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

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. 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. 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. 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. The purpose of our report is to alert others to consider all commensal organisms of the skin in recalcitrant infections of the hand.