Majocchi Granuloma Superinfected With Herpes Zoster.

Herpes zoster (HZ) infection is caused by the reactivation of the varicella-zoster virus (VZV) and has very rarely been reported at the site of a superficial fungal infection. Also, HZ occurring at the site of a deep fungal infection has not been reported in the literature. We discuss a unique case of a 45-year-old male patient presenting with a Majocchi granuloma (MG) superinfected with disseminated HZ.

Widespread form of Majocchi's granuloma in a kidney transplant recipient.

Kidney transplantation is the encouraged kidney replacement therapy due to providing more prolonged survival with a better quality of life. Unfortunately, kidney transplant recipients are susceptible to infections because of long-term utilization of immunosuppression. Despite dermatophyte infections are generally not life-threatening, the clinical significance has been recently enhanced by an increasing number of immunocompromised patients. We have presented a rare dermatophytosis course, Majocchi's granuloma, that spreads to all extremities during the early post-transplant period. A young kidney transplant recipient was exposed to intensive immunosuppression therapy due to acute rejection in the early period of post-transplantation. After four months, numerous nodular skin lesions were raised on various body parts. An invasive fungal infection was identified in the skin biopsy. Also, Trichophyton rubrum was isolated in the tissue cultures. Consequently, the patient was diagnosed with Majocchi's granuloma. An effectual treatment was attained with an oral terbinafine tablet. Majocchi's granuloma is a distinct form of dermatophytosis characterized by the spreading of infection into the dermis. In this unexpected case, we alerted physicians to opportunistic infections in the kidney transplant recipient.

Atypical and Unpredictable Superficial Mycosis Presentations: A Narrative Review.

While typically exhibiting characteristic features, fungal infections can sometimes present in an unusual context, having improbable localization (eyelid, face, or joint); mimicking other skin diseases such as eczema, psoriasis, or mycosis fungoides; and appearing with unexpected color, shape, or distribution. The emergence of such a challenging clinical picture is attributed to the complex interplay of host characteristics (hygiene and aging population), environment (climate change), advances in medical procedures, and agent factors (fungal resistance and species emergence). We aim to provide a better understanding of unusual epidemiological contexts and atypical manifestations of fungal superficial diseases, knowing that there is no pre-established clinical guide for these conditions. Thus, a literature examination was performed to provide a comprehensive analysis on rare and atypical superficial mycosis as well as an update on certain fungal clinical manifestations and their significance. The research and standard data extraction were performed using PubMed, Medline, Scopus, and EMBASE databases, and a total of 222 articles were identified. This review covers published research findings for the past six months.

Pigmented purpuric dermatosis (Majocchi type) in a patient with vitiligo.

Pigmented purpuric dermatosis is diagnosed clinically and does not require skin biopsy. However, in cases where rashes mimic cutaneous vasculitis, skin biopsies should be done to confirm the diagnosis, especially in patients who have underlying autoimmune disease.

Majocchi's Granuloma - The Great Mimicker: A Case Report.

Fungal infections can be challenging to diagnose, but doctors of every specialty may encounter this issue. They can be mistaken for other common dermatoses such as eczema or psoriasis and inadvertently be treated with topical corticosteroids or calcineurin inhibitors. This may lead to tinea incognita, a term used to describe a fungal infection with an altered clinical appearance, which may confuse the clinician even further. This case report presents a 54-year-old previously healthy man with a 4-month history of a painful and pruritic rash in the genitoinguinal region. The patient's general practitioner had unsuccessfully attempted to treat the rash with topical terbinafine, econazole-triamcinolone, and betamethasone-fusidic acid, in addition to peroral dicloxacillin capsules. On examination, there were multiple red-bluish nodules and pustules coalescing into infiltrating erythematous plaques on both thighs and in the pubic region. Fungal cultures were negative, but the clinical features together with the history of prolonged use of combined topical steroids and antifungals raised suspicion of a deep fungal infection. Histopathological skin examination revealed deep suppurative and granulomatous folliculitis with ruptured hair follicles which was consistent with a diagnosis of Majocchi's granuloma. Treatment with itraconazole capsules was initiated, and after a 16-week course of systemic antifungal therapy, the rash resolved. In conclusion, our case report presents a case of Majocchi's granuloma, which is a great mimicker, especially for non-dermatologists. It is therefore important that the diagnosis is considered as a differential diagnosis, even though a patient has previously been treated with a topical antifungal.

