Protothecosis: report of a case with 20-year follow-up, and review of previously published cases

assimilation of nutrients [10,17,18].Recently there have been two excellent general reviews of human protothecosis, by Beatriz Leimann et al.,20].We will report our case, and then our review will focus on going back to the case reports and making a quantitative analysis of the epidemiology and treatment of human protothecosis. Case reportA white female with hypothyroidism, who has lived in Louisiana since age 16, developed pain in the right and left wrists in 1984 and 1986, respectively.An orthopedist diagnosed tendonitis and gave six cortisone injections into the right wrist from 1985-1988.In September, 1988, the orthopedist operated for tendonitis on both wrists.The patient worked in her yard and garden while the surgical wounds were fresh, and new pain in the right wrist started 1 -2 weeks after surgery.The right wrist wound healed very slowly, and drained thin yellow fl uid, but the pain and drainage eventually resolved.Swelling of the right wrist started in May 1989, and waxed and waned.The orthopedist surgically