Tiña incógnita y granuloma de Majocchi adquirido de un erizo. Un caso mexicano / Mexican case of tinea incognito and granuloma de Majocchi acquired from a hedgehog

Resumen Las mascotas exóticas, como el erizo de tierra, son capaces de transmitir al ser humano diferentes infecciones, como salmonelosis, micobacterias, protozoos como Cryptosporidium parvum, y dermatofitosis. Presentamos el caso de un paciente adulto masculino, que recientemente había adquirido un erizo de tierra, que presentó en la mano una lesión de tiña incógnita y un granuloma de Majocchi. Se identificó el agente etiológico como Trichophyton erinacei, por cultivo micológico y biología molecular. El paciente se trató con terbinafina por vía oral, por seis meses, con excelente respuesta.

Exotic pets, such as the ground hedgehog, are capable of transmitting to the human being different zoonoses, such as salmonellosis, mycobacteria, protozoa such as Cryptosporidium parvum, and dermatophytosis. We present the case report of a male adult patient, who had recently acquired a ground hedgehog, who presented in his hand a ringworm lesion incognito and a Majocchi granuloma. The etiological agent was identified as Trichophyton erinacei by mycological culture and molecular biology. The patient was treated with terbinafine oral, with excellent response.

Majocchi's Granuloma of the Knee Caused by Trichophyton rubrum Presented as Tinea Incognito / 대한의진균학회지

Majocchi's granuloma is a well recognized but uncommon infection of dermal and subcutaneous layers that is caused by fungal organism. It often presents as plaques and papules on areas where trauma is common. Majocchi's granuloma appears usually in immunocompromised patient but can also appear in immunocompetent patient. Tinea incognito appears in various forms of skin diseases, but it is rarely presented as Majocchi's granuloma. We report a case of trichophytic granuloma of the knee caused by Trichophyton(T.) rubrum in a 70-year-old male, who showed a pruritic, 7.0 × 2.0 cm sized, erythematous scaly patches with multiple papules on the right knee for 2 months. Fungal culture of the biopsy specimen grew out typical white cottony colonies of T. rubrum. The nucleotide sequence of internal transcribed spacer for clinical isolate was identical to that of T. rubrum strain ATCC 52013 (GenBank accession number KX092384.1). Histiologic examination showed chronic granulomatous inflammation and fungal elements in the dermis. After one month of itraconazole 200 mg/day and sertaconzole cream treatment, the lesion was completely cleared.

Cutaneous Tumor-like Majocchi's Granuloma of the Face in the Immunocompetent Patient: a Case Report and Review of the Literature / 대한의진균학회지

We report a case of Majocchi's granuloma in a 71-year-old immunocompetent male patient, who presented with a 6-month history of mass with multiple erythematous nodules and indurated plaques with scale on the left cheek. Even though the lesion strongly suggested cutaneous tumor, the histopathologic findings were consistent with the Majocchi's granuloma, showing numerous hyphae, perifolliculitis and granulomatous inflammation with central abscess formation in the dermis. Trichophyton rubrum was isolated from the biopsy specimen fungus culture. The cutaneous lesion was treated with oral administration of itraconazole (200 mg/day) and topical lanoconazole cream for 4 weeks, and successfully treated.

A Case of Majocchi Granuloma Caused by Microsporum canis Presented as Tinea Incognito / 대한피부과학회지

No abstract available.

Majocchi's Granuloma Arising in Previous Burn Area / 대한의진균학회지

Majocchi's granuloma is deep dermatophyte infections rarely form ulceration, nodules and abscesses and usually occur in immunocompromised patients. Although progression of deep dermatophytosis may be induced by the use of topical or systemic steroids, immunosuppression may not be found in some cases. We report a case of Majocchi's granuloma arising in previous burn area, who had pruritic erythematous macules, patches and papules on the left forearm for 7 months. KOH mount was negative. Histopathological examination showed granulomatous reaction and numerous hyphae and spore in the dermis, and the organism was identified as Trichophyton rubrum on tissue culture. The patient was treated with 2 times of itraconazole pulse therapy and then terbinafine (250 mg/day) for 4 weeks, resulting in the clearing of the lesion.

