Adult kerion caused by Trichophyton rubrum in a vegetarian woman with onychomycosis

Abstract

A 75-year-old vegetarian woman presented with a 1.5-year history of an enlarging, inflammatory scalp mass. Physical examination revealed a wide scarring area of alopecia on the scalp with perifollicular pustules and crusts (Fig. 1a) with tinea pedis and onychomycosis (Fig. 1b). The patient weighed 38 kg. Fluorescence staining revealed numerous septate hyphae in the pus, piles of ectothrix spores and septate hyphae located in the outer part of the hair cortex (Fig. 2a and b). Histopathologic examination revealed suppurative and granulomatous perifolliculitis, whereas periodic acid–Schiff staining revealed follicular hyphae (Fig. 1c).