Division of Hand Surgery, Department of Orthopedic Surgery, Jeju National University Hospital, Jeju, South Korea.
Division of Infectious Disease, Department of Internal Medicine, Jeju National University Hospital, Jeju, South Korea.
BMC Infect Dis. 2022 Mar 29;22(1):304. doi: 10.1186/s12879-022-07280-y.
Fungal infection secondary to a penetrating plant thorn injury in upper extremities is infrequently reported especially in immunocompetent hosts. Alternaria is a dematicaceous hyphomycete, commonly found in decay and plant pathogens, and Alternaria alternata has been regarded as the most frequent species among more than 400 s of its species. This case is the first report of thorn-induced Alternaria alternata infection of the hand in an immunocompetent host.
A 47-year-old male patient was admitted to our institution with persistent pain and swelling of the right hand even after a prior surgical removal of a previous thorn injury. Upon impression of abscess, chronic extensor tenosynovitis, and septic arthritis at the 3rd metacarpophalangeal joint based on advanced imaging, the patient underwent surgical incision and drainage. Intraoperative culture, biopsy, and gene molecular sequencing results revealed fungal infection with Alternaria alternata. Postoperatively, the patient was treated with oral itraconazole (200 mg q 12 h) for nine consecutive months.
We report the first case of chronic extensor tenosynovitis and septic arthritis of the hand with Alternaria alternata after a thorn injury in an immunocompetent host. Despite rare incidences of fungal extensor tenosynovitis and septic arthritis, the current case strongly suggests a careful examination of social history and surgical debridement along with a prolonged use of appropriate anti-fungal agents in thorn injuries.
上肢穿透性植物刺伤继发真菌感染在免疫功能正常的宿主中很少见报道。链格孢是一种暗梗霉，通常存在于腐烂物和植物病原体中，而链格孢Alternata 被认为是其 400 多种物种中最常见的物种。本例是首例免疫功能正常的宿主手部刺伤引起的链格孢Alternata 感染。
一名 47 岁男性患者因右手持续性疼痛和肿胀而入院，尽管先前已进行了手术切除先前的刺伤。根据先进的影像学检查，印象为脓肿、慢性伸肌腱滑膜炎和第 3 掌指关节化脓性关节炎，患者接受了手术切开引流。术中培养、活检和基因分子测序结果显示真菌感染为链格孢Alternata。术后，患者接受了口服伊曲康唑（200mg q12h）治疗，共 9 个月。
我们报告首例免疫功能正常的宿主手部刺伤后慢性伸肌腱滑膜炎和化脓性关节炎伴链格孢Alternata。尽管真菌性伸肌腱滑膜炎和化脓性关节炎的发病率较低，但本例强烈提示在刺伤时仔细检查社会史和手术清创，并延长使用适当的抗真菌药物。