A Case of Majocchi's Granuloma of the Face of an Immunocompetent Patient Caused by Trichophyton rubrum / 대한의진균학회지

Majocchi's granuloma is well recognized but uncommon infection of dermal and subcutaneous tissue by fungal organisms usually limited to the superficial epidermis. The organism most commonly associated with Majocchi's granuloma is Trichophyton(T.) rubrum, however, other dermatophytes may be the causative agent. A 44-year-old male patient presented with a 6 month history of two well defined erythematous nodular plaques on his right jaw and preauricular area. Histopathologic findings were consistent with the Majocchi's granuloma, showing perifolliculitis and granulomatous inflammation in the dermis. Many fungal elements were noted within the giant cells of the perifollicular dermis of PAS stained section. T. rubrum was cultured from the biopsy specimen and confirmed by slide culture. After 10 weeks of terbinafine (Lamisil(R)) therapy (250 mg/day), lesions were cleared with mild erythematous patches and atrophic scars.

The Clinical, Histopathologic and Mycologic Characteristics of Dermatophytosis Which were Initially Diagnosed by Skin Biopsies / 대한피부과학회지

BACKGROUND: Dermatophytosis is sometimes difficult to definitively diagnose if it has atypical clinical characteristics or the mycological tests are negative. For these cases, skin biopsy will be helpful to diagnose a fungal infection. OBJECTIVE: The purpose of the present study was to evaluate the clinical, histopathologic and mycologic characteristics of dermatophytosis patients who were initially diagnosed by skin biopsies. METHODS: We performed a retrospective study of the clinical characteristics and the histopathologic and mycologic features of 16 patients with dermatophytosis and who were initially diagnosed by skin biopsy. RESULTS: The final diagnosis of dermatophytic infections were tinea incognito (7 cases) and Majocchi's granuloma (9 cases). The main symptoms were pruritus (4 cases) and pain (2 cases). The skin lesions of tinea incognito and Majocchi's granuloma mimicked inflammatory skin disease, lupus vulgaris or deep mycosis. The most common site of involvement was the face. The possible predisposing factors causing tinea incognito and Majocchi's granulomas appeared to be application of steroid ointment (6 cases), physical trauma (2 cases) and diabetes mellitus (1 case). The histopathologic features of tinea incognito revealed the sandwich sign (100%) and neutrophils in the epidermis (71.5%) and dermis (71.5%). Majocchi's granuloma showed rupture of hair follicles (88.9%) and suppurative folliculitis (66.7%). With Periodic acid Schiff and methenamine silver staining, hyphae and spores could be identified on the horny layers, within the hair follicles and/or on the dermis in the biopsy specimens of all the cases. Culture of the causative organisms using dermal fragments and skin scales on Sabouraud media demonstrated Trichophyton rubrum (4 cases), T. mentagrophytes (3 cases) and Microsporum canis (3 cases). Systemic treatment with itraconazole or terbinafine for 2~10 weeks was effective, except for two cases. CONCLUSION: We consider that the histopatholgic findings may be of great help to diagnose a dermatophytosis that has atypical clinical characteristics or negative mycological tests. Fungal culture is also important for making an accurate diagnosis of dermatophytosis.

Granuloma de Majocchi / Majocchi's granuloma

El granuloma de Majocchi o granuloma dermatofítico es una micosis causada por dermatofitos, regularmente del género Trichophyton, predominando T. rubrum en 50%. Se presenta en pacientes inmunocompetentes o inmunodeprimidos. No se sabe cómo se produce la infección, al parecer inicia con trauma físico que guía a alteraciones del folículo piloso y a la introducción pasiva del hongo. Para el desarrollo de la infección se requieren factores predisponentes y desencadenantes, los más importantes son la diabetes y el uso de esteroides. Clínicamente se clasifica en papular perifolicular o superficial en pacientes inmunocompetentes, y en nodular subcutánea o profunda en pacientes con inmunosupresión. Se confirma el diagnóstico por histopatología, encontrando granulomas en dermis media y profunda, con estructuras dermatofíticas en forma de filamentos o esporas. El tratamiento es con antimicóticos sistémicos. Se hace una revisión del tema resaltando los aspectos etiopatogénicos, clínico-patológicos y terapéuticos de la enfermedad.

Majocchi's granuloma or dermatophytic granuloma is a mycosis observed among immunocompetent and immunocompromised patients caused by dermatophytes, particularly Trichophyton rubrum, which may be responsible for 50% of cases. The mechanism by which it occurs is yet unknown although reports suggest it may occur after localized trauma that alters the hair follicle and enables the entrance of the microorganism. Diabetes and the use of topical steroids are among some of the predispEl cuadro 1 no está acotado. Favor de hacerloEl cuadro 1 no está acotado. Favor de hacerloosing factors. Majocchi's granuloma has two clinical presentations, among immunocompetent patients it displays follicular papules and among immunocom-promised patients a subcutaneous nodular type is observed. Diagnosis is confirmed through histopathology, where granulomas and dermatophytes in the form of filaments or spores are observed in the mid and deep dermis. Treatment includes systemic antimycotics. We reviewed the etiopathogenic, clinical, histopathological and therapeutic aspects of Majocchi's granuloma.

