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Subcutaneous entomophthoromycosis in an immunocompetent individual: a localised forearm swelling
  1. VishnuKumar Katari Gopalakrishanan1,
  2. Magesh Murali1,
  3. Shruthi Kamal Venkatraman1 and
  4. Muthuvel Essaki2
  1. 1General Surgery, Saveetha University Saveetha Medical College and Hospital, Chennai, Tamil Nadu, India
  2. 2Pathology, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, India
  1. Correspondence to Dr VishnuKumar Katari Gopalakrishanan; vishnukgvk{at}gmail.com

Abstract

A man in his 80s with no known comorbidities presented with diffuse swelling on the dorsal aspect of his right forearm for 3 months. Clinical features were suggestive of soft tissue sarcoma of the right forearm. A high resolution CT scan of the thorax showed allergic bronchopulmonary aspergillosis associated with mild mediastinal lymphadenopathy. MRI of the right upper limb showed a suspicious neoplastic/infective aetiology. A core biopsy of the right arm swelling found a granuloma with no malignancy features so an incisional biopsy of the lesion was carried out. This indicated granulomatous inflammation with excessive giant cell reaction and focal panniculitis with the possibility of a mycotic lesion. Bronchoalveolar lavage was negative for tuberculosis and fungal infection. After a multidisciplinary team discussion, the patient was started on antifungal medication. There was a marked reduction in both the size and consistency of the swelling after several weeks of oral itraconazole and potassium iodide solution. The purpose of this report is to increase the awareness of this uncommon treatable condition which, if misdiagnosed, could result in an inappropriate intervention.

  • Dermatology
  • Infections
  • Oncology
  • General surgery

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Footnotes

  • Deceased As second author

  • Contributors SKV: primary surgeon; MM, first assistant. VKG, second assistant; ME, pathologist.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.