Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 6, 2020; 8(17): 3853-3858
Published online Sep 6, 2020. doi: 10.12998/wjcc.v8.i17.3853
Majocchi's granuloma caused by Trichophyton rubrum after facial injection with hyaluronic acid: A case report
Jie Liu, Wen-Qiang Xin, Lan-Ting Liu, Chao-Feng Chen, Lin Wu, Xiao-Ping Hu
Jie Liu, Lan-Ting Liu, Chao-Feng Chen, Lin Wu, Xiao-Ping Hu, 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
Author contributions: Liu J and Xin WQ contributed to writing the article and extracting data; Chen CF, Liu LT, and Wu L contributed to revising and editing the article.
Supported by the Scientific Research Project of Peking University Shenzhen Hospital, No. JCYJ2018011; and the "San-ming" Project of Medicine in Shenzhen, No. SZSM201812059.
Informed consent statement: Informed written consent was obtained from the patient for the publication of this report and any accompanying images.
Conflict-of-interest statement: No conflicts of interest declared.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Xiao-Ping Hu, PhD, Doctor, Department of Dermatology and Venereology, Peking University Shenzhen Hospital, No. 1120 Lianhua Road, Futian District, Shenzhen 518036, Guangdong Province, China. xiaoping7752@sohu.com
Received: June 6, 2020
Peer-review started: June 6, 2020
First decision: June 19, 2020
Revised: July 2, 2020
Accepted: July 30, 2020
Article in press: July 30, 2020
Published online: September 6, 2020
Processing time: 89 Days and 20.8 Hours
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.

Keywords: Trichophyton rubrum; Facial injection; Hyaluronic acid; Case report

Core tip: Facial cosmetic procedures become popular due to the demand to attain a younger appearance and the development of cosmetic technology over the past decades. The risk of infection is increasing because of improper disinfection of the patient’s skin, incorrect injection technique, decreased general immunity, and the presence of pathogens. Here, we describe a case of Majocchi’s granuloma caused by Trichophyton rubrum, and the patient was successfully treated with itraconazole.