Multifocal but Non-Disseminated Phaeohyphomycosis in a Healthy Man via a Unique Mechanism: Ejection from MVA into a Vegetable Field in Afghanistan Resulting in Multiple Contaminated Skin Wounds.

A 20 year-old male presented with multiple subcutaneous nodules on the head, neck, chest and oral cavity. FNA and biopsy showed pigmented fungal hyphae diagnostic of multifocal phaeohyphomycosis, found to be Exophiala spinifera by molecular diagnostics. The presentation initially raised concern for disseminated disease and occult immunosuppression. However, the patient appeared to be immunocompetent and otherwise healthy. Upon further inquiry, the patient was in a motor vehicle accident four years before presentation; he was ejected into a vegetable field resulting in multiple open wounds. Multifocal phaeohyphomycosis usually indicates disseminated systemic disease from immunosuppression and carries a grave prognosis.