ABSTRACT
Exophiala jeanselmei is a dematiaceous fungus causing black grain mycetoma, chromoblastomycosis and phaeohyphomycosis. It tends to involve cutaneous, subcutaneous tissues or visceral organs. We present a case of a previously healthy young male with a five year history of multiple soft tissue swellings of the body, as well as indolent soft tissue infection of his digits. He had received several courses of antibiotic and anti-tuberculous therapy without improvement. Two of the subcutaneous cystic masses were aspirated through fine needle and sent for histopathology and culture. Histopathology revealed acute on chronic inflammation with granuloma formation, and septate fungal hyphae with spores. The fungus was identified on culture as Exophiala jeanselmei and a diagnosis of subcutaneous phaeohyphomycosis was confirmed. He was treated with oral itraconazole along with incision and drainage and has shown marked clinical improvement. He continues to be on therapy at this time