Majocchi's granuloma-A multicenter retrospective cohort study.

Background: Majocchi's granuloma (MG) is an uncommon deep fungal folliculitis predominantly caused by dermatophytes. Given the rarity of this condition, available data regarding predisposing comorbidities/risk factors, clinical characteristics, offending microbiologic pathogens, diagnostics, pathologic findings, and treatment approaches has been inferred from historical cases. Objectives: To review our institutional experience with MG. Methods: We retrospectively analyzed a multicenter cohort of adult patients diagnosed with MG between 1992 and 2022. Results: We analyzed 147 patients with MG, 105 of which were male with a median age of 55.6 years. Immunosuppressant and topical corticosteroid use were common prior to development of MG. Dermatologic lesions and their sites of involvement did not differ based on the immune status of patients. Trichophyton rubrum was the most common causative pathogen of MG, in addition to other dermatophytes. Treatment duration for all prescribed agents was median 31.5 days with oral terbinafine being the most frequently utilized agent. Clinical resolution was achieved in 96.6% of cases. Limitations: Retrospective, nonrandomized study. Conclusions: Although rare and clinically variable in presentation, diagnosis of MG often requires histopathologic confirmation to subsequently direct prolonged treatment with systemic antifungal therapy for mycological cure.

Purpura annularis telangiectodes of Majocchi: A case report.

BACKGROUND: Purpura annularis telangiectodes of Majocchi (PATM), also known as Majocchi, is a rare subclass of pigmented purpuric dermatoses. The etiology of PATM is unknown, but it seems more common in children and young women. The skin lesions are mostly symmetrical ring-shaped reddish-brown macules on the lower limbs. CASE SUMMARY: A 9-year-old girl, who has received treated in our department, presented with reddish-brown ring-shaped rash on both lower limbs that had been present for 6 mo. These lesions, red brownish annular or petaloid patches, were mostly found on ankles and lower limber, which do not fade when adding pressure and no feel of infiltration and no atrophy when touching those lesions. Pathological examination showed deposition of hemosiderin in papillary dermis. However, dermoscopy showed the pigmentation in the center as well as the lavender patches on the edge of lesion. The child was thus diagnosed with PATM. After diagnosis, we suggested the patient avoid strenuous exercise. she was given vitamin C tablets for oral and mometasone furoate cream for external use. Follow-up examinations and treatment continue to support the clinical diagnosis to date. CONCLUSION: This is the first report of investigating PATM using dermoscopy, which can differentiate PATM from other diseases due to its unique microscopic feature under dermoscopy. Although PATM is harmless, it still requires long-term follow-up. Moreover, dermoscopy technique can be applied for observation of multi-site lesions and correlated with histopathology. Thus, we believe this approach could be generalized for future diagnosis of PATM.

Facial Majocchi's granuloma.

Majocchi's granuloma (MG) is an uncommon form of deep fungal folliculitis that is most frequently caused by dermatophytes. Here, we present a case of facial MG.

What Percentage of Hairs Are Infected in Biopsies of Fungal Folliculitis?

Fungal folliculitis (including tinea capitis and Majocchi granuloma) has a wide range of clinical presentations, and biopsy may be obtained to distinguish this from other conditions with similar presentations. The study aims to evaluate the proportion of hairs infected in biopsies of fungal folliculitis. Copath records were searched for diagnoses of fungal folliculitis, tinea capitis and Majocchi granuloma between 1 January 2000 and 31 December 2020. Confirmed cases were pulled and reviewed by a dermatopathologist to count the total number of hairs on the sample and the total infected. Of 72 included cases, the median number of hair follicles per biopsy was 3 (IQR 1,4), and the median proportion of hairs infected was 54.2% (IQR 33.3%, 100.0%). Nineteen (26.4%) had only one hair included in the biopsy which was also an infected hair (100% of hairs were infected). The percentage of total hair follicles infected differed significantly depending upon location (p = 0.0443), with a smaller percentage of infected hairs in biopsies of tinea capitis. Clinicians should be cautious when using biopsy for diagnosis of fungal folliculitis, specifically, when there are few hairs in the specimen. Failure to capture infected hairs leads to false negative diagnoses.

Histopathology in the Diagnosis of Tinea Capitis: When to Do, How to Interpret?

