PHEOHYPHOMYCOSIS CAUSED BY EXOPHIALA-DERMATITIDIS FOLLOWING INTRAARTICULAR STEROID INJECTION

A patient with long-standing rheumatoid arthritis presented with a pai nful pigmented chronic nodule on the dorsum of the right hand, at the site of intra-articular steroid injections undertaken 5 years previous ly, Histology showed pigmented fungal elements consistent with phaeohy phomycosis. Cultures yielded black yeast-like colonies, identified as Exophiala dermatitidis and sensitive to itraconazole and amphotericin. A 1-month course of itraconazole resulted in marked clinical improvem ent but surgical excision and skin grafting were required for complete resolution, Phaeohyphomycosis has been related to inoculation injury but association with intra-articular steroid injection appears hithert o to be unreported.