Granuloma tricofítico de Majocchi: comunicación de un caso / Majocchi trichophytic Granuloma: case report

El granuloma tricofítico de Majocchi es una infección causada por hongos dermatofitos que invaden dermis profunda y tejido celular subcutáneo. Existen pocos reportes de esta entidad. Se han descripto diferentes características clínicas de acuerdo al estado inmune del paciente. Presentamos el caso de una paciente de 8 años de edad con múltiples nódulos ligeramente dolorosos, en cuero cabelludo y cara, de 6 meses de evolución, que había sido tratada con corticoides tópicos y sistémicos. El estudio anatomopatológico evidenció abundantes estructuras micóticas con formación de granulomas en dermis profunda. Se estableció el diagnóstico de granuloma tricofítico de Majocchi y se inició terapia antimicótica con itraconazol, 5 mg/kg/día, con mejoría clínica parcial a la cuarta semana de tratamiento

Trichophytic Majocchi granuloma is an infection by dermatophytes which invade deep dermis and fat. There are few reports about this disease. Some clinical features have been described depending on immune state of patients. We present a case in an 8 years old girl with tenderness nodules in scalp and face of 6 months of evolution, who had been previously treated with topical and systemic steroids. Histological findings showed many fungal structures and a dermal granulomatous inflammatory infiltrate in deep dermis. Diagnosis of trichophytic Majocchi granuloma was done and initiated anti fungal therapy with itraconazole 5 mg/kg once a day with partial improvement at the fourth week of treatment

A case of Majocchi's granuloma induced by var. raubitschekii of Trichophyton rubrum / 中华皮肤科杂志

Objective To report a case of Majocchi's granuloma induced by var. raubitschekii of Trichophyton rubrum, and to evaluate the relationship between deep and superficial fungal infection with genotyping technique. Methods The patient underwent physical, pathological and mycologic examination,which included microscopic observation, fungal culture, and urease reaction. The sequence of intertranscribed spacer (ITS) of rDNA was analysed by PCR and sequencing. Isolates from affected toes and tissue as well as one reference strain and six clinical strains of T. rubrum, were subjected to analysis of the tandem repeat subelement(TRS-1) in nontranscribed spacer(NTS)of rDNA by PCR. Results A 48-year-old female patient presented with a 2-month history of red papules and nodular lesions on the back, buttock and thigh,as well as a 3-year history of onychomycosis which had become more severe after a liver transplantation 9 months before. Pathological and mycologic examinations confirmed the diagnosis of Majocchi's granuloma. The pathogen was identified as var. raubitschekii of T. rubrum by microscopic examination, fungal culture, positive urease reaction and the sequence of ITS. As shown by the amplications of TRS-1 of NTS, the genotypes of strains from affected nails and tissue were identical, but differed from those of other clinical strains of T.rubrum. Conclusions There is a polymorphism in TRS-1 of rDNA NTS of T. rubrum, with the genotypes of isolates from affected nails and tissue being identical, which suggests they are of the same origin.

A Case of Majocchi's Granuloma / 대한의진균학회지

Majocchi's granuloma is a well recognized but uncommon infection of dermal and subcutaneous tissue by fungal organisms usually limited to the superficial epidermis. The organism usually associated with Majocchi's granuloma is Trichophyton(T.) rubrum, however, other dermatophytes may be the causative agent. We presented a 74-year-old female who had a well defined erythematous nodular plaque on her right cheek for 1 month. Histopathologic findings was consistent with the Majocchi's granuloma, showing perifolliculitis and granulomatous inflammation in dermis. Many fungal elements were noted in the follicular keratin plug and giant cells in the granulomatous inflammation of the perifollicular dermis in the H & E stain. But no fungal hyphae was noted in horny layer of the epidermis and a culture for the fungus was failed. The cutaneous lesion treated with terbinafine (Lamisil(R)) 250 mg and lanoconazole cream daily with cured one month later.

A Case of Majocchi's Granuloma Caused by Trichophyton rubrum / 대한의진균학회지

Dermatophytes usually do not invade beyond the epidermis. However mechanical breakage of the skin resulting from scratching or trauma and immunocompromised state may allow penetration of the fungi into reticular dermis. We report a patient with an unusual manifestation of Trichophyton rubrum infection. A 39-year-old male presented with 3.5x5 cm sized, erythematous, ulcerated lesion on the left heel for about 1 month. Histologic findings of the skin lesion showed granulomatous change and numerous hyphae in the dermis. Trichophyton rubrum was isolated on the fungus culture. The patient was treated with terbinafine (250 mg/day) for 10 weeks, resulting in the clearing of the skin lesion.

