Deep Invasive Fungal Infection of the Hand in a Child Mimicking a Local Gigantism

Abstract

Subcutaneous and deep fungal infections in the hand are rare among children. These are usually found in immunocompromised adults or in persons engaged in soil handling activities, due to direct exposure, especially in the tropics. Delay in diagnosis is usual because pyogenic and other granulomatous infections are considered first.

The authors present the case of a healthy, immunocompetent 2½-year-old child who presented with progressive swelling of the right hand mimicking a localized gigantism of the entire hand. Multiple operative drainage procedures done previously had failed to resolve the condition. A biopsy established the presence of fungal hyphae, thus confirming the diagnosis of deep fungal infection of the hand and guided proper therapeutic intervention. A strong index of suspicion needs to be maintained in cases not responding to conventional antibacterial therapy, and both microbiologic and histopathologic samples need to be obtained to establish the diagnosis.

Keywords

pediatric hand infection - deep fungal infection - local gigantism

• References

• 1 al-Qattan MM. Opportunistic mycotic infections of the upper limb. A review. J Hand Surg [Br] 1996; 21 (02) 148-150
• 2 Jain A, Jain S, Rawat S. Emerging fungal infections among children: a review on its clinical manifestations, diagnosis, and prevention. J Pharm Bioallied Sci 2010; 2 (04) 314-320
• 3 Raizman NM, Parisien M, Grafe MW, Gordon RJ, Rosenwasser MP. Mucormycosis of the upper extremity in a patient with alcoholic encephalopathy. J Hand Surg Am 2007; 32 (03) 384-388
• 4 Guarner J, Brandt ME. Histopathologic diagnosis of fungal infections in the 21st century. Clin Microbiol Rev 2011; 24 (02) 247-280
• 5 Patel MR. Chronic infections. In: Wolfe SW, Pederson WC, Hotchkiss RN, Kozin SC, Cohen MS. eds. Green's Operative Hand Surgery. 7th ed.. Philadelphia, PA: Elsevier; 2016. 3 62-127
• 6 Bahk WJ, Chang ED, Chun KA, Lee AH, Park JM, Bahk YW. Chromomycosis presenting as soft-tissue mass: report of a case with MRI features. Skeletal Radiol 2009; 38 (02) 177-180
• 7 Smith GD, Shatford RAD. Histoplasmosis infection presenting as an isolated subcutaneous periarticular upper limb swelling in the immunosuppressed patient. J Hand Surg [Br] 2005; 30 (02) 229-232
• 8 Rodig SJ, Dorfman DM. Splendore-Hoeppli phenomenon. Arch Pathol Lab Med 2001; 125 (11) 1515-1516
• 9 Chandler FW, Watts JC. Botryomycosis. In: Connor DH, Chandler FW, Schwartz DA. et al eds Pathology of Infectious Diseases. Stamford, CT: Appleton and Lange; 1997: 441-445
• 10 Firinci F, Erdemir Y, Cetin B, Abaci A. A 6-year-old boy with a nodule on his hand. Pediatr Ann 2012; 41 (09) 360-361
• 11 Koga T, Matsuda T, Matsumoto T, Furue M. Therapeutic approaches to subcutaneous mycoses. Am J Clin Dermatol 2003; 4 (08) 537-543