Querión de Celso, aspectos diagnósticos y terapéuticos: Presentación de un caso / Kerion Celsi, diagnostic and therapeutic aspects: a case report

RESUMEN La tiña capitis es una enfermedad que afecta con mayor frecuencia a la población pediátrica; es ocasionada por hongos dermatofitos y es el querión su forma inflamatoria severa. Su diagnóstico e intervención temprana evita posibles secuelas estéticas y psicológicas en quienes lo padecen. Se presenta caso de paciente masculino de 4 años quien consultó al servicio de dermatología por cuadro de 4 meses de placa eritemato-descamativa con pústulas que progresó a única placa de predominio alopécica y adenopatías cervicales. El reporte microbiológico confirmó su diagnóstico, y el ultrasonido contribuyó al pronóstico y conducta terapéutica.

ABSTRACT Tinea capitis is a disease that most frequently affects the pediatric population caused by dermatophyte fungi, of which kerion is the severe inflammatory form of it. Its early diagnosis and intervention avoids possible aesthetic and psychological consequences in those who suffer from it. The case of a 4-year-old male patient is presented, who attend the dermatology service for 4 months of erythematous-desquamative plaque with pustules that evolved to a single plaque of predominantly alopecia and cervical lymphadenopathy. Microbiological report confirmed its diagnosis, and ultrasound contributed to the prognosis and therapeutic behavior.

A Descriptive Review of Kerion and Non-inflammatory Tinea Capitis / 대한피부과학회지

BACKGROUND: Tinea capitis manifests either as a non-inflammatory or inflammatory type including kerion, which may cause permanent alopecia. In addition to antifungals, systemic corticosteroids (prednisolone at 1~2 mg/kg/day) have been used to reduce inflammation in patients with kerion. OBJECTIVE: We studied the clinical and laboratory features, treatments, and prognosis of tinea capitis. METHODS: We performed a retrospective review of 12 cases of kerion and 12 cases of non-inflammatory tinea capitis (median age, 8 years; range, 3 months~80 years) diagnosed using a potassium hydroxide mount at the National Health Insurance Service Ilsan Hospital between November 2011 and April 2018. RESULTS: Fungal cultures showed Microsporum species in 6 cases and Trichophyton species in 1 case. The duration of diseases and extent of lesions were greater in the kerion group than in the non-inflammatory tinea capitis group (p<0.05). Sixteen patients were treated with systemic antifungals. In the kerion group, 10 patients were treated with systemic antifungals (6 with itraconazole [median, 26 days; range, 21~58 days] and 4 with terbinafine [median, 24.5 days; range, 13~31 days]). The median intervals between the onset of treatment and scalp clearing (in 10 cases), the onset of new hair growth (in 9 cases), and complete regrowth of hair (in 7 cases) were 27 (range, 13~77), 33 (range, 19~63), and 89 (range, 42~180) days, respectively, in the kerion group. The median dosage of prednisolone used in patients with kerion was 0.26 mg/kg/day (range, 0.15~0.42) with good clinical response. CONCLUSION: The patients with kerion responded well to antifungal treatments. A lower dose of prednisolone was adequate when systemic corticosteroids were required for the treatment of kerion.

Tiña capitis por Microsporum gypseum, una especie infrecuente / Tinea capitis by Microsporum gypseum, an infrequent species

La tiña capitis es considerada la infección por dermatofitos más frecuente en los niños. Los agentes etiológicos varían con el tiempo y según la zona geográfica, aunque, normalmente, son dermatofitos de origen zoofílico y, en los últimos años, también dermatofitos antropofílicos. Se presenta un caso de tiña capitis inflamatoria en un niño de 6 años de edad causada por Microsporum gypseum, un hongo geofílico patógeno para humanos y animales. Las fuentes de infección humana son el suelo, los gatos, los perros y pequeños mamíferos. Esta especie es poco frecuente como causa de dermatofitosis en el hombre, descrita, sobre todo, en tiña corporis y, raramente, en tiña capitis. En el diagnóstico de tiña capitis, identificar la especie causal es un factor determinante para el tratamiento.

Tinea capitis is considered the most frequent dermatophyte infection in children. The etiological agents vary from time to time and by geographical area, although they normally are zoophilic dermatophytes and in the last years also anthropophilic species. We report a clinical case of inflammatory tinea capitis in a 6-year-old child caused by Microsporum gypseum, a geophilic fungus pathogenic to humans and animals. The sources of human infection are soil, cats, dogs and small mammals. This species is less frequent as a cause of dermatophytosis in humans, described mainly in tinea corporis and rarely in tinea capitis. In the diagnosis of tinea capitis identifying the causative species is a determinant of the treatment.

Kerion Celsi Caused by Trichophyton verrucosum in an Adult / 대한피부과학회지

No abstract available.

