Background Protothecosis is a rare infection in humans and animals caused by the achlorophyllic algae Prototheca species. More than half of the protothecosis cases are cutaneous infections, and most cases are observed in immunocompromised individuals. Case presentation We report a case of Prototheca wickerhamii infection in the mucosa of the pharynx in a 53-year-old immunocompetent woman with an incidentally found mass lesion at the left tongue base. Histopathological findings of the mass lesion suggested cryptococcosis, but P. wickerhamii was identified from the oropharynx scrape culture based on DNA sequencing. After surgical resection, fosfluconazole treatment was initiated, and subsequently, treatment was switched to topical amphotericin B. The residual mass lesion did not deteriorate during the 4-month antifungal treatment and 1-year observational period. Conclusions Prototheca species can be easily misdiagnosed as yeasts because of their morphological and pathological similarities. Prototheca, in addition to Cryptococcus should be considered if slow-growing, large Gram-positive organisms are encountered. Lactophenol cotton blue staining of the colony helps distinguish these organisms. Further study is needed to determine the appropriate treatment according to the infection focus.

BackgroundAntineoplastic drugs have often been shown to be mutagenic, teratogenic and carcinogenic, and these drugs are recommended to be prepared in a biological safety cabinet (BSC). Among them, 5-fluorouracil (5-FU) is a common cytotoxic antineoplastic drug, and can potentially cause harm if not handled properly.PurposeTo investigate the relationship between the level of 5-FU contamination during normal mixing, the time spent in preparation, the operator’s experience in mixing, the number of 5-FU vials prepared during this study, and the number of anticancer agents prepared at each hospital.Material and methodsDuring preparation, 5-FU contamination was determined on 2 stainless steel plates (10 × 10 cm) in the BSC in 8 national hospitals. These stainless steel plates were collected at the end of the study period. Samples were analysed by a validated liquid chromatography coupled to tandem mass spectrometry method.ResultsThe subjects were 16 pharmacists from 8 hospitals. The median preparation experience was 18 months (1–168 months), and the median number of 5-FU vials prepared by each pharmacist was 7 vials (2–38 vials). The level of 5-FU contamination was 2,079.5 ng (0–10,148.0 ng)/200 cm2. Comparing the level of contamination to the amount of 5-FU prepared, the time spent in preparation, the years of preparation experience, and the number of anticancer agents prepared at each hospital, no correlations were observed (r2 = 0.0062, 0.0002, 0.0562, 0.016).Conclusion5 pharmacists achieved 5-FU contamination at levels below the detection limit. Importantly, years of preparation experience varied among these pharmacists. These results suggested that even experienced pharmacists may underestimate the risk of environmental exposure during normal preparation. Routine training in mixing skills is needed to safely handle antineoplastic agents.ReferenceNational Institute for Occupational Safety and Health (NIOSH) NIOSH alert 2004-165. Preventing occupational exposures to antineoplastic and other hazardous drugs in health care settings. Cincinnati, OH: NIOSH; 2004.No conflict of interest.