The unusual case of a 29-year-old woman with tinea manus caused by infection due to Trichophyton erinacei is described. The patient presented with marked erosive inflammation of the entire fifth finger of her right hand. Mycological and genomic diagnostics resulted in identification of T. erinacei as the responsible pathogen, which had been transmitted by a domestic African pygmy hedgehog, Atelerix albiventris. Upon prolonged treatment with topical and systemic antifungal agents skin lesions slowly resolved. This case illustrates that the increasingly popular keeping of extraordinary pets such as hedgehogs may bear the risk of infections with uncommon dermatophytes.
A 66-year-old woman had a four-week history of spreading erythematous plaques and fl accid, yellow-tinged blisters. The lesions had a tendency to coalesce, appearing fi rst on the trunk and then spreading to the proximal extremities. The woman reported moderately severe pruritus, but otherwise her general condition was unaffected. Local treatment with a polidocanol-based topical agent and oral amoxicillin/ fl ucloxacillin failed to lead to improvement. The patient had breast cancer which had metastasized to the bone, and most recently to the liver. Five months before a chemotherapy with trastuzumab (Herceptin ® ) and paclitaxel had been initiated to treat the new liver metastases followed by trastuzumab monotherapy for few weeks.
Clinical findingsPredominantly on the trunk, and to a lesser extent on the proximal portions of the extremities and inguinal regions, numerous fl accid blisters containing cloudy yellow material with an erythematous rim were noted. There were also multiple erythematous, sometimes circular plaques with a pronounced border and scarlatina-like scale directed inward. Mucosal fi ndings were normal. The patient had undergone a mastectomy of the left breast (Figure 1). The cervical, axillary, and inguinal lymph nodes were normal on palpation. Figure 1 Mainly on the abdomen (a) and back (b) multiple flaccid bullae with formation of a hypopyon-like purulent fluid level on a red base (inset). In addition, circular, partly polycyclic plaques were present with a collarette of scale. Status post left mastectomy.
Laboratory findingsDifferental blood counts were normal. Transaminase levels and LDH were slightly elevated. Serum electrophoresis showed oligoclonal gammopathy. Pustular contents were sterile. Direct and indirect immunofl uorescence using human split skin and monkey esophagus, incubated with antiIgA and anti-IgG, were negative. When using rat bladder as a substrate (but not monkey bladder), immunofl uorescence showed minimal IgG in the intercellular space. The results of ELISA with recombinant desmoglein 1 and 3 as well as BP180 NC16A were negative.
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