A Case of Kerion Celsi Misdiagnosed as Ruptured Epidermal Cyst / 대한의진균학회지

Kerion celsi is an inflammatory infection, caused by a vigorous T-cell mediated host response to the dermatophyte infection. In the case of severe inflammation, it can be misdiagnosed as other disease like cellulitis, impetigo, furuncle and epidermal cyst. Microsporum(M.) canis is most likely transmitted by contact of animal hosts such as cats and dogs with humans. We report the 75-year-old female who presented two months history of tender erythematous scaly plaques with pustules, crusts on right scalp area. At first, from the histopathologic findings of the lesion, the patient was diagnosed epidermal cyst because of cyst-like structure in mid-dermis. But the fungal culture revealed M. canis as the causative fungus. Herein we report a educational case of kerion celsi mistaken for ruptured epidermal cyst.

Kerion Celsi Caused by Trichophyton rubrum in an Elderly / 대한의진균학회지

Kerion celsi is a severe inflammatory type of tinea capitis that presents as a boggy mass studded with broken hairs, oozing purulent material from follicular orifices. This infection is caused most commonly by zoophilic or geophilic pathogens. Trichophyton(T.) rubrum is an anthropophilic dermatophyte that is found all over the world. It has become one of the most important causative agents in tinea unguium and tinea pedis. But, kerion celsi caused by T. rubrum is rare. Kerion celsi is uncommon in adult. We report a case of kerion celsi caused by T. rubrum in a 72-year-old woman. She presented with localized tender erythematous plaques with pustules with oozing purulent material on the frontal scalp. A fungal culture from tissue of the lesions was grown on Sabouraud's dextrose agar and showed typical whitish cottony colonies of T. rubrum. The nucleotide sequence of internal transcribed spacer region for clinical isolate was identical to that of T. rubrum strain UZ1588_14 (GenBank accession number KP326579.1). She was treated with 200 mg of oral itraconazole daily for 3 months. The skin lesions improved 1 month after treatment, and recurrence has not been observed.

A Case of Kerion Celsi Caused by Microsporum gypseum / 대한피부과학회지

No abstract available.

Tinea capitis inflamatoria por Trichophyton tonsurans var. sulfureum / Inflammatory tinea capitis by Trichophyton tonsurans var. sulfureum

Los dermatofitos constituyen un grupo de hongos queratinofílicos y queratinolíticos que pueden producir lesiones en piel y sus anexos en animales y el hombre. Las lesiones pueden variar de intensidad desde leves a severas, algunas de las cuales son altamente inflamatorias. Trichophyton tonsurans es un dermatofito antropofílico agente de tiñas no inflamatorias, de piel y raramente de uñas. Es altamente contagioso, que se adquiere por contacto interhumano y de escasa presentación en nuestro medio. Raramente y asociado a estados de inmunocompromiso ocasiona tiña inflamatoria de cuero cabelludo (Kerion Celsi o Querión de Celso). Kerion Celsi es una lesión altamente inflamatoria y supurativa, generalmente causada por dermatofitos zoofílicos que se transmiten de animales al hombre, la cual representa una respuesta inmune exagerada del huésped a la presencia del hongo. Se documenta un caso de Kerion Celsi a T. tonsurans presentado por un niño de 4 años de edad, sin inmunocompromiso, residente en el interior de la provincia. Se trata del primer caso local de tinea capitis altamente inflamatoria a T. tonsurans. El propósito es demostrar que el hongo, a pesar de ser antropofílico, puede ocasionar esta forma clínica en paciente sin inmunocompromiso. Su existencia en el medio requiere de diagnóstico rápido, de extremar medidas higiénicas y posterior control para evitar su propagación.

The dermatophytes are keratinophilic and keratinolytic fungi that cause skin and its annexes lesions in animals and man. T. tonsurans is an anthropophilic fungi, highly contagious, of rare presentation in our environment. Infection is acquired by interpersonal. Noninflammatory ringworm occurs in children and adults. Very rarely it causes highly inflammatory and suppurative ringworm of the scalp (Celsi kerion) associated with immunocompromised states. The kerion is caused by zoophilic dermatophytes. It represents an exaggerated host immune response to the presence of the fungus. This paper presents a case of T. tonsurans Kerion in a 4-year-old non-immunocompromised patient, who lives in rural area in the province. This is the first local case of severe inflammatory tinea capitis to T. tonsurans. The purpose of the study is to demonstrate that T. tonsurans can cause Kerion not associated to immunocompromised. Furthermore, it shows its existence in the medium, which requires immediate diagnosis of the diseases and increase hygiene and disease control to prevent the spread of the fungus.

