A 6-Year-Old Boy with a Nodule on His Hand

Abstract

A 6-year-old boy was referred to our clinic with erythema and multiple nodules dorsum of the right hand and forearm. As we learned from the history of the patient, he first developed an erythema due to a thorn prick to the third finger on his right hand while playing. A single nodule appeared on the dorsum of the right hand 2 weeks later. After 1 month, multiple nodules developed in a linear distribution toward the right axillary.On examination, the appearance of the lesions was mildly ulcerative, and papillomatous growth toward the right axillary was seen (see Figure 1). A few axillary lymph nodes were found. Systemic examination was normal. Routine blood parameters, PPD, and immunoglobulin values were normal. An HIV test was negative.Microscopic examination of the nodule on the dorsum of the right hand with potassium hydroxide (KOH) stain, Gram's stain, and acid fast bacteria (AFB) stain were negative and the sample was sent for culture. Skin biopsy showed several round-tooval bodies, and one round body in the center along with chronic inflammatory cells.Culture on Sabouraud dextrose agar showed the growth of multiple fungal colonies that were grayish-black. Skin biopsy with periodic acid-Schiff (PAS) stain showed several round to oval spores of Sporothrix schenckii. One spore located in the center showed single budding along with chronic inflammatory cells.

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

“…A nodular lesion with lymphocutaneous spread in the hand of a child has been reported, which was ultimately diagnosed on fungal culture and responded to antifungal therapy. 10 Treatment requires administration of appropriate antimicrobial agents. 11 In this case, a variety of broad-spectrum antibiotics was given prior to presentation to the authors, to cover both gram-positive and gram-negative organisms, but with poor response.…”