Cutaneous candidal infection caused by Yarrowia lipolytica in an immunocompetent patient.

Introduction
Yarrowia lipolytica is an environmental yeast that rarely causes human infection and is typically reported in immunocompromised hosts. Cutaneous involvement in immunocompetent individuals is highly unusual and may mimic more common infectious dermatoses, making diagnosis challenging. We report a case occurring in an immunocompetent man to highlight this uncommon presentation and the diagnostic difficulties associated with this organism.

Case presentation
A 56-year-old immunocompetent Armenian man presented with a chronic, pruritic lesion on the dorsum of his right wrist, persisting for 3 years and unresponsive to potent topical corticosteroids. He denied systemic symptoms, recent trauma, or previous similar episodes. His history was notable for frequent handling of a home aquarium without protective gloves and remote travel to rural regions of Armenia and France over 10 years prior.
Physical examination revealed a well-demarcated erythemato-squamous plaque (Fig 1). Dermoscopy demonstrated a pink background with white reticular streaks and focal yellow-orange crusts (Fig 2). A punch biopsy was performed. Histopathologic examination showed dermal granulomatous inflammation with suppurative foci (Fig 3). Ziehl–Neelsen staining and polymerase chain reaction for Leishmania spp. were negative. Giemsa staining revealed small budding yeast-like organisms. Fungal cultures on Sabouraud medium yielded creamy colonies that grew more rapidly at 30 °C than at 37 °C. matrix-assisted laser desorption/ionization time-of-flight mass spectrometry confirmed the isolate as Y. lipolytica.