A Unique Clinicopathological Manifestation of Fungal Infection: A Case Series of Deep Dermatophytosis in Immunosuppressed Patients

Abstract

This case-series study suggests that deep dermatophytosis is a separate entity, distinct from Majocchi's granuloma. It occurs only in immunocompromised patients and is characterized by discrete nodules, an indolent course, the absence of follicular invasion, and proximity to a superficial dermatophyte infection. Systemic antifungal treatment leads to complete resolution. The urgent need for the treatment of superficial fungal infections in immunocompromised patients is emphasized.

Severe dermatophytosis in solid organ transplant recipients: A French retrospective series and literature review

“…Finally, cutaneous cryptococcosis is common in SOT (18% among an international cohort) presenting with nodules, maculopapules, ulcers, pustules, abscesses, and cellulitis of the lower extremities . In our series of invasive dermatophytosis and in the series of Kershenovich et al, all patients had superficial dermatophytosis lesions in association with nodules. Superficial dermatophytosis in association with nodules in a SOT patient should evoke diagnosis of invasive dermatophytosis.…”

Ulcerated Nodule in the Right Sole of an Immunocompromised Patient

“…Surgery complemented with topical antifungal should be considered in cases unresponsive to systemic therapy or for patients who cannot be medicated with systemic antifungals. 5 In conclusion, this case emphasizes the possibility of deep dermatophytosis in immunocompromised patients with preceding superficial fungal infections which may progress to invasive and disseminated fungal infection. Therefore, physicians should promptly treat superficial dermatophytosis, if possible before immunosuppression is initiated.…”

“…It usually appears early after initiation of immunosuppressive medication (< 3 years) in patients with superficial fungal infections. 5 Histological diagnosis of deep dermatophytosis can be confirmed only if fungi are observed inside the granuloma, excluding contamination of the specimen by a superficial infection. The most prevalent dermatophyte species isolated is the anthropophilic Trichophyton rubrum, as in the present case.…”

“…The most prevalent dermatophyte species isolated is the anthropophilic Trichophyton rubrum, as in the present case. 5 It responds well to systemic antifungal treatment, especially terbinafine or triazoles. Surgery complemented with topical antifungal should be considered in cases unresponsive to systemic therapy or for patients who cannot be medicated with systemic antifungals.…”

Image Gallery: Molluscum contagiosum-like facial lesions in a patient with a renal transplant: deep dermatophytosis due to Trichophyton rubrum

“…The papules resolved with oral terbinafine. Atypical manifestations of T. rubrum infection are reported in immunosuppressed patients including ‘molluscum‐like’ lesions on the back . Other reports of T. rubrum presenting with molluscum contagiosum‐like facial lesions could not be found.…”