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P221 Deep dermatophytosis presented as multiple exophytic masses caused by Trichophyton rubrum in immunocompromised patient with rheumatoid arthritis; a case report
POSTER SESSION 2, SEPTEMBER 22, 2022, 12:30 PM - 1:30 PM: : Dermatophyte invades the stratum corneum and infects the skin, nails, and hair, mostly resulting in superficial infection. Deep dermatophytosis involving dermis and subcutaneous layer was rarely reported in immunocompromised state. Herei...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9509909/ http://dx.doi.org/10.1093/mmy/myac072.P221 |
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author | Hong, Seong Min Jang, Seung Hee Ahn, Sang Woo Choi, Jong Soo Shin, Jeong Hwan Kim, Jayoung Seol, Jung Eun Kim, Hyojin |
author_facet | Hong, Seong Min Jang, Seung Hee Ahn, Sang Woo Choi, Jong Soo Shin, Jeong Hwan Kim, Jayoung Seol, Jung Eun Kim, Hyojin |
author_sort | Hong, Seong Min |
collection | PubMed |
description | POSTER SESSION 2, SEPTEMBER 22, 2022, 12:30 PM - 1:30 PM: : Dermatophyte invades the stratum corneum and infects the skin, nails, and hair, mostly resulting in superficial infection. Deep dermatophytosis involving dermis and subcutaneous layer was rarely reported in immunocompromised state. Herein, we report a case with deep dermatophytosis caused by Trichophyton (T.) rubrum. A 71-year-old woman presented with multiple erythematous exophytic and subcutaneous nodules located on both lower legs. She was taking immunosuppressive agents for rheumatoid arthritis and had taken antifungal agents for tinea pedis and onychomycosis, which was improperly ceased. Histopathologic examination revealed pseudoepitheliomatous epidermal hyperplasia with microabscess formation in epidermis and diffuse granulomatous inflammation consisting of multinucleated giant cells, lymphocytes, neutrophils, and histiocytes in dermis. Imuunohistochemical staining with periodic acid-schiff (PAS) and Gomori methenamine silver (GMS) showed septate and branched fungal hyphae in dermis. Trichophyton rubrum was identified in fungal culture with tissue and confirmed through phylogenetic analysis of internal transcribed spacer (ITS) and large subunit regions (LSU) in ribosomal RNA. Prior to identification of causative organism, her condition deteriorated into septic shock. Amphotericin B was administered empirically for 6 days in order to prevent hematogenous dissemination and skin lesions were simultaneously resolved. Since deep dermatophytosis appears in various clinical manifestations, it is easy to be mistaken for another disease. If treatment is delayed, immunocompetent patients can progress to severe disease courses like hematogenous dissemination, so clinicians should differentiate this disease and conduct treatment at an appropriate time. |
format | Online Article Text |
id | pubmed-9509909 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-95099092022-09-26 P221 Deep dermatophytosis presented as multiple exophytic masses caused by Trichophyton rubrum in immunocompromised patient with rheumatoid arthritis; a case report Hong, Seong Min Jang, Seung Hee Ahn, Sang Woo Choi, Jong Soo Shin, Jeong Hwan Kim, Jayoung Seol, Jung Eun Kim, Hyojin Med Mycol Oral Presentations POSTER SESSION 2, SEPTEMBER 22, 2022, 12:30 PM - 1:30 PM: : Dermatophyte invades the stratum corneum and infects the skin, nails, and hair, mostly resulting in superficial infection. Deep dermatophytosis involving dermis and subcutaneous layer was rarely reported in immunocompromised state. Herein, we report a case with deep dermatophytosis caused by Trichophyton (T.) rubrum. A 71-year-old woman presented with multiple erythematous exophytic and subcutaneous nodules located on both lower legs. She was taking immunosuppressive agents for rheumatoid arthritis and had taken antifungal agents for tinea pedis and onychomycosis, which was improperly ceased. Histopathologic examination revealed pseudoepitheliomatous epidermal hyperplasia with microabscess formation in epidermis and diffuse granulomatous inflammation consisting of multinucleated giant cells, lymphocytes, neutrophils, and histiocytes in dermis. Imuunohistochemical staining with periodic acid-schiff (PAS) and Gomori methenamine silver (GMS) showed septate and branched fungal hyphae in dermis. Trichophyton rubrum was identified in fungal culture with tissue and confirmed through phylogenetic analysis of internal transcribed spacer (ITS) and large subunit regions (LSU) in ribosomal RNA. Prior to identification of causative organism, her condition deteriorated into septic shock. Amphotericin B was administered empirically for 6 days in order to prevent hematogenous dissemination and skin lesions were simultaneously resolved. Since deep dermatophytosis appears in various clinical manifestations, it is easy to be mistaken for another disease. If treatment is delayed, immunocompetent patients can progress to severe disease courses like hematogenous dissemination, so clinicians should differentiate this disease and conduct treatment at an appropriate time. Oxford University Press 2022-09-20 /pmc/articles/PMC9509909/ http://dx.doi.org/10.1093/mmy/myac072.P221 Text en © The Author(s) 2022. Published by Oxford University Press on behalf of The International Society for Human and Animal Mycology. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (https://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
spellingShingle | Oral Presentations Hong, Seong Min Jang, Seung Hee Ahn, Sang Woo Choi, Jong Soo Shin, Jeong Hwan Kim, Jayoung Seol, Jung Eun Kim, Hyojin P221 Deep dermatophytosis presented as multiple exophytic masses caused by Trichophyton rubrum in immunocompromised patient with rheumatoid arthritis; a case report |
title | P221 Deep dermatophytosis presented as multiple exophytic masses caused by Trichophyton rubrum in immunocompromised patient with rheumatoid arthritis; a case report |
title_full | P221 Deep dermatophytosis presented as multiple exophytic masses caused by Trichophyton rubrum in immunocompromised patient with rheumatoid arthritis; a case report |
title_fullStr | P221 Deep dermatophytosis presented as multiple exophytic masses caused by Trichophyton rubrum in immunocompromised patient with rheumatoid arthritis; a case report |
title_full_unstemmed | P221 Deep dermatophytosis presented as multiple exophytic masses caused by Trichophyton rubrum in immunocompromised patient with rheumatoid arthritis; a case report |
title_short | P221 Deep dermatophytosis presented as multiple exophytic masses caused by Trichophyton rubrum in immunocompromised patient with rheumatoid arthritis; a case report |
title_sort | p221 deep dermatophytosis presented as multiple exophytic masses caused by trichophyton rubrum in immunocompromised patient with rheumatoid arthritis; a case report |
topic | Oral Presentations |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9509909/ http://dx.doi.org/10.1093/mmy/myac072.P221 |
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