Wednesday, November 6, 2002
1069

Fungal Finger Abscess in an Immunocompromised Patient

Anthony M. Zacharek, MD, James N. Long, MD, and Linda G. Phillips, MD.

Finger abscess is a common occurrence. The majority of cases involve bacterial infection, typically Staphylococcus and Streptococcus species. However, we present a case of finger abscess in an immunocompromised host in which fungus was identified. A 41-year-old right hand dominant man with history of recent cadaveric renal transplant presented with a one week history of progressive swelling and pain involving the right index finger. His medications included tacrolimus and prednisone. An incision and drainage of the finger abscess was performed, with evacuation of 5 cc of purulent material from the right index finger. Gram stain revealed rare hyphae, with fungal cultures showing Exophiala species. The patient was begun empirically on topical nystatin and oral itraconazole. His abscess has since resolved with return of full hand function. We present this case as it is unusual to make a diagnosis of fungal finger abscess. The majority of infections involving the non-nail portion of the finger are bacterial, with occasional viral etiologies. Fungal infection presenting as a finger abscess has not been discussed at length in the literature. The immunocompromised state would appear to represent a risk factor for the development of such infections. Once the presence of hyphae is detected on gram stain, the patient is begun on empiric topical and oral treatment for fungal infection, with final culture results guiding definitive treatment. The clinician should be alert to the possibility of fungal finger abscess in any patient with a history of immunocompromise.
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