Deep Dermatophytosis Presented as Multiple Exophytic Masses caused by Trichophyton rubrum in Immunocompromised Patient with Rheumatoid Arthritis; A Case Report

Q4 Medicine

Journal of Mycology and Infection Pub Date : 2022-12-31 DOI:10.17966/jmi.2022.27.4.85

J. Seol, S. Hong, Seung Hee Jang, Sang-Woo Ahn, J. Choi, J. Shin, Jayoung Kim, Hyojin Kim

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引用次数: 0

Abstract

Dermatophytes invade the stratum corneum and infect the skin, nails, and hair, mostly resulting in superficial infections. Deep dermatophytosis involving the dermis and subcutaneous layer has rarely been reported in immunocompromised individuals. Herein, we report a case of deep dermatophytosis caused by Trichophyton rubrum. A 71-year-old woman presented with multiple erythematous exophytic and subcutaneous nodules in both the lower legs. The patient was taking immunosuppressive agents for rheumatoid arthritis and antifungal agents for tinea pedis and onychomycosis, which was improperly ceased. Histopathological findings showed diffuse granulomatous infiltration with multinucleated cells, lymphocytes, histiocytes, and neutrophils in the dermis. Septate and branched hyphae were observed in the dermis using periodic acid-Schiff diastase and Gomori methenamine silver staining. T. rubrum was identified in fungal culture from the tissue sample and confirmed through phylogenetic analysis of the internal transcribed spacer and large subunit regions in ribosomal ribonucleic acid gene. Intravenous amphotericin B was administered for septic shock before the confirmation of the causative organism, which rapidly improved the condition.

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免疫功能低下的类风湿关节炎患者皮肤深部真菌病表现为多发外生肿块，由红毛癣菌引起病例报告

皮肤癣菌侵入角质层并感染皮肤、指甲和头发，大多导致浅表感染。涉及真皮和皮下层的深层皮肤真菌病在免疫功能受损的个体中很少报道。在此，我们报告一例由红色毛癣菌引起的深部皮肤真菌病。一位71岁的女性，双腿出现多发性红斑性外生性和皮下结节。该患者正在服用治疗类风湿性关节炎的免疫抑制剂和治疗足癣和甲真菌病的抗真菌药物，但未适当停止。组织病理学检查显示真皮弥漫性肉芽肿性浸润，有多核细胞、淋巴细胞、组织细胞和中性粒细胞。用碘酸Schiff淀粉酶和Gomori-methenamine银染法在真皮中观察到分隔和分支菌丝。从组织样本中的真菌培养物中鉴定出红色葡萄球菌，并通过核糖体核糖核酸基因中内部转录间隔区和大亚基区域的系统发育分析进行了确认。在确认病原体之前，静脉注射两性霉素B治疗感染性休克，这迅速改善了病情。

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来源期刊

Journal of Mycology and Infection Medicine-Infectious Diseases

CiteScore

0.20

自引率

0.00%

发文量

期刊介绍： The Journal of mycology and infection (Acronym: JMI, Abbreviation: J Mycol Infect) aims to publish articles of exceptional interests in the field of medical mycology. The journal originally was launched in 1996 as the Korean Journal of Medical Mycology and has reformed into the current state beginning on March of 2018. The contents of the journal should elucidate important microbiological fundamentals and provide qualitative insights to respective clinical aspects. JMI underlines the submission of novel findings and studies in clinical mycology that are enriched by analyses achieved through investigative methods. The journal should be of general interests to the scientific communities at large and should provide medical societies with advanced breadth and depth of mycological expertise. In addition, the journal supplements infectious diseases in adjunct to the field of mycology to address a well-rounded understanding of infectious disorders. The Journal of mycology and infection, which is issued quarterly, in March, June, September and December each year, published in English. The scope of the Journal of mycology and infection includes invited reviews, original articles, case reports, letter to the editor, and images in mycology. The journal is compliant to peer-review/open access and all articles undergo rigorous reviewing processes by our internationally acknowledged team of editorial boards. The articles directed to publication should encompass in-depth materials that employ scholastic values of mycology and various infectious diseases. Articles responding to critical methodology and outcomes which have potential to enhance better understanding of mycology and infectious diseases are also suitable for publication.