Invasive dermatophyte infection with <i>Trichophyton interdigitale</i>
 is associated with prurigo-induced pseudoperforation and a signal transducer and activator of transcription 3 mutation

Simpson, J.K.; Fröbel, Philipp; Seneviratne, Suranjith L.; Brown, Matthew A.; Lowe, David M.; Grimbacher, Bodo; Fliegauf, Manfred; Fearfield, L.

doi:10.1111/bjd.15781

Cited by 14 publications

(16 citation statements)

References 15 publications

(19 reference statements)

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“…Genomic DNA was extracted from the peripheral blood of the patient. We analyzed all the exons encoding caspase recruitment domain-containing protein 9 (CARD9) [13] and signal transducer and activator of transcription 3 (STAT3) [14], which have previously been linked to invasive fungal infections. And no disease-causing mutation was found in these two genes.…”

Section: Case Presentationmentioning

confidence: 99%

Simultaneous dermatophytosis and keratomycosis caused by Trichophyton interdigitale infection: a case report and literature review

Zhang

Jiang

et al. 2019

BMC Infect Dis

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BackgroundDermatophytosis is a fungal infectious disease caused by dermatophytes, which produce protease and keratinase to digest keratin, leading to the colonization, invasion, and infection of the stratum corneum of the skin, hair shafts, and nails. Trichophyton interdigitale belongs to Trichophyton mentagrophytes complex, which is the common pathogen causing dermatophytosis. Fungal keratitis, also called keratomycosis, is an infectious disease of cornea.Case presentationHere, we report a case of simultaneous dermatophytosis and keratomycosis caused by Trichophyton interdigitale. A 67-year-old man presented with extensive erythema all over the body since 4 years ago, fungal infection of left eye for 2 years, and loss of vision in the eye. These symptoms had become aggravated in the last month. Dermatological examinations showed extensive erythematous plaques with clear borders and scales, scattered red papules with ulceration, and scabs throughout the body. Onychomycosis was observed on the nails of left hand, conjunctival infection with secretion and loss of vision were noted in left eye. Hyaline septate hyphae were observed under direct microscopic examination, fungal culture and internal transcribed spacer sequencing revealed T. interdigitale. Histopathological examination suggested infectious granuloma. A diagnosis of dermatophytosis and keratomycosis caused by T. interdigitale with loss of vision in left eye was made. The patient was treated with luliconazole cream (two applications per day) and itraconazole (100 mg, BID, PO). Complete clinical remission was achieved after 1 month. Subsequently, the patient underwent left eye enucleation in the ophthalmology department.ConclusionsIn the present study, we reported a case of simultaneous dermatophytosis and keratomycosis caused by T. interdigitale, and reviewed the literature on corneal infection caused by Trichophyton. A total of 10 articles with 45 patients were published between 1973 and 2018. The pathogen of 27 patient were identified to species level. There were T. schoenleinii (17), T. mentagrophytes (4), T. verrucosum (3), T. rubrum (1), T. erinacei (1), and T. interdigitale (1). Five patients had corneal trauma, one had contact lens use history. Direct microscopic examination, fungal culture, and analysis of physiological characteristics were the main methods of identification. Early diagnosis and prompt treatment may help improve the management and outcomes.

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Section: Case Presentationmentioning

confidence: 99%

Simultaneous dermatophytosis and keratomycosis caused by Trichophyton interdigitale infection: a case report and literature review

Zhang

Jiang

et al. 2019

BMC Infect Dis

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“…Moreover, CARD9 mutations were also reported to cause deep dermatophytosis due to attenuated Th17 responses, highlighting the essential role of the Th17 pathway in host defence against dermatophytes . Thus, it is conceivable that the current STAT3 LOF mutation may lead to susceptibility to invasive dermatophytosis due to the same Th17‐deficient mechanisms, which was verified by functional analysis …”

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confidence: 76%

“…In this issue of the BJD , Simpson et al . described a novel link between invasive dermatophytosis and STAT3 loss‐of‐function (LOF) mutation.…”

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confidence: 99%

“…described a novel link between invasive dermatophytosis and STAT3 loss‐of‐function (LOF) mutation. The patient presented with an enlarging soft tissue mass in the right groin, which was diagnosed as invasive dermatophytosis due to Trichophyton interdigitale . Interestingly, the patient also had scattered prurigo and prurigo‐induced pseudoperforation, which the authors speculated to be a portal for deep fungal infection.…”

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confidence: 99%

“…Interestingly, the patient also had scattered prurigo and prurigo‐induced pseudoperforation, which the authors speculated to be a portal for deep fungal infection. Using targeted next‐generation sequencing, the authors identified a heterozygous mutation (p.Phe561del) in the linker domain of STAT3 . Further functional studies showed patient‐derived cells had decreased target gene expression on STAT3 pathway stimulation, as well as reduced T‐helper (Th) 17 cell differentiation …”

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confidence: 99%

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