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Veerakumar RD, Murthy AB, Cinna T Durai P, Narasimhan M. Deep Dermal Dilemma: A Case Report on Majocchi's Granuloma After Topical Steroid Use. Cureus 2024; 16:e71807. [PMID: 39559684 PMCID: PMC11570442 DOI: 10.7759/cureus.71807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2024] [Accepted: 10/18/2024] [Indexed: 11/20/2024] Open
Abstract
Majocchi's granuloma represents a unique dermatological entity characterized by the invasion of dermatophytes into the dermis and subcutaneous tissue, typically following trauma or topical corticosteroids, most commonly caused by Trichophyton rubrum. The unrestrained use of over-the-counter topical steroids has led to the rise of Majocchi's granuloma in the past few years. A 57-year-old male presented with complaints of itchy skin lesions over his right ankle for 20 days. There was a history of over-the-counter topical steroid application, following which the lesions exacerbated. Clinical examination showed multiple ill-defined erythematous nodules, 2-3 cm in size, with serosanguinous discharge associated with right ankle swelling. A single annular hyperpigmented scaly patch was also noted over the right leg below the knee. Potassium hydroxide (KOH) examination was positive for fungal hyphae. Histopathological examination (HPE) of the nodule showed features suggestive of Majocchi's granuloma. Fungal culture was performed, which showed growth of Trichophyton rubrum. The patient was started on oral terbinafine 250 mg once daily and topical luliconazole cream twice daily topical application, which resolved the lesions in three weeks, but the patient was advised to continue the treatment for a total duration of two months.
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Affiliation(s)
- Renuka Devi Veerakumar
- Dermatology, Venereology, and Leprosy, Sri Ramaswamy Memorial (SRM) Medical College Hospital and Research Centre, Chennai, IND
| | - Aravind Baskar Murthy
- Dermatology, Venereology, and Leprosy, Sri Ramaswamy Memorial (SRM) Medical College Hospital and Research Centre, Chennai, IND
| | - Priya Cinna T Durai
- Dermatology, Venereology, and Leprosy, Sri Ramaswamy Memorial (SRM) Medical College Hospital and Research Centre, Chennai, IND
| | - Murali Narasimhan
- Dermatology, Venereology, and Leprosy, Sri Ramaswamy Memorial (SRM) Medical College Hospital and Research Centre, Chennai, IND
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Si H, Li Y, Huang Z, Cui Y, Li S. Erythroderma combined with deeper dermal dermatophytosis due to Trichophyton rubrum in a patient with myasthenia gravis: first case report and literature review. BMC Infect Dis 2023; 23:789. [PMID: 37957543 PMCID: PMC10644414 DOI: 10.1186/s12879-023-08752-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 10/25/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Dermatophytes are the most common causative pathogens of mycoses worldwide and usually cause superficial infections. However, they can enter deep into the dermis lead to invasive dermatophytosis such as deeper dermal dermatophytosis on rare occasions. Erythroderma is a severe dermatological manifestation of various diseases resulting in generalized skin redness, but erythroderma due to fungi infections is barely reported. In this article, we reported the first case of erythroderma combined with deeper dermal dermatophytosis due to Trichophyton rubrum (T. rubrum) in a patient with myasthenia gravis. CASE PRESENTATION A 48-year-old man was hospitalized because of erythema with scaling and nodules covering his body for a month. The patient had a history of myasthenia gravis controlled by regularly taking prednisolone for > 10 years and accompanied by onychomycosis and tinea pedis lasting > 8 years. Based on histopathological examinations, fungal cultures, and DNA sequencing results, the patient was finally diagnosed with dermatophyte-induced erythroderma combined with deeper dermal dermatophytosis caused by T. rubrum. After 2 weeks of antifungal treatment, the patient had recovered well. CONCLUSIONS This case report shows that immunosuppressed patients with long histories of superficial mycoses tend to have a higher risk of developing invasive dermatophytic infections or disseminated fungal infections. Dermatologists should be alert to this condition and promptly treat the superficial dermatophytosis.
