title: Trichophyton mentagrophytes-associated Majocchi's granuloma treated with cryotherapy.
abstract: We here report the case of a woman with dermatophytosis of the thighs due to Trichophyton mentagrophytes where an unusual clinical picture posed considerable diagnostic and therapeutic problems. She presented numerous skin lesions located on the dorsolateral face of the left thigh and the medial surface of the right calf. The initial lesions consisted of small itchy pustules that evolved to exfoliation after scratching. Results of histopathologic examination ofa skin biopsy were consistent with dermatophytosis, although the negativity of PAS staining did not allow confirmation of this diagnosis. Direct microscopic examination with 10% KOH was negative; however, skin cultures on BioMerieux media revealed Tr. Mentagrophytes. Following the diagnosis of Trichophyton infection, the patient was treated with a combination of isoconazole nitrate and difluocortolone valerate. After therapy, both direct microscopic mycologic examination and culture on BioMerieux medium were negative; however, the lesions persisted, assuming a completely different aspect. Cryotherapy with liquid nitrogen was started. This led to a spectacular improvement: the surface of the skin became almost normal, merely showing slight discoloration. An unusual clinical presentation and non-responsiveness to treatment should prompt revision of the primary diagnosis. A negative result of direct microscopy should not exclude the diagnosis of dermatophytosis. Cryotherapy should be considered in cases that do not respond to conventional antifungal medication.
authors.affiliation: Department of Dermatology, Venereology and Pediatric Dermatology, Medical University of Lublin, Poland. aldonkapietrzak2@o2.pl
authors.forename: Aldona
authors.initials: A
authors.lastname: Pietrzak
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Tomasiewicz
authors.forename: Jean
authors.initials: J
authors.lastname: Kanitakis
authors.forename: Tomasz
authors.initials: T
authors.lastname: Paszkowski
authors.forename: Ewa
authors.initials: E
authors.lastname: Dybiec
authors.forename: Helena
authors.initials: H
authors.lastname: Donica
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Wójtowicz
authors.forename: Piotr
authors.initials: P
authors.lastname: Terlecki
authors.forename: Grażyna
authors.initials: G
authors.lastname: Chodorowska
mesh_terms: D000935:Antifungal Agents / Q000494:pharmacology / Q000627:therapeutic use; D003131:Combined Modality Therapy; D017679:Cryotherapy; D005260:Female; D006099:Granuloma / Q000150:complications* / Q000188:drug therapy / Q000473:pathology / Q000628:therapy*; D006801:Humans; D014005:Tinea / Q000150:complications* / Q000188:drug therapy / Q000473:pathology / Q000628:therapy*; D014249:Trichophyton / Q000187:drug effects / Q000502:physiology*; D055815:Young Adult
chemical_list: D000935:Antifungal Agents