We present a Prototheca wickerhamii wound infection case that failed treatment with ketoconazole but was cured with amphotericin-B plus tetracycline. The patient was immunocompetent but had had local steroid injections. We reviewed another 159 cases from the literature. Prototheca has infected many areas of the human body, but most often skin, olecranon bursa, or wounds. Prior treatment with steroids and immune deficiencies are contributing factors. Itraconazole and fluconazole are reasonable initial treatments for patients with mild infections. For serious infections, or for infections that have failed azole treatment, amphotericin-B is the treatment of choice.

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The relationship between granuloma annulare (GA) and malignant neoplasms is uncertain. Several case reports and clinical correlation studies have addressed this issue; however, no review articles have summarized those reported cases and statistically analyzed the association. Fourteen case reports and two correlation studies directly addressing the relationship of GA and malignant neoplasms were found from the Medline database from 1966-2001. A total of 16 cases from case reports were available with the mean age of 54. Most of the GA patients had an atypical clinical presentation. The time between the onset of GA and the discovery of the malignant neoplasms varied from 18 months before (median = 5 months) to 7 years after (median = 42 months). More than half of those cases were associated with lymphoma. No definite relationship was found between GA and malignant neoplasms. Older patients with skin lesions not clinically typical of GA but that histologically resemble classic GA, may be considered for investigation of underlying malignant lymphoma or other malignancies.