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Affiliation(s)
- Henan Si
- Department of Dermatology and Venerology, First Hospital of Jilin University, Changchun, Jilin, 130021, China
| | - Yang Li
- Department of Dermatology and Venerology, First Hospital of Jilin University, Changchun, Jilin, 130021, China
| | - Zhiyang Huang
- Department of Dermatology and Venerology, First Hospital of Jilin University, Changchun, Jilin, 130021, China
| | - Yan Cui
- Department of Dermatology and Venerology, First Hospital of Jilin University, Changchun, Jilin, 130021, China.
| | - Shanshan Li
- Department of Dermatology and Venerology, First Hospital of Jilin University, Changchun, Jilin, 130021, China.
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Liu J, Xin WQ, Liu LT, Chen CF, Wu L, Hu XP. Majocchi's granuloma caused by Trichophyton rubrum after facial injection with hyaluronic acid: A case report. World J Clin Cases 2020; 8:3853-3858. [PMID: 32953864 PMCID: PMC7479567 DOI: 10.12998/wjcc.v8.i17.3853] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 07/02/2020] [Accepted: 07/30/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Facial cosmetic procedures become popular for people with a desire to have a younger appearance, and cosmetic technology has developed rapidly over the past several decades. However, increasing complications related to cosmetic injections have been reported, and infection is one of the most serious problems and can cause anxiety and facial injury. We here report a case of Majocchi's granuloma (MG) caused by Trichophyton rubrum after facial injection of hyaluronic acid.
CASE SUMMARY A 37-year-old woman presented to our hospital with a history of red papules, nodules, and abscesses on her left zygomatic arch for 2 mo. She had received a cosmetic injection of hyaluronic acid on the left side of her face prior to the appearance of the lesions. MG caused by Trichophyton rubrum after facial injection of hyaluronic acid was diagnosed based on morphology and molecular biological identification. In vitro antifungal susceptibility testing was conducted according to the Clinical and Laboratory Standards Institute M38-A2 method. Minimal inhibitory concentrations were used to evaluate the antifungal susceptibility. The antifungal agents and their minimal inhibitory concentrations for the strain were terbinafine (< 0.5 μg/mL), itraconazole (0.06 μg/mL), amphotericin B (0.25 μg/mL), fluconazole (32 μg/mL), voriconazole (0.125 μg/mL), posaconazole (0.125 μg/mL), and isavuconazole (0.06 μg/mL). We initially administered 250 mg/d oral terbinafine for 2 mo, but the patient still had painful papules, nodules and abscesses on her face. Then, we adjusted the treatment to itraconazole 400 mg/d for 8 wk based on the in vitro antifungal susceptibility testing results. The skin lesions improved significantly, and there was no recurrence during follow-up.
CONCLUSION This case revealed that facial injection of hyaluronic acid may cause serious MG. Antifungal susceptibility testing should be considered in the treatment of MG caused by Trichophyton rubrum.
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Affiliation(s)
- Jie Liu
- Department of Dermatology, Skin Research Institute of Peking University Shenzhen Hospital, Peking University Shenzhen Hospital, Shenzhen 518036, Guangdong Province, China
| | - Wen-Qiang Xin
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Lan-Ting Liu
- Department of Dermatology, Skin Research Institute of Peking University Shenzhen Hospital, Peking University Shenzhen Hospital, Shenzhen 518036, Guangdong Province, China
| | - Chao-Feng Chen
- Department of Dermatology, Skin Research Institute of Peking University Shenzhen Hospital, Peking University Shenzhen Hospital, Shenzhen 518036, Guangdong Province, China
| | - Lin Wu
- Department of Dermatology, Skin Research Institute of Peking University Shenzhen Hospital, Peking University Shenzhen Hospital, Shenzhen 518036, Guangdong Province, China
| | - Xiao-Ping Hu
- Department of Dermatology, Skin Research Institute of Peking University Shenzhen Hospital, Peking University Shenzhen Hospital, Shenzhen 518036, Guangdong Province, China
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Zheng YY, Li Y, Chen MY, Mei QY, Zhang RZ. Majocchi's granuloma on the forearm caused by Trichophyton tonsurans in an immunocompetent patient. Ann Clin Microbiol Antimicrob 2020; 19:39. [PMID: 32878629 PMCID: PMC7466491 DOI: 10.1186/s12941-020-00382-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 08/25/2020] [Indexed: 12/26/2022] Open
Abstract
Majocchi's granuloma is an uncommon fungal infection of the dermis and subcutaneous tissue. The most frequently identified cause of Majocchi's granuloma is anthropophilic Trichophyton rubrum, and it is most commonly located on the anterior aspect of the lower limbs in women. Here, we report a case of Majocchi's granuloma on the forearm, a site that is rarely involved, in a 62-year-old woman who had been bitten by a dog. Histological examination revealed a dense dermal infiltrate composed of lymphoplasmacytic cells and neutrophils, with hyphae in the dermis. The presence of the fungus, Trichophyton tonsurans, was confirmed by mycological examination and molecular methods. Therefore, histological and mycological examination confirmed the diagnosis of Majocchi's granuloma. The patient was treated with local moxibustion and itraconazole, 200 mg/day, for 60 days, which facilitated a complete resolution of the lesions.
