A case of disseminated cutaneous granuloma caused by Trichophyton rubrum

Abstract

A case of disseminated cutaneous granuloma due to Trichophyton rubrum is reported.A 35-year-old man presented with generalized pruritic erythema,plaques and nodules for 8 years.Dermatological examination revealed patchy papules,erythema,infiltrated plaques and nodules on the scalp,face,trunk and limbs,and some of the lesions were slightly scaling and crusting with clear borders and atrophic scar.Also,his bilateral eyelids were swollen,right auricle was impaired,left auricle was deformed,hair,eyebrows and eyelashes were lost,and nails of the fingers and toes were thickened,impaired and even broken.Direct microscopic examination of scrapings from skin lesions showed the presence of branched and septate hyphae,and fungal culture grew Trichophyton rubrum.Skin biopsy specimen revealed epidermal hyperplasia,stratum spinosum hyperplasia and thickening,epithelioid granuloma in the superficial and mid dermis consisting mainly of lymphocytes and plasmocytes with scattered eosinophils and multinucleated giant cells.Periodic acid-Schiff(PAS)and silver stain both showed branched and septate hyphae within the upper dermis.A diagnosis of disseminated cutaneous granuloma caused by Trichophyton rubrum was made.After 3 months of treatment with itraconazole,the lesions subsided with hyperpigmentation and atrophic scar left,and both microscopic examination and fungal culture turned negative.No side effects were observed during the treatment. Key words: Trichophyton; Granuloma; Itraconazole; Dermatomycoses