Multiple Subcutaneous Nodules Caused by Plant Fungus Thyridium flavostromatum in an Immunocompromised Patient.
Pranav Dinesh Kamat, Ayan Basu, Dipankar Paul et al.
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Case in brief
A man with rheumatoid arthritis receiving immunosuppressants developed multiple tender subcutaneous nodules. Aspirate showed yeast-like cells with chlamydospores, but the organism was not identified by the matrix-assisted laser desorption/ionization time-of-flight mass spectrometry database. DNA sequencing identified the plant fungus Thyridium flavostromatum. The nodules were treated successfully with voriconazole.
What made this case unusual
The causative organism was a plant fungus, T. flavostromatum, identified by DNA sequencing after it was not found in the mass spectrometry database. The report describes nodules on human skin caused by Thyridium.
Diagnostic / clinical pearl
When fungal cells from a subcutaneous lesion are not identified by routine mass spectrometry, DNA sequencing can help identify an unexpected organism.