title: Majocchi's granuloma after kidney transplantation.
abstract: Mycosis may follow an atypical course in an individual undergoing immunosuppressive therapy. We describe a patient with a fungal infection that was manifested as a bilateral inguinal granuloma. Owing to suspected inguinal lymphadenopathy characterized by distinct subcutaneous swellings in the groin, a 39-year-old man who had undergone kidney transplantation 14 years earlier was admitted to the Nephrologisches Zentrum in Hann. Muenden, Germany. The results of a clinical examination revealed bilateral, soft, partly fluctuant, indolent swellings in the groin as well as onychomycosis of the right great toe. An ultrasonographic scan showed bilateral hypoechogenic lesions (<or= 1.5 cm) in the groin. The lesions were surgically removed, and the results of histologic examination revealed severe granulating pseudocystic inflammation with a distinct foreign body reaction. Dermatophytes of the species Trichophyton rubrum were detected microbiologically. After the lesions had been resected, the wound healed without complications. Immunosuppressive treatment with tacrolimus 8 mg/d and steroids 7.5 mg/d was not changed. Local antimycotic treatment of the onychomycosis with ciclopirox cream was initiated. At the patient's 2-year followup examination, there was no evidence of recurrence. In transplant recipients, local fungal infections should be treated as a matter of course, because dermatophytosis is present in almost every other such patient. In patients with a suspicious inguinal lesion, an atypical form of dermatophytosis must be considered. T rubrum, the most frequently occurring dermatophyte, causes 80% of the dermatophytosis that develops in immunosuppressed patients.
authors.affiliation: Department of Internal Medicine and Nephrology, Nephrologisches Zentrum Niedersachsen, Hann. Muenden, Germany. m.burg@awogsd.de
authors.forename: Michael
authors.initials: M
authors.lastname: Burg
authors.forename: Dagmar
authors.initials: D
authors.lastname: Jaekel
authors.forename: Eva
authors.initials: E
authors.lastname: Kiss
authors.forename: Volker
authors.initials: V
authors.lastname: Kliem
mesh_terms: D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use; D000077768:Ciclopirox; D006099:Granuloma / Q000473:pathology*; D006801:Humans; D016030:Kidney Transplantation / Q000473:pathology*; D008297:Male; D011183:Postoperative Complications / Q000473:pathology*; D011728:Pyridones / Q000627:therapeutic use; D014005:Tinea / Q000188:drug therapy / Q000473:pathology; D016896:Treatment Outcome; D014249:Trichophyton / Q000302:isolation & purification
chemical_list: D000935:Antifungal Agents; D011728:Pyridones; D000077768:Ciclopirox