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Unusual Suspects: Candida parapsilosis Tenosynovitis in Immunocompetent Hands - A Case Series
Kai Hsiang Yu, M.D.
1; Dun-Hao Chang, MD
2(1)Far Eastern Memorial Hospital, New Taipei City, Taiwan, (2)Taipei Veterans General Hospital, Taipei, Taiwan
Introduction:Candida parapsilosis is a known commensal organism of human skin. Although deep fungal soft tissue infections are rare, they may occur following direct inoculation, particularly in patients with prior hand trauma, surgery, prosthetic devices, or poor local circulation. In immunocompetent individuals, fungal tenosynovitis presents differently from bacterial infections, typically showing slow progression and minimal pain. This study presents our experience in diagnosing and managing
Candida parapsilosis tenosynovitis in immunocompetent patients.
Materials and Methods:Between July 2021 and June 2025, we retrospectively reviewed cases of culture-confirmed
Candida parapsilosis tenosynovitis. Patient demographics, comorbidities, wound characteristics, treatment modalities, complications, and healing outcomes were analyzed.
Results:Three patients were identified.
- Case 1: A 58-year-old man with swelling and limited flexion of the left middle and little fingers, initially misdiagnosed as trigger finger and treated with pulley release.
- Case 2: A 64-year-old woman with progressive erythema and swelling of the right middle finger two months after a platelet-rich plasma injection.
- Case 3: A 79-year-old woman with a history of garbage disposal work presented with erythema and bulla formation on the left palm following minor trauma.
All patients underwent multiple surgical debridements and/or catheter irrigation. Cultures confirmed Candida parapsilosis infection in all cases; in Case 3, the organism was further identified as Candida orthopsilosis, a subtype of C. parapsilosis. All patients received systemic antifungal therapy for 6 to 12 weeks.
- Case 1 achieved wound healing by primary closure.
- Case 2 had a palmar skin defect with exposed flexor tendons and underwent reconstruction using a dorsal metacarpal artery perforator (DMAP) flap.
- Case 3 healed by secondary intention.
Conclusions:
Fungal tenosynovitis, although rare, should be considered in cases of atypical, slowly progressive hand infections, especially following surgery or trauma. Candida parapsilosis may cause tenosynovitis even in immunocompetent patients. Early suspicion, intraoperative cultures, and appropriate antifungal therapy are crucial for successful outcomes. Various wound management strategies, including reconstructive procedures, can result in satisfactory healing.
Key words: Candida parapsilosis, Candida orthopsilosis, tenosynovitis
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