Thread by @MayoClinicINFD

70M with swollen R 5th digit, hand and forearm. No fever / chills.

MRI: complex multi-compartment fluid collection with extensive flexor and extensor tenosynovitis

Debridement. Culture (photo).

What is your diagnosis and Rx?
#MayoIDQ MCQ to follow...

Elderly man with swollen right hand and forearm. MRI: complex fluid collection, extensive tenosynovitis. Debridement performed. Culture is shown (photo prior tweet).

Which of the following is the exposure associated with this infection?

3/
Beaver dam and blastomyces

When #IDBR says #beaverdam - you think #BLASTOMYCOSIS

nejm.org/doi/10.1056/NE…

4/
#Spelunking and histoplasmosis

When #IDBR says spelunking - you think #Histoplasmosis

doi.org/10.1111/j.1708…

5/
Insect bite and invasive mucocutaneous mycoses

RARE
Only 22 reports
Mucorales group is most common!
Others: Aspergillus, Sporothrix, Fusarium

doi.org/10.1093/ofid/o…

6/
#Sporothricosis and sphagnum moss

When #IDBR says sphagnum moss - you think Sporothricosis

This is the suggested answer to the MCQ

What are the other exposures associated with sporothrix? Next...

7/
#Sporothricosis
Soil and decaying vegetable and organic matter
- Hay
- Sphagnum moss
- Rose garden
Zoonotic- cat scratch and bite
- Endemic in Brazil

Sporotrichosis | Fungal Diseases | CDC

8/
Cat scratch/bite and sporothrix

Animal sporothricosis affects cats > dogs
Endemic in Rio de Janeiro / Brazil

Sporothrix brasiliensis
Transmitted to human: cat scratch and bites

ncbi.nlm.nih.gov/pmc/articles/P…

9/
Case diagnosis: #Sporothricosis with extensive tenosynovitis

Treatment
- Itraconazole: preferred for localized disease (alternate: terbinafine, high dose fluconazole)

- Potassium iodide (historical Rx)

- Amphotericin B: severely ill patients