The diagnosis of tinea capitis is usually made by clinical signs and direct microscopic examination. Early diagnosis of this dermatophytic infection, which may cause permanent hair loss if not treated appropriately, is very crucial. In recent years, the use of dermoscopy has helped with early diagnosis. However, when tinea capitis has an atypical course and develops in adulthood, it can be confused with several diseases, such as psoriasis, seborrheic dermatitis, folliculitis decalvans, acne keloidalis, and dissecting cellulitis. Due to the different treatment approaches and prognoses, it is important to distinguish tinea capitis from invasive dermatoses on the scalp. In this article, histopathological findings of tinea capitis and several advantages and disadvantages of histopathology in the diagnosis of fungal infections are also reviewed and updated.

A Case of Purpura Annularis Telangiectodes of Majocchi after Anti-SARS-CoV-2 Pfizer-BioNTech Vaccine: Is There an Association?

The advent of vaccines has drastically reduced the incidence, morbidity, and mortality related to COVID-19, and with the increase in the number of vaccinated subjects, there have been reports of some adverse events, including skin reactions. In this paper, we report a clinical case of Purpura Annularis Telangiectodes of Majocchi following a third-dose administration of the Pfizer-BioNTech COVID-19 vaccine. Almost 30 days after the third dose, the patient presented erythematous annular patches on the lower limbs with purpuric peripheral areas and a central clearing with no other symptoms. A dermoscopic examination showed capillaritis, reddish-brown dot-clods on a coppery-red background caused by leaky capillaries. To date, the causes of Majocchi's disease are not well-defined; in the literature, three vaccination-related cases have been reported: one after a flu vaccination and two after an anti-SARS-CoV-2 one. Dermatologists should be trained to promptly recognize these clinical manifestations after vaccination, which will likely become a common finding in daily clinical practice, especially given the large diffusion of SARS-CoV-2 vaccinations.

Unusual Inflammatory Tinea Infections: Majocchi's Granuloma and Deep/Systemic Dermatophytosis.

PURPOSE OF REVIEW: Inflammatory tinea is an uncommon group of dermatophyte entities that predominantly cause fungal infection of the skin and hair. This review intends to present all of the available evidence regarding its epidemiology, etiopathogenesis, clinical features, and diagnostic methods as well as treatments recommended for various inflammatory tinea infections. This article provides a review of Majocchi's granuloma and dermatophytic or Hadida's disease. RECENT FINDINGS: The new phylogenetic classification of dermatophytes includes nine genera, and those that affect humans are Trichophyton, Microsporum, Epidermophyton, and Nannizzia. Furthermore, molecular advancements have revealed impaired antifungal immune responses caused by inflammatory tinea, which are detailed in this article. SUMMARY: The common denominator in these pathologies is the presence of impaired immune responses and, consequently, an impaired inflammatory response by the host. It is necessary to be familiar with these immunological characteristics in order to use the appropriate diagnostic methods and to provide adequate treatment.

Majocchi's granuloma: Autoinoculation and adaption of Trichophyton rubrum with molecular evidence.

BACKGROUND: Trichophyton rubrum, an important aetiological agent of superficial dermatophytosis, occasionally penetrates into deeper tissues, causing inflammation and a granulomatous response. Only few case reports of T. rubrum granuloma with molecular evidence for autoinoculation have been published. OBJECTIVES: To find the genetic basis of adaptation to a different microhabitat following autoinoculation of Trichophyton rubrum. METHODS: A case of Majocchi's granuloma is reported, with isolation of T. rubrum strains from foot and chin, respectively. Whole-genome sequencing of the two strains has been performed. Phylogenetic reconstruction and SIFT analysis were conducted. RESULTS: A phenotypic difference has been observed between the two isolates. 20 and 19 indels, 8 and 15 SNVs were found in foot and chin strains, respectively. Foot and chin strains formed a monophyletic group. Two non-synonymous mutations of chin strains were observed in the TERG_06754 gene encoding cytochrome c peroxidase (CCP). The G293C amino acid change in TERG_03373 was predicted to affect protein function significantly. The mutated amino acid (cysteine) was only found in the chin strain in all dermatophyte non-redundant sequences. CONCLUSIONS: Non-synonymous mutations located in TERG_06754 and TERG_03373 were predicted to affect protein functions, which may facilitate the adaption for invasion of the superficial cutaneous strain. As the different living environments of these two strains (oxygenous, lower-temperature for the pedal strain; hypoxia, higher-temperature for the chin strain), a stratum corneum-to-dermal adaption hypothesis of T. rubrum was proposed.

