Just the tip of the iceberg: Extensive flexor tenosynovitis due to Candida parapsilosis, a case report

Abstract

Rationale: We present a case of a healthy 51-year-old female who developed extensive flexor tenosynovitis due to Candida parapsilosis following treatment for trigger thumb. Patient concerns: Initial care had included corticosteroid injections and operative trigger finger release. She presented to us with reduced range of motion of her right thumb and a nodular swelling of the thenar eminence. No purulence was found with incision and drainage of the nodule and an empiric course of trimethoprim-sulfamethoxazole was given. Diagnosis: Weeks later, an increase in thenar swelling and inability to extend her fingers lead to operative debridement. Multiple intraoperative samples grew C. parapsilosis, and a diagnosis of extensive flexor tenosynovitis was made. Interventions: We suspect that corticosteroid injections to treat trigger finger and exposure to a broad-spectrum antibacterial selected for the growth of Candida species. The unique anatomy of the hand, indolent nature of Candida in a normal host and underestimation of the infectious burden contributed to a delay in diagnosis. Outcomes and Lessons: The purpose of our report is to alert others to consider all commensal organisms of the skin in recalcitrant infections of the hand.