A Patient with Cystic Granuloma Trichophyticum who Required Surgical Resection

Abstract

A 62-year-old male with numerous subcutaneous nodules in the lower extremities was referred to The University of Tokyo Hospital. The patient suffered from systemic lupus erythematosus（SLE） , diabetes mellitus, and persisting hepatic dysfunction, and had been treated for SLE with oral prednisolone 20 mg/day and oral cyclosporine 3 mg/kg/day. The culture of scales collected from the patientʼs skin surface on Sabouraudʼs dextrose agar medium showed features of Trichophyton rubrum. Topically applied bifonazole cream was effective for tinea corporis, but oral griseofulvin 500 mg/day was discontinued after 2-month administration because of deteriorated liver function. All the nodules were resected surgically. Histologically, resected granulomas showed dermal abscesses that were tightly encapsulated by fibrous capsules. Grocott staining revealed numerous fungal elements within abscesses. The patientʼ s condition indicated the need to perform histopathological examination of granuloma trichophyticum in order to determine whether it is tightly encapsulated. Namely, the presence of cystic granuloma trichophyticum with abscesses encapsulated by fibrous capsules suggested that the patient should be treated by surgical resection of the lesions.

Subcutaneous abscesses caused by Trichophyton rubrum in the unilateral groin of an immunocompromised patient: A case report

“…According to the reports of 48 cases of deeper dermal dermatophytosis between 1966 and 2017 [4] , [5] , [6] , [7] , 39 cases (81%) occurred in immunocompromised patients. The lesions most frequently affected the lower extremities, including the buttocks and groin (n = 27, 56%), although they could occur on any part of body.…”

“…Oral terbinafine or itraconazole would be effective. When the lesion forms a well-demarcated, subcutaneous nodule, the combination of resection and systemic antifungal therapy might be useful [7] .…”