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Affiliation(s)
- Yun-Yan Zheng
- Department of Dermatology, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, Jiangsu, China
| | - Yue Li
- Department of Dermatology, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, Jiangsu, China
| | - Ming-Yan Chen
- Department of Dermatology, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, Jiangsu, China
| | - Qian-Yun Mei
- Department of Dermatology, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, Jiangsu, China
| | - Ru-Zhi Zhang
- Department of Dermatology, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, Jiangsu, China.
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Changing Concepts and Current Definition of Majocchi's Granuloma. Mycopathologia 2019; 185:187-192. [PMID: 31297666 DOI: 10.1007/s11046-019-00358-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 07/01/2019] [Indexed: 01/13/2023]
Abstract
Dermatophytic granuloma characterized by perifollicular granulomatous inflammation was first described by Domenico Majocchi and was later named after him, Majocchi's granuloma (MG). Although the initial description was related to a dermatophyte Trichophyton tonsurans, later reports linked MG to non-dermatophytes (Phoma, Aspergillus, Malbranchea), which led to a confusion of disease patterns caused by cutaneous pathogens and general opportunistic microorganisms. Furthermore, several causative agents of MG described in the literature were not confirmed as such. Our review addressed the following aspects: (1) significance of histopathological finding for MG diagnosis, (2) dermatophytes as exclusive agents of MG, (3) spectrum of etiological agents causing different types of invasive dermatophytic infections, and (4) treatment options.
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Morán Rodríguez MÁ, Alvarez Paredes L, Buzón Martin LM, Martinez Nuñez P. Lesión pretibial izquierda fluctuante postraumática. Enferm Infecc Microbiol Clin 2019; 37:205-206. [DOI: 10.1016/j.eimc.2018.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 04/04/2018] [Accepted: 04/09/2018] [Indexed: 10/16/2022]
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Abstract
Majocchi’s granuloma (MG) is a rare fungal infection of the dermis that is mainly caused by dermatophytes (in ≥95% of cases); the most frequently identified cause is anthropophilic Trichophyton rubrum. In the rest of the cases, the causes are non-dermatophytic fungi such as Aspergillus species. This review aimed to provide information about the current perspectives on MG regarding its clinical characteristics, predisposing factors, laboratory diagnosis, and treatment strategies. Although the lower extremities were reported to be the most common site of infection, facial involvement has been predominant in the past 5 years. Our literature research showed that the most common predisposing factor (55%) is the use of topical steroid creams without potassium hydroxide examination during treatment of erythematous squamous dermatoses. A reliable diagnosis of MG is based on histopathological examination, including fungal culture and molecular analyses. MG should be treated not only with topical agents but also with systemic antifungal agents that are continued until the lesions are completely resolved. In systemic treatment, the most preferred drug is terbinafine, because of its efficacy, side effects, and safety.
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Affiliation(s)
- Hazal Boral
- Division of Mycology, Department of Microbiology, Faculty of Medicine, University of Çukurova, Adana, Turkey
| | - Murat Durdu
- Department of Dermatology, Faculty of Medicine, Başkent University Adana Hospital, Adana, Turkey
| | - Macit Ilkit
- Division of Mycology, Department of Microbiology, Faculty of Medicine, University of Çukurova, Adana, Turkey
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