medicine, Chosun University, Gwangju, Republic of Korea.
authors.forename: Joa
authors.initials: J
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, School of Medicine, Chosun University, Gwangju, Republic of Korea.
authors.forename: Hoe-Soo
authors.initials: HS
authors.lastname: Jang
authors.affiliation: Department of Internal Medicine, School of Medicine, Chosun University, Gwangju, Republic of Korea.
authors.forename: Jong-Hun
authors.initials: JH
authors.lastname: Chung
authors.affiliation: Department of Internal Medicine, School of Medicine, Chosun University, Gwangju, Republic of Korea.
authors.forename: Na-Ra
authors.initials: NR
authors.lastname: Yun
authors.affiliation: Department of Internal Medicine, School of Medicine, Chosun University, Gwangju, Republic of Korea. drongkim@chosun.ac.kr.
authors.forename: Dong-Min
authors.initials: DM
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, School of Medicine, Chosun University, Gwangju, Republic of Korea.
authors.forename: Piyush
authors.initials: P
authors.lastname: Jha
authors.affiliation: Department of Internal Medicine, School of Medicine, Chosun University, Gwangju, Republic of Korea.
authors.forename: Babita
authors.initials: B
authors.lastname: Jha
authors.affiliation: Department of Neurosurgery, School of Medicine, Chosun University, Gwangju, Republic of Korea.
authors.forename: Seok Won
authors.initials: SW
authors.lastname: Kim
authors.affiliation: Department of Laboratory Medicine, School of Medicine, Chosun University, Gwangju, Republic of Korea.
authors.forename: Sook Jin
authors.initials: SJ
authors.lastname: Jang
authors.affiliation: Department of Laboratory Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea.
authors.forename: Jong Hee
authors.initials: JH
authors.lastname: Shin
mesh_terms: D000368:Aged; D000528:Alternaria; D060487:Alternariosis / Q000175:diagnosis; D000935:Antifungal Agents / Q000627:therapeutic use; D004271:DNA, Fungal / Q000235:genetics*; D003646:Debridement; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000276:immunology; D003951:Diagnostic Errors; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use; D050823:Hand Joints; D006801:Humans; D016867:Immunocompromised Host; D008279:Magnetic Resonance Imaging; D009181:Mycoses / Q000150:complications / Q000175:diagnosis* / Q000276:immunology / Q000628:therapy; D021681:Scedosporium / Q000235:genetics*; D017422:Sequence Analysis, DNA; D013717:Tenosynovitis / Q000150:complications / Q000175:diagnosis* / Q000276:immunology / Q000628:therapy
chemical_list: D000935:Antifungal Agents; D004271:DNA, Fungal; D015725:Fluconazole
keywords: Case report; Debridement; Scedospermum apiospermum; Tenosynovitis