Invasive Trichophyton rubrum infection occurring with infliximab and long-term prednisone treatment.
BACKGROUND
A 64-year-old woman presented with erythematous plaques, tender nodules, and pustules of the dorsal right hand and both legs following long-term treatment with systemic steroids and infliximab. Skin biopsy demonstrated dermal inflammation with foci of necrosis and multinucleated giant cells containing fungal spores. Tissue culture grew Trichophyton rubrum.


OBJECTIVE
To report a case that demonstrates the pathophysiology of invasive T. rubrum infection, the mechanisms of action and uses of tumor necrosis factor alpha (TNF-alpha)-inhibiting drugs, and how these drugs may increase patients' risk of invasive dermatophytosis.


CONCLUSIONS
Dermatophytes such as T. rubrum rarely cause invasive disease. This unusual presentation of invasive T. rubrum occurred with immunosuppression by infliximab and systemic steroids. Patients should have a thorough examination for signs of latent infection before TNF-alpha inhibitors are prescribed, including inspection of the skin and nails for signs of dermatophytosis.
Lowther
Abigail L
AL
Metrohealth Medical Center, Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, OH 44109, USA.
Somani
Ally-Khan
AK
Camouse
Melissa
M
Florentino
Frances T
FT
Somach
Stephen C
SC
D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D017809:Fatal Outcome; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D016867:Immunocompromised Host; D000069285:Infliximab; D008875:Middle Aged; D011241:Prednisone / Q000008:administration & dosage / Q000627:therapeutic use*; D014005:Tinea / Q000209:etiology / Q000276:immunology / Q000503:physiopathology*; D014409:Tumor Necrosis Factor-alpha / Q000009:adverse effects*
D000911:Antibodies, Monoclonal; D005938:Glucocorticoids; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D011241:Prednisone