Fungal infections of the hand and upper extremity

Although fungal infections of the hand and upper extremity are relatively uncommon, they are now being reported with increasing frequency. Immunocompromised patients are at especially high risk for these infections and hand surgeons should have a high index of suspicion for fungal infections in susceptible immunocompromised and diabetic patients and patients with hematologic malignancies and on chronic steroid medications. Because fungal infections often present with an indolent onset, diagnosis and treatment often are delayed. Definitive diagnosis only can be made with a surgical biopsy examination and special fungal stains and cultures. Early aggressive surgical treatment includes debridement of all involved soft tissues and bone, followed by adjuvant antifungal therapy.