Exaggerated Immune Reaction to Trichophyton Fungus Results in an Inflammatory Tinea Pedis.

We report a case of a 58-year-old African American male with a long history of scaly itchy feet. The patient presented to the clinic on February 8th, 2018 with an apparent inflammatory reaction on the plantar surface of both feet (Figures 1 and 2). An initial specimen collection from the patient’s plantar surface revealed hyphae indicative of a fungal infection under KOH preparation. This supported the diagnosis of a tinea pedis infection. The patient was treated with ketoconazole topical cream and 20% Urea creams to be applied daily. Follow-up approximately 6 weeks later revealed resolution of underlying fungal infection with minimal remaining inflammation (Figures 3 and 4). With consideration to the subject’s initial presentation of a possible exaggerated immune reaction caused by Trichophyton, we suspected an underlying allergic response (delayed-type hypersensitivity reaction) to the fungus, instead of a cutaneous fungal infection alone. In order to test this hypothesis, we subjected the patient to intradermal skin testing with intradermal Candida and Trichophyton