Thread by @IUIDfellowship

#idboardreview 30 M chronic steroids scraped elbow on tree now w/ progressive swelling/pain: olecranon bursitis. No improvement on abx. Diagnosis? #medEd #idmedEd #IDtwitter

#Prototheca #wickerhamii reference pic P&P Mandell

#Prototheca is an algae that rarely causes infection, mainly occurring in patients with predisposing conditions such as immunosuppression, occupation exposure like aquariums and traumatic inoculation

Unicellular algae, lack cholorophyll and reproduce by endosporulation.environmental: tree slim, sewage, fresh & marine water, soil & food. May colonize human skin, respiratory & GI track

Most common presentation is progressively painless plaque/papulonoduoar that may ulcerate. Favor olecranon bursitis, minor trauma, steroid injections, surgical wounds exposed to soil #prototheca

#prototheca cells 3-30 microm in diameter GMS and PAS stain 2-8 tightly packed endospores in each cell. White opaque colonies in few days on standard mycologic media

Surgical plus amphotericin for treatment #prototheca R to flucytosine. Reports w/ successful tax w/ itra, fluc or ketoconazole