Cat’s Curse: A Case of Misdiagnosed Kerion

Kerion is an inflammatory type of tinea capitis which can be mistaken for bacterial infection or folliculitis as both conditions display similar clinical features. It occurs most frequently in prepubescent children and rarely in adults. We report a 26-yearold woman who presented with multiple tender inflammed nodules on her scalp. Her condition was misdiagnosed as bacterial abscess and treated with multiple courses of antibiotics without improvement. Later, her condition was re-diagnosed as kerion based on clinical appearance, history of contact with infected animal and Wood’s lamp examination. Symptoms and lesions resolved completely with systemic antifungal treatment leaving residual scarring alopecia. The delay in the diagnosis and treatment of this patient resulted in permanent scarring alopecia.

Kerion Celsi Caused by Trichophyton verrucosum Probably Transmitted from Cattle / 대한의진균학회지

Kerion celsi is a severe inflammatory type of tinea capitis that presents as an inflammatory, boggy mass with broken hairs and hair loss. It is usually occurred in children between the age of 4 and 14 years that caused by zoophilic or geophilic pathogens such as Microsporum(M.) canis, Trichophyton(T.) mentagrophytes, T. verrucosum, M. gypseum, T. verrucosum was chiefly found from cattle which infect the human through direct contact. We report a case of kerion celsi caused by T. verrucosum probably transmitted from cattle in a 3-year-old boy. The patient had a solitary, tender, 6.0 x 5.5 cm sized, erythematous boggy plaque and pustules with hair loss on the right side of occipital scalp for 2 weeks. Chains of chlamydoconidia were observed in KOH mount and slide culture by light microscopy. The nucleotide sequence of internal transcribed spacer (ITS) region for clinical isolate was identical to that of T. verrucosum strain IFM 57570. He was treated with 125 mg of terbinafine daily for 12 weeks and short term therapy of low dose of prednisolone. Skin lesion was cured without recurrence.

A Case of Kerion Celsi in an Adult Caused by Trichophyton mentagrophytes Probably Transmitted from Rabbit / 대한의진균학회지

Kerion celsi is a severe inflammatory type of tinea capitis that presents as an inflammatory, boggy plaque studded with broken hairs. It usually occurrs in children between the age of 4 and 14 years which is caused by zoophilic pathogens such as Microsporum(M.) canis, Trichophyton(T.) mentagrophytes, and T. verrucosum. Recently various mammals have become a pet in Korea and there has been increase in reports of dermatophytosis transmitted from these pets sporadically. We report a case of kerion celsi caused by T. mentagrophytes probably transmitted from rabbit in a 34-year-old adult male patient. The patient had localized, tender to mild pruritic, erythematous plaque with pustular nodules and irregular hair loss on the right temporal scalp for 2 months. Culture from a scalp lesion of patient on Sabouraud's dextrose agar showed typical T. mentagrophytes. He was treated with 250 mg of terbinafine daily for 12 weeks and short term therapy of low dose of prednisolone. He was cured without recurrence.

A Case of Kerion Celsi Caused by Trichophyton verrucosum / 대한의진균학회지

Kerion Celsi is a highly inflammatory, suppurative fungal infection of the scalp caused by zoophilic or geophilic dermatophytes. We report a case of Kerion Celsi caused by Trichophyton verrucosum in a 19-year-old female presenting with an indurated, pus-discharging, erythematous boggy mass on the frontal scalp for 2 weeks. Restriction fragment length polymorphism shows 100% concordance with Trichophyton verrucosum, which we had maintained as our standard strain. Systemic treatment with steroid and antifungal agents was administered.

A Case of Kerion Celsi Caused by Microsporum canis Probably Transmitted from Hamster / 대한의진균학회지

Kerion celsi is an inflammatory type of tinea capitis. It is usually seen with zoophilic pathogens, with common examples being Microsporum(M.) canis, Trichophyton(T.) mentagrophytes and T. verrucosum. Hamster is the mammal which belongs to the rodent family, usually small in size and frequently nocturnal in their habits and small pet kept in many countries today. We report a case of kerion celsi caused by M. canis probably transmitted from hamster in a 8-year-old boy. The patient had various sized, erythematous boggy nodules and pustules with irregular hair loss on the scalp for 2 months. Culture from a scalp lesion of patient on Sabouraud's dextrose agar showed M. canis. He was treated with 125 mg of terbinafine daily for 12 weeks and short term therapy of low dose of prednisolone. Skin lesions were cured without recurrence.

A Case of Kerion Celsi Caused by Trichophyton tonsurans / 대한의진균학회지

We report a case of kerion celsi caused by Trichophyton(T.) tonsurans in a 14-year-old student of a middle school wrestling team. The lesion was on the scalp for 1 month and 6.5X5.0X1.0 cm sized, markedly inflammatory, swollen, boggy pus exuding plaque. Culture from the scalp lesion of the patient on Sabouraud dextrose agar showed T. tonsurans. The patient was treated with 250 mg of terbinafine daily for 12 weeks and short term therapy of low dose of prednisolone. Skin lesions were completely cured and recurrence is not observed to date.