A Case of Majocchi's Granuloma Caused by Trichophyton rubrum / 대한의진균학회지

Dermatophytes usually do not invade beyond the epidermis. However mechanical breakage of the skin resulting from scratching or trauma and immunocompromised state may allow penetration of the fungi into reticular dermis. We report a patient with an unusual manifestation of Trichophyton rubrum infection. A 39-year-old male presented with 3.5x5 cm sized, erythematous, ulcerated lesion on the left heel for about 1 month. Histologic findings of the skin lesion showed granulomatous change and numerous hyphae in the dermis. Trichophyton rubrum was isolated on the fungus culture. The patient was treated with terbinafine (250 mg/day) for 10 weeks, resulting in the clearing of the skin lesion.

A Case of Purpura Annularis Telangiectodes (Majocchi's disease) / 대한피부과학회지

Purpura annularis telangiectodes is an uncommon pigmented purpuric eruption that is seen more commonly in young adult females, and it is one of the subgroups of pigmented purpuric dermatoses. Clinically, the disease is characterized by symmetrical telangiectatic, purpuric, annular patches with a predilection for the lower extremities and buttock. We report a case of purpura annularis telangiectodes (Majocchi disease) on the lower extremities of a 31-year-old male patient.

A Case of Majocchi's Granuloma in a Renal Transplant Recipient / 대한의진균학회지

Majocchi's granuloma is a well recognized but uncommon infection of dermal and subcutaneous tissue by fungal organisms usually limited to the superficial epidermis. The organism usually associated with Majocchi's granuloma is Trichophyton rubrum, however, other dermatophytes may be the causative agent. We presented a 29-year-old female, who underwent kidney transplantation for end stage renal disease 3 years earlier, had an erythematous nodule on her left lower leg for 6 months. Histology showed suppurative granulomatous inflammatory cellular infiltrates in the dermis. Many septate hyphae were noted within the granulomatous tissue stained with PAS. A fungal culture from biopsy specimen revealed T. rubrum. The cutaneous lesion treated with terbinafine 250 mg daily and 10 weeks later, there was a marked improvement in the lesion.

Granulomatous Skin Lesion Due to Hot-resistant Trichophyton rubrum and Its Variation in Molecular Biology / 中华皮肤科杂志

Objective To investigate the mycologic features and variation in gene sequence of a hot-resistant Trichophyton rubrum which caused granulomatous skin lesion.Methods The isolate was identified by routine and polymerase chain reaction(PCR)technique.Ribosomal conserved sequence and trs-1(tandem repetitive subelement)sequence in the ribosomal non-transcribed spacer(NTS)were determined.Results The hot-resistant isolate was identified as T.rubrum by routine and PCR technique.The trs-1sequence variation in rDNA NTS was found in the strain.Conclusion The trs-1sequence variation suggests that this strain be one of isotypic variants of T.rubrum,which has much higher pathogenicity to cause granulomatous skin lesion,or sequence variation of the strain may be the result of adapting itself to environmental change(37℃),which needs further studies.

A Case Considering of Majocchi's Granuloma Caused by Trichophyton mentagrophytes / 대한의진균학회지

Majocchi's granuloma is well recognized, uncommon infection of dermal and subcutaneous tissue by dermatophytes. The organism usually associated with Majocchi's granuloma is Trichophyton (T.) rubrum. However, other dermatophytes including T. mentagrophytes, T. violaceum, M. audouinii, M. gypseum, M. ferrugineum, and M. canis may be the causative agent. Dermatophytes usually do not invade beyond epidermis. However mechanical breakage of the skin resulting from scratching or trauma and immunocompromised state, such as diabetes mellitus, malignancy, and long term steroid use may allow penetration of fungi together with keratin and necrotic materials into the dermis. A 19-year-old woman presented with erythematous patch on the left lower extremity for 2 years. She had a history of breeding pet dog infected with fungus 3 years ago and treated with antifungal agent for 6 months in local clinic under the impression of tinea corporis. The examination revealed erythematous discrete papulopustular patch with brownish to violaceous scaly margin. KOH examination showed negative result, but histopathologic finding of pustular skin lesion showed chronic granulomatous inflammation with fungal element. The fungal culture grew T. mentagrophytes. The patient was started on itraconazole 200mg daily for 4 weeks and successfully treated. Herein we report a case considering of Majocchi's granuloma by T. mentagrophytes.