title: Trichophyton rubrum-induced Majocchi's Granuloma in a heart transplant recipient. A therapeutic challenge.
abstract: BACKGROUND
  Solid organ transplant recipients are at an increased risk for infections because of long-term immunosuppression to prevent graft rejection. Fungal infections with dermatophytes are a common cause of cutaneous infections seen in organ transplant recipients and cutaneous dermatophyte infections may progress to Majocchi's granuloma. Itraconazole is an anti-fungal compound used for the treatment of infections of the skin, nails and mucous membranes.
  
  
  METHODS
  We report on a heart transplant recipient who developed widespread Trichophyton rubrum infection presenting as Majocchi's granuloma. Itraconazole treatment was complicated by drug interactions. Tricho-phyton rubrum infection progressed, while itraconazole treatment was varied in dose and delivery form.
  
  
  CONCLUSIONS
  In patients with Trichophyton rubrum infections, refractory to itraconazole treatment, altered drug absorption or drug interactions has to be considered. Careful monitoring and adjustment of itraconazole is of vital importance.
authors.affiliation: Department of Dermatology, University Hospital, Zürich, Switzerland.
authors.forename: Urs C
authors.initials: UC
authors.lastname: Steiner
authors.forename: Ralph M
authors.initials: RM
authors.lastname: Trüeb
authors.forename: Karin
authors.initials: K
authors.lastname: Schad
authors.forename: Jivko
authors.initials: J
authors.lastname: Kamarashev
authors.forename: Simon
authors.initials: S
authors.lastname: Koch
authors.forename: Lars E
authors.initials: LE
authors.lastname: French
authors.forename: Günther F L
authors.initials: GF
authors.lastname: Hofbauer
keywords: Majocchi's Granuloma; Trichophyton rubrum; adverse event; fungal infection; itraconazole; mycosis