Trichophyton mentagrophytes-associated Majocchi’s granuloma treated with cryotherapy Trichophyton mentagrophytes-associated Majocchi’s granuloma treated with cryotherapy

• Main Authors: Aldona Pietrzak, Krzysztof Tomasiewicz, Jean Kanitakis, Tomasz Paszkowski, Ewa Dybiec, Helena Donica, Agnieszka Wójtowicz, Piotr Terlecki, Grażyna Chodorowska
• Format: Article
• Language: English
• Published: Via Medica 2012-10-01
• Series: Folia Histochemica et Cytobiologica
• Online Access: http://czasopisma.viamedica.pl/fhc/article/view/19762
• ISSN: 0239-8508; 1897-5631

We here report the case of a woman with dermatophytosis of the thighs due to Trichophyton mentagrophytes&lt;br /&gt;where an unusual clinical picture posed considerable diagnostic and therapeutic problems. She presented numerous&lt;br /&gt;skin lesions located on the dorsolateral face of the left thigh and the medial surface of the right calf. The initial lesions&lt;br /&gt;consisted of small itchy pustules that evolved to exfoliation after scratching. Results of histopathologic examination of&lt;br /&gt;a skin biopsy were consistent with dermatophytosis, although the negativity of PAS staining did not allow confirmation&lt;br /&gt;of this diagnosis. Direct microscopic examination with 10% KOH was negative; however, skin cultures on BioMerieux&lt;br /&gt;media revealed Tr. Mentagrophytes. Following the diagnosis of Trichophyton infection, the patient was treated with&lt;br /&gt;a combination of isoconazole nitrate and difluocortolone valerate. After therapy, both direct microscopic mycologic&lt;br /&gt;examination and culture on BioMerieux medium were negative; however, the lesions persisted, assuming a completely&lt;br /&gt;different aspect. Cryotherapy with liquid nitrogen was started. This led to a spectacular improvement: the surface of&lt;br /&gt;the skin became almost normal, merely showing slight discoloration. An unusual clinical presentation and non-responsiveness&lt;br /&gt;to treatment should prompt revision of the primary diagnosis. A negative result of direct microscopy&lt;br /&gt;should not exclude the diagnosis of dermatophytosis. Cryotherapy should be considered in cases that do not respond&lt;br /&gt;to conventional antifungal medication.<br>We here report the case of a woman with dermatophytosis of the thighs due to Trichophyton mentagrophytes&lt;br /&gt;where an unusual clinical picture posed considerable diagnostic and therapeutic problems. She presented numerous&lt;br /&gt;skin lesions located on the dorsolateral face of the left thigh and the medial surface of the right calf. The initial lesions&lt;br /&gt;consisted of small itchy pustules that evolved to exfoliation after scratching. Results of histopathologic examination of&lt;br /&gt;a skin biopsy were consistent with dermatophytosis, although the negativity of PAS staining did not allow confirmation&lt;br /&gt;of this diagnosis. Direct microscopic examination with 10% KOH was negative; however, skin cultures on BioMerieux&lt;br /&gt;media revealed Tr. Mentagrophytes. Following the diagnosis of Trichophyton infection, the patient was treated with&lt;br /&gt;a combination of isoconazole nitrate and difluocortolone valerate. After therapy, both direct microscopic mycologic&lt;br /&gt;examination and culture on BioMerieux medium were negative; however, the lesions persisted, assuming a completely&lt;br /&gt;different aspect. Cryotherapy with liquid nitrogen was started. This led to a spectacular improvement: the surface of&lt;br /&gt;the skin became almost normal, merely showing slight discoloration. An unusual clinical presentation and non-responsiveness&lt;br /&gt;to treatment should prompt revision of the primary diagnosis. A negative result of direct microscopy&lt;br /&gt;should not exclude the diagnosis of dermatophytosis. Cryotherapy should be considered in cases that do not respond&lt;br /&gt;to conventional antifungal medication.