Pseudallescheria angusta(P. angusta), ubiquitous molds in soil and polluted water, belongs to the Pseudallescheria boydii complex. The clinical manifestations of cutaneous infection caused by P. angusta include edematous erythematous nodules, pustules and subcutaneous abscess. A 73-year-old female presented with painful multiple 1-3mm sized erythematous nodules and pustules on left hand dorsum for 4 months. Histopathologically, there were mixed inflammatory cells infiltrates and cyst like structures in the dermis and fungal hyphae were positive in Gomori methenamine silver stain (GMS) and Periodic -Acid-Schiff stain (PAS). She was treated with puncture and drainage for inflammatory pustules, and took oral itraconazole 200mg/day for one month. Cutnaeous lesions showed only slightly improved pattern after treatments. So the authors were forced to wait for the identifications of the fungal strain. After 4 weeks, the specific strain was confirmed as P. angusta by PCR. We changed itraconazole to oral voriconazole 400mg/day. After three months of treatment with voriconazole, there was no evidence of recurrence after 3 months of follow up. Herein, we report the first case of primary cutaneous Pseudallescheria angusta infection successfully treated with voriconazole in an immunocompetent patient.