ABSTRACT
BACKGROUND: Dermatophyte infection is almost exclusively a superficial cutaneous mycosis usually confined to the stratum corneum of nails and hairs of normal hosts. Deep cutaneous and subcutaneous infections due to dermatophytes are exceedingly rare and usually limited to immunosuppressed individuals. These infections remain chronic and persist in spite of treatment. MATERIALS AND METHODS: We report two clinical cases of disseminated dermatophytic pseudomycetoma caused by Microsporum gypseum and Microsporum canis in immunosuppressed patients. RESULTS: Patient 1, in 2008, showed improvement with fluconazole, cephalothin, and terbinafine treatment for Microsporum gypseum. After suspension of the treatment, new lesions appeared and culture from material was positive. In 2009, she presented confluent papules and nodules forming plaques on her face and neck with the isolation of Microsporum canis. Clinical response to this treatment was poor. Patient 2 was affected by both tinea corporis due to Trichophyton rubrum and dermatophytic pseudomycetoma caused by Microsporum canis. The response to treatment was successful with oral itraconazole and local surgical excision. CONCLUSIONS: It is important to recognize these atypical presentations of dermatophytic infections in immunosuppressed patients, which may warrant a more aggressive treatment in order to achieve resolution.
Subject(s)
Dermatomycoses/microbiology , Facial Dermatoses/microbiology , Microsporum/isolation & purification , Mycetoma/microbiology , Scalp/microbiology , Aged , Alopecia/drug therapy , Alopecia/microbiology , Alopecia/pathology , Antifungal Agents/therapeutic use , Dermatomycoses/drug therapy , Dermatomycoses/pathology , Facial Dermatoses/drug therapy , Facial Dermatoses/pathology , Female , Humans , Immunocompromised Host , Mycetoma/drug therapy , Mycetoma/pathology , Opportunistic Infections/drug therapy , Opportunistic Infections/microbiology , Opportunistic Infections/pathology , Scalp/pathologyABSTRACT
The rewarding use of nail clippings processed histologically for the diagnosis of some nail diseases is well established. A new application of the nail plate biopsies (NPBs) is the detection of crystals in the subungual horn. Besides other subungual crystals, urate crystals are heretofore undescribed. This presentation adds to the advantages of an NPB: the detection of some cases of gout on which urate crystals are extruded subclinically. While searching for fungi, 2 cases of gout were diagnosed histologically, aided by unstained thick sections. A history of gout was then confirmed. No tophi were noted in or near the nail field. Chasing for crystals opens the study of fluids that may exude or transude into nail structures, a kind of "nail window" into hematic or metabolic abnormalities. In sum, the abundance of cytologic and histologic findings in an NPB can expand the armamentarium of physicians to evaluate nail diseases and even systemic diseases in a noninvasive manner.