Pigmented Purpuric Dermatoses: A Complete Narrative Review.

Pigmented purpuric dermatoses (PPD) include several skin diseases characterized by multiple petechial hemorrhage as consequence of capillaritis. PPD generally present with red to purple macules that progressively evolve to golden-brown color as the hemosiderin is reabsorbed. These lesions, often asymptomatic or associated with mild pruritus, usually occur on the lower extremities and may be a diagnostic and therapeutic challenge both for general practitioners and specialists in internal medicine or flebology. Clinical presentations include many subtypes that have been described over the years, although histology is usually superimposable. Prompt recognition and patient reassurance on the benign nature of these diseases is crucial. In this comprehensive review, we focused on pathogenesis and clinical pictures.

ALA-PDT successfully treated Majocchi's granuloma by directly killing Trichophyton tonsurans and recruiting T lymphocytes.

BACKGROUND: Majocchi's granuloma (MG) is a deep persistent suppurative granulomatous perifolliculitis which might be caused by Trichophyton tonsurans (T. tonsurans). Conventional treatment for MG is oral administration of systematic antifungal drugs, associated with a low cure rate and a high relapse rate. ALA-PDT is a new approach for fungal infection. METHODS: A case of refractory MG was treated by 3 times of ALA-PDT. At the same time, T. tonsurans strains isolated from the lesions of the patient were used for an in vitro inhibition experiment and an in vivo experiment in guinea pig model to furtherly verify the effectiveness and investigate the mechanism of ALA-PDT for T. tonsurans. RESULTS: After 3 times of ALA-PDT, the lesions of MG were eliminated. And the mycological and pathological examination showed a disappearance of fungi in follicles. In vitro and in vivo experiment both demonstrated that ALA-PDT could obviously inhibit the growth of T. tonsurans partly by directly destroying the structure of fungal cells and recruiting CD4 + T cells. CONCLUSION: ALA-PDT is a potentially effective noninvasive method for the treatment of MG with mechanisms of direct killing and with CD4+ T cell-mediated immune response.

[Purpura annularis telangiectodes : Case report and review of the literature]. / Purpura anularis teleangiectodes : Fallbericht und Literaturübersicht.

Pupura annularis telangiectodes (PAT) is a rare entity belonging to the spectrum of the pigmented purpuric dermatoses. PAT presents clinically as symmetric, annular erythema with teleangiectasia on the lower extremities and preferably affects young women. Histology usually reveals extravasated erythrocytes accompanied by a lymphocyte-dominated inflammatory infiltrate in the superficial dermis. Medication can often be identified as causative. In patients with idiopathic disease, topical corticoidsteroids are the treatment of choice. Compression therapy may be supportive.

Majocchi's granuloma on the forearm caused by Trichophyton tonsurans in an immunocompetent patient.

Majocchi's granuloma is an uncommon fungal infection of the dermis and subcutaneous tissue. The most frequently identified cause of Majocchi's granuloma is anthropophilic Trichophyton rubrum, and it is most commonly located on the anterior aspect of the lower limbs in women. Here, we report a case of Majocchi's granuloma on the forearm, a site that is rarely involved, in a 62-year-old woman who had been bitten by a dog. Histological examination revealed a dense dermal infiltrate composed of lymphoplasmacytic cells and neutrophils, with hyphae in the dermis. The presence of the fungus, Trichophyton tonsurans, was confirmed by mycological examination and molecular methods. Therefore, histological and mycological examination confirmed the diagnosis of Majocchi's granuloma. The patient was treated with local moxibustion and itraconazole, 200 mg/day, for 60 days, which facilitated a complete resolution of the lesions.

Two Rare Cases of Tinea Corporis Caused by Trichophyton verrucosum and Trichophyton interdigitale in a Teenage Girl.

We present two cases of tinea corporis caused by Trichophyton verrucosum and Trichophyton interdigitale in a teenage girl who works with farm animals. We describe the differences in presentation between zoophilic dermatophytes and anthropophilic dermatophytes. Also, we report some of the typical features of the two rare species, T. verrucosum and T. interdigitale. This case is significant to dermatology as it raises awareness about these uncommon zoophilic dermatophytoses and demonstrates the importance of educating patients about their mode of infection.