title: Multifocal but non-disseminated phaeohyphomycosis in a healthy man via a unique mechanism: Ejection from motor vehicle accident into a vegetable field in Afghanistan resulting in multiple contaminated skin wounds.
abstract: A 20-year-old male presented with multiple subcutaneous nodules on the head, neck, chest and oral cavity. FNA and biopsy showed pigmented fungal hyphae diagnostic of multifocal phaeohyphomycosis, found to be Exophiala spinifera by molecular diagnostics. The presentation initially raised concern for disseminated disease and occult immunosuppression. However, the patient appeared to be immunocompetent and otherwise healthy. Upon further inquiry, the patient was in a motor vehicle accident 4 years before presentation; he was ejected into a vegetable field resulting in multiple open wounds. Multifocal phaeohyphomycosis usually indicates disseminated systemic disease from immunosuppression and carries a grave prognosis.
authors.affiliation: Department of Pathology, CURE International Hospital of Kabul, Kabul, Afghanistan.
authors.forename: M Omer
authors.initials: MO
authors.lastname: Malakzai
authors.affiliation: Department of Pathology, CURE International Hospital of Kabul, Kabul, Afghanistan.
authors.forename: Janat G
authors.initials: JG
authors.lastname: Sahak
authors.affiliation: Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors.forename: Ryan
authors.identifier: http://orcid.org/0000-0002-9357-2192
authors.initials: R
authors.lastname: Campbell
authors.affiliation: Department of Pathology, CURE International Hospital of Kabul, Kabul, Afghanistan.
authors.forename: Mirwais
authors.initials: M
authors.lastname: Abobakar
authors.affiliation: Department of Laboratory Medicine, University of Washington, Seattle, Washington.
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Hoogestraat
authors.affiliation: Department of Laboratory Medicine, University of Washington, Seattle, Washington.
authors.forename: Dhruba J
authors.initials: DJ
authors.lastname: SenGupta
authors.affiliation: Department of Laboratory Medicine, University of Washington, Seattle, Washington.
authors.forename: Andrew
authors.initials: A
authors.lastname: Bryan
authors.affiliation: Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors.forename: Jerad M
authors.identifier: http://orcid.org/0000-0001-7397-2159
authors.initials: JM
authors.lastname: Gardner
keywords: Afghanistan; Exophiala spinifera
  ; dematiaceous; fungus; motor vehicle accident; multifocal phaeohyphomycosis