Abstract
A 66-year-old man with a history of cirrhosis due to chronic hepatitis C infection and hepatocellular carcinoma presented with a skin nodule on his left foot that had gradually increased in size over the previous two months. He recalled no traumatic injury that could account for the lesion. Upon examination, a semispherical skin nodule with tenderness, 20×16mm in size, was observed on the dorsum of his left foot. The nodule, excised under local anesthesia, exhibited a capsulated cystic structure containing pus in the dermis and subcutis. Direct microscopic examination of the pus revealed hyphal fungal elements. Histopathological examination demonstrated hyphal fungal elements in granulomatous tissue lining the cystic lesion and in the cavity. Fungal cultures from the pus identified Phaeoacremonium parasiticum as the causative agent. The skin nodule was successfully removed; however, he died of liver failure three weeks after the excision. This case was suggested to be an opportunistic infection due to immunodeficiency associated with liver failure.Skin Research, 16: 322-327, 2017
