Multiple abscesses in the lower extremities caused by Trichophyton rubrum

Abstract

BackgroundDermatophytes are keratinophilic fungi, that usually infect the hair, stratum corneum, and nails. However, dermatophytes occasionally invade the dermis, subcutaneous tissues, and internal organs, resulting in a condition called deep dermatophytosis. We report a case of an unusual presentation of Trichophyton rubrum infection causing multiple fungal abscesses in the lower extremities of an immunocompromised patient.Case presentationA 66-year-old male who had been receiving immunosuppressive drugs for 7 years developed numerous subcutaneous nodules in the lower extremities. The yellow purulent fluid obtained from the cyst was positive for T. rubrum. Topical bifonazole cream was effective for tinea pedis, but oral Sporanox 400 mg/day was discontinued after 2 months because the patient died from pneumonia after hospitalization for a lumbar fracture.ConclusionsAlthough deep dermatophytosis is very rare, dermatomycosis should be considered in any examination of patients who are receiving immunosuppressive drugs. Fungi can enter the bloodstream and disseminate to distant major organs, including the lymph nodes, liver, brain, and bone, which often causes systemic infections that can be fatal.

Major challenges and perspectives in the diagnostics and treatment of dermatophyte infections

“…Discovering new drugs for use in antifungal therapy is a challenge for at least two reasons. First, most dermatomycoses affect people with impaired immune function, and therefore these patients are more dependent on the effectiveness of the antifungal drug than those with normal immunity (Angadi et al 2019;Dai et al 2019;Kalita et al 2019;Toussaint and Sticherling 2019). Second, the development of effective and yet high safety profiles of antifungal drugs is difficult because many basic biological processes are highly conservative between fungi and humans (Roemer and Krysan 2014;Mercer et al 2019).…”

Subcutaneous Trichophyton rubrum abscesses in an immunocompromised patient

“…However, dermatophytes can invade the deep dermis and subcutaneous tissues in immunocompromised patients. 1,2 In these cases, fungi can enter the bloodstream and disseminate to distant major organs, including the lymph nodes, liver, brain and bone, often causing systemic infections that can be fatal. 1 The lesions most frequently affect the lower extremities, buttocks and groin.…”

“…1,2 In these cases, fungi can enter the bloodstream and disseminate to distant major organs, including the lymph nodes, liver, brain and bone, often causing systemic infections that can be fatal. 1 The lesions most frequently affect the lower extremities, buttocks and groin. 1,2 The most common pathogen for deep dermal dermatophytosis is T. rubrum, and serum b-D-glucan levels were elevated in some cases.…”

“…1 The lesions most frequently affect the lower extremities, buttocks and groin. 1,2 The most common pathogen for deep dermal dermatophytosis is T. rubrum, and serum b-D-glucan levels were elevated in some cases. 2 In typical cases of trichophytic granuloma, the route of infection is believed to be hair follicles.…”

“…Dear Editor, Mycosis fungoides (MF) is the most common primary cutaneous lymphoma. 1 Clinical features of MF are varied, which can sometimes lead to misdiagnoses such as atopic dermatitis, psoriasis vulgaris and seborrheic keratosis. [2][3][4] Here, we present the case of a 40-year-old man with MF, who developed multiple seborrheic keratosis-like lesions.…”