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Department of Nephrology, Georges Pompidou European Hospital, AP-HP, Paris, FranceDepartment of Internal Medicine, Percy Military Teaching Hospital, Clamart, France
Requests for reprints should be addressed to Hélène Lazareth, Department of Nephrology, Georges Pompidou European Hospital, 20 rue Leblanc, 75015 Paris, France.
A 52-year-old woman presented with a 5-month history of painless swelling of a non-dominant
hand finger, without contributing factors such as trauma. Past medical history was
notable for diabetes mellitus with glycated hemoglobin level of 7.9%, and autosomal
dominant polycystic kidney disease that required a kidney transplant 1 year earlier.
She was receiving immunosuppressive maintenance therapy with prednisone (10 mg daily),
tacrolimus (with targeted trough level between 5-7 ng/mL), and mycophenolate mofetil
(1000 mg daily). Clinical examination revealed a fluctuant nodule (measuring 15 × 10
mm) of the palmar surface of the left index (Figure). There was no fever, no argument for a deep infection such as a flexor tenosynovitis,
nor regional adenopathy. Clinical examination was otherwise unremarkable.
Figure(A) Fluctuant nodule of the palmar surface of the first phalanx of the second finger.
(B) Magnetic resonance T2-weighted imaging: nodular lesion facing the flexor tendon
with high signal intensity. (C) Histological study: central necrotic cavity surrounded by chronic inflammation and
fibrosis at low magnification (hematoxylin and eosin staining; scale bar: 2 mm). Insert:
silver staining shows fungi forming vesicular mycelium in the central necrotic area
(Grocott silver stain; scale bar: 200 µm).
