IADVL
Indexed with PubMed and Science Citation Index (E) 
 
Users online: 2416 
     Home | Feedback | Login 
About Current Issue Archive Ahead of print Search Instructions Online Submission Subscribe What's New Contact  
  Navigate here 
  Search
 
  
 Resource links
   Similar in PUBMED
   Article in PDF (1,949 KB)
   Citation Manager
   Access Statistics
   Reader Comments
   Email Alert *
   Add to My List *
* Registration required (free)  

 
  In this article
  Question
  Answer
  Discussion
   References
   Article Figures

 Article Access Statistics
    Viewed1962    
    Printed55    
    Emailed0    
    PDF Downloaded149    
    Comments [Add]    

Recommend this journal

 


 
 Table of Contents    
QUIZ
Year : 2018  |  Volume : 84  |  Issue : 1  |  Page : 54-56

A red, swollen and painful lesion on the right hand after local steroid injections


1 Department of Pathology, Ditmanson Medical Foundation Chiayi Christian Hospital; Department of Nursing, Chung-Jen College of Nursing, Health Sciences and Management, Chiayi, Taiwan
2 Department of Surgery, Division of Plastic Surgery, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi, Taiwan
3 Department of Pathology, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi; Department of Cosmetic Science, Chia Nan University of Pharmacy and Science, Tainan, Taiwan

Date of Web Publication26-Dec-2017

Correspondence Address:
Chienchin Chen
No. 539, Zhongxiao Road, East District, Chiayi 600
Taiwan
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijdvl.IJDVL_582_16

Rights and Permissions



How to cite this article:
Liao K, Fang C, Chen C. A red, swollen and painful lesion on the right hand after local steroid injections. Indian J Dermatol Venereol Leprol 2018;84:54-6

How to cite this URL:
Liao K, Fang C, Chen C. A red, swollen and painful lesion on the right hand after local steroid injections. Indian J Dermatol Venereol Leprol [serial online] 2018 [cited 2019 Dec 7];84:54-6. Available from: http://www.ijdvl.com/text.asp?2018/84/1/54/205294


A 60-year-old woman with a history of trigger finger presented with a 2-week history of a swollen right middle finger. She had received local steroid injections twice for trigger finger 1 month before the visit. Unfortunately, the injection site became red, swollen and painful [Figure 1a]. No evidence of immunosuppression was proven by tests for human immunodeficiency virus, hepatitis B virus, hepatitis C virus and diabetes. She subsequently underwent local debridement. On incision, there was serosanguinous discharge and necrotic synovitis of the volar side of the right third metacarpal head region [Figure 1b]. Histopathological examination revealed numerous spore-like microorganisms in the necrotic debris [Figure 2]. Numerous endospores with occasional floret-like arrangement were identified on periodic acid-Schiff and silver stains [Figure 3]. Tissue cultures were set up on blood agar plate and Sabouraud dextrose agar. The wet mount revealed round-to-oval spores of varying sizes (about 10–20 μ) with varying number of endospores inside.
Figure 1a: The right hand showed local redness and inflammation

Click here to view
Figure 1b: On surgical exploration necrosis was observed

Click here to view
Figure 2: Spore-like microorganisms were found in necrotic debris (H and E, ×400)

Click here to view
Figure 3: The Periodic acid-Schiff stain revealed numerous spore-like microorganisms (×400). The endospores with typical floret-like arrangement are identified (inset)

Click here to view



  Question Top


What is the diagnosis?



Click here to view answer. View Answer


 
  References Top

1.
Todd JR, King JW, Oberle A, Matsumoto T, Odaka Y, Fowler M, et al. Protothecosis: Report of a case with 20-year follow-up, and review of previously published cases. Med Mycol 2012;50:673-89.  Back to cited text no. 1
[PUBMED]    
2.
Nguyen QG, Rosen T. Cutaneous protothecosis in a patient with chronic lymphocytic leukemia: A case report and literature review. J Fungi 2015;1:4-12.  Back to cited text no. 2
    
3.
Hillesheim PB, Bahrami S. Cutaneous protothecosis. Arch Pathol Lab Med 2011;135:941-4.  Back to cited text no. 3
[PUBMED]    
4.
Lass-Flörl C, Mayr A. Human protothecosis. Clin Microbiol Rev 2007;20:230-42.  Back to cited text no. 4
    


    Figures

  [Figure 1a], [Figure 1b], [Figure 2], [Figure 3]



 

Top
Print this article  Email this article

    

Online since 15th March '04
Published by Wolters Kluwer - Medknow