A 69-year-old male presented with chronic right hand swelling, tenderness, and erythema, initially misdiagnosed as a hematoma after a fall. Despite surgical drainage, symptoms persisted, leading to a second debridement. Histopathology revealed septate hyphae and yeast-like cells, prompting fungal culture. The culture grew a black yeast-like fungus, subsequently identified as Exophiala jeanselmei through ITS sequencing. This confirmed a diagnosis of subcutaneous phaeohyphomycosis. The patient received voriconazole, showing improvement. This case highlights the diagnostic challenge of rare fungal infections mimicking common conditions, especially in immunocompetent individuals with no clear exposure.
Key note: Subcutaneous phaeohyphomycosis due to Exophiala jeanselmei can masquerade as a hematoma, requiring high suspicion and mycological investigation for accurate diagnosis.