Widespread Trichophyton Rubrum Granulomas Treated with Griseofulvin

Subcutaneous <i>Trichophyton rubrum </i>Abscesses

“…The patient also had a long-standing T. rubrum infection of the feet, but was not taking steroids. The case report was somewhat similar to that reported by Blank and Sm ith [2]. The latter 2 patients appear to have infections which invaded directly through the epidermis (via the pilosebaceous apparatus?)…”

“…Usually this ubiquitous organism causes a chronic, mildly inflammatory, hyperkeratotic eruption of the palms or soles; however, because of the anatomy of the skin (i.e. hair follicle), the dermatophyte can invade the deep corium invariably through an infection of the pilosebaceous apparatus [1,2,4,5,7,9,12,14]. Our patient is an example of a deep T. rubrum infection whose pathogenesis is probably different from the usual deep forms because of the patient's systemic disease and chronic steroid therapy.…”

Immunology of Surface Fungi Dermatophytes

“…Wilson et al (1954), who described such subcutaneous granulomatous infections of the leg, observed "bizarre" forms of the dermatophyte in lesions. Blank and Smith (1960) also found abnormal forms of the dermatophyte in a patient with such widespread granulomatous lesions due to T. rubrum. Elevated serum "V-globulins and decreased cell-mediated reactions have been reported in such cases.…”

“…Underlying disease such as Cushing's syndrome, or adrenal hypercorticism (Canizares et al, 1959;Nelson and McNiece, 1959;Pillsbury and Jacobson, 1955), malignant lymphoma (Levene, 1973;Lewis et al, 1953), rheumatoid arthritis (Blank and Smith, 1960), or diabetes (Mandel, 1960), as well as treatment with immunosuppressive agents (Canizares et al, 1959;Lavalle, 1975;Burgoon et al, 1974;Marks and Dawber, 1972;Goss et al, 1963), has been associated with widespread intractable infections. Graham (1972) suggested that T. rubrum should also be considered as an opportunistic organism which takes advantage of a wide spectrum of systemic illnesses, in some instances masking the underlying disease that has altered the host-parasite relationship.…”

“…Blank and Smith (1960) measured the antidermatophytic activity of serum from their patient with widespread granulomatous dermal nodules and subcutaneous abscesses due to T. rubrum. They reported an abnormally low titer of "serum factor" in that patient.…”