Infect Chemother.  2017 Dec;49(4):293-296. 10.3947/ic.2017.49.4.293.

Successful Treatment of Protothecal Tenosynovitis in an Immunocompetent Patient using Amphotericin B Deoxycholate

• Kim JE
• Oh TH
• Lee KH
• Shin JH
• Jung SI

• KMID: 2399198
• DOI: http://doi.org/10.3947/ic.2017.49.4.293

Abstract

Protothecosis is an uncommon human infection caused by achlorophyllic algae of the genus Prototheca, especially P. wickerhamii. The skin is the most frequently involved organ and cases of protothecal tenosynovitis are very rare. A 71-year-old woman without prior medical history except hypertension presented with painful swelling of her right hand that did not improve despite receiving antibiotic treatment. She underwent tenosynovectomy and drainage. Histopathologic examination revealed necrotizing granulomatous inflammation and numerous spherical or morula-like organisms with a spoked wheel appearance. P. wickerhamii was identified from tissue culture. The lesion did not improve with empirical fluconazole therapy. Conventional amphotericin B was administered according to antifungal susceptibility tests and the lesion completely resolved. Protothecosis should be considered in the differential diagnosis for chronic tenosynovitis that does not respond to conventional antibacterial treatment; tissue biopsy with culture is required for diagnosis.

Keyword

Protothecosis; Prototheca wickerhamii; Tenosynovitis; Immunocompetent; Antifungal susceptibility

MeSH Terms

Aged
Amphotericin B*
Biopsy
Deoxycholic Acid*
Diagnosis
Diagnosis, Differential
Drainage
Female
Fluconazole
Hand
Humans
Hypertension
Inflammation
Prototheca
Skin
Tenosynovitis*
Amphotericin B
Deoxycholic Acid
Fluconazole

Figure

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  Figure 1 (A) The lesion showed necrotizing granulomatous inflammation composed of geographic necrosis and abundant inflammatory infiltration (hematoxylin and eosin stain, original magnification ×40). (B) Some portions of the synovial surfaces revealed reactive papillary hyperplasia (hematoxylin and eosin stain, original magnification ×100). (C) Numerous spherical organisms of variable sizes were identified at a high magnification (hematoxylin and eosin stain, original magnification ×400). An example of a sporangiospore with a “spoked wheel” appearance is indicated by an arrow head and its magnified image is in the inset box (hematoxylin and eosin stain, original magnification ×1000). (D) The organisms were identified using methenamine silver staining (original magnification ×400).

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