Erythema Nodosum Developed in a Child with Kerion Celsi / 대한피부과학회지

A 7 year-old boy visited our hospital with a 2 week history of inflammatory, pustular, tender patches and plaques on the right scalp and face area. He had been treated with topical steroid and antibiotics in a private clinic. In a KOH smear mount, multiple hyphaes and spores appeared on stratum corneum of the outer root sheath layer of his hair. The diagnosis of kerion celsi induced by dermatophytes was made. The patient was treated with oral griseofulvin, and on the 2nd day after starting treatment, multiple erythematous and tendered subcutaneous nodules occurred on his shin. A photosensitive dermatitis like lesion also occurred on his periorbital area. Griseofulvin changed to terbinafine. On the 6th day after treatment, the skin lesions on his face and scalp had improved, as had his shin lesions. The interest of this case lies in the unusual association of kerion and erythema nodosum, of which only eleven cases have been reported in dermatologic literature, and all cases were kerion induced Trichophyton species.

A Case of Kerion Celsi Caused by Trichophyton mentagrophytes / 대한의진균학회지

Kerion celsi is an inflammatory type of tinea capitis. It is a deep, boggy swelling and is painful. Patchy hair loss and broken hairs, inflammation and scaling are characteristic. We report a case of kerion celsi caused by Trichophyton(T.) mentagrophytes in 4 year-old boy. He presented with 6 cm x 7 cm and 2cm x 2cm sized erythematous boggy masses with multiple pustules and crusts on the vertex. Cultures from a scalp lesion of the patient on Sabouraud dextrose agar media showed T. mentagrophytes. Treatment was done systemically with itraconazole and prednisolone for 14 weeks.

A Case of Kerion Celsi Caused by Trichophyton tonsurans in Adult Female Patient / 대한피부과학회지

Trichophyton (T.) tonsurans is an anthrophophilic dermatophyte and children are the primary target population. The "seborrheic" type is the most common clinical type of tinea capitis caused by T. tonsurans but kerion celsi is much less common. We report a case of kerion celsi caused by T. tonsurans in a 21-year-old woman. The patient had various-sized, erythematous nodules and pustules with irregular alopecia on the scalp. On mycological investigation, T. tonsurans was identified within the lesion. The patient did not respond to itraconazole therapy but was successfully treated with ultramicronized griseofulvin.

Kerion Celsi Associated with Trauma: A Case Report

Kerion celsi is most inflammatory presentation of tinea capitis, which is consisted of pustules and area of crusting, either localized or diffuse. It is considered to be an exaggerated cell mediated response to fungus. It is caused by a number of different fungal species of the genera Trichophyton and Microsporum. In Korea, the vast majority of infections are caused by Microsporum canis, a zoophilic species spread primarily by cats and dogs. This lesion may easily be misinterpreted as bacterial infection, particularly an abscess in the emergency room or outpatient clinic. It's important to keep kerion celsi for differential diagnosis to avoid unnecessary surgical intervention. In this article, we report the case of kerion celsi misinterpreted as bacterial abscess, which developed after trauma.

Erythema Nodosum Probably Induced by Kerion Celsi

A 6-year-old girl visited us with a 4-week history of inflammatory, pustular, tender patches and plaques on the scalp, and a 3-day history of multiple, erythematous, indurated, tender, subcutaneous nodules on both pretibial areas. A swab was taken from the scalp lesion and colonies of Tiichophyton mentagrophytes grew on culture. The histopathological findings of the leg nodule were consistent with erythema nodosum. The patient was treated with oral itraconazole and deflazacort, combined with topical potassium permanganate solution. Erythema nodosum regressed two weeks later and the kerion of the scalp regressed six weeks after starting the treatment, leaving residual scarring alopecia. The patient was diagnosed as erythema nodosum probably induced by kerion celsi, that has not been reported in the Korean literature.

A Case of Kerion Celsi Caused by Trichophyton mentagrophytes / 대한의진균학회지

Kerion celsi is severe inflammatory type of tinea capitis and presents as an inflammatory, boggy mass studded with broken hairs. Mostly, it is caused by zoophilic or geophilic dermatophytes. Recently small various mammals have become a popular pet in Korea and there has been increase in reports of dermatophytosis transmitted from these pets sporadically. We report a case of kerion celsi caused by Trichophyton mentagrophytes which is zoophilic or anthropophilic dermatophyte in a 8-year-old boy. He presented with erythematous edematous patches with multiple pustules on the scalp. Initial KOH examination showed negative result. So, we treated him with antibiotics under the impression of folliculitis, but symptom and skin lesion were gradually aggravated. Repeated KOH examination and culture showed positive result. Therefore, we switched treatment regimen to antifungal agent and he was successfully treated.