title: Disseminated dermatophytic pseudomycetoma caused by Microsporum species.
abstract: BACKGROUND
  Dermatophyte infection is almost exclusively a superficial cutaneous mycosis usually confined to the stratum corneum of nails and hairs of normal hosts. Deep cutaneous and subcutaneous infections due to dermatophytes are exceedingly rare and usually limited to immunosuppressed individuals. These infections remain chronic and persist in spite of treatment.
  
  
  METHODS
  We report two clinical cases of disseminated dermatophytic pseudomycetoma caused by Microsporum gypseum and Microsporum canis in immunosuppressed patients.
  
  
  RESULTS
  Patient 1, in 2008, showed improvement with fluconazole, cephalothin, and terbinafine treatment for Microsporum gypseum. After suspension of the treatment, new lesions appeared and culture from material was positive. In 2009, she presented confluent papules and nodules forming plaques on her face and neck with the isolation of Microsporum canis. Clinical response to this treatment was poor. Patient 2 was affected by both tinea corporis due to Trichophyton rubrum and dermatophytic pseudomycetoma caused by Microsporum canis. The response to treatment was successful with oral itraconazole and local surgical excision.
  
  
  CONCLUSIONS
  It is important to recognize these atypical presentations of dermatophytic infections in immunosuppressed patients, which may warrant a more aggressive treatment in order to achieve resolution.
authors.affiliation: Department of Pathology, Baptist Health System, Birmingham, AL, USA. mariantonietatirado@gmail.com
authors.forename: Mariantonieta
authors.initials: M
authors.lastname: Tirado-González
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Ball
authors.forename: Angela
authors.initials: A
authors.lastname: Ruiz
authors.forename: Ysabel
authors.initials: Y
authors.lastname: Rodriguez
authors.forename: Carmen Elena
authors.initials: CE
authors.lastname: Goudet
authors.forename: Oksana
authors.initials: O
authors.lastname: Finkel
authors.forename: Haim
authors.initials: H
authors.lastname: Golan
authors.forename: Helena Martinez
authors.initials: HM
authors.lastname: de Morentin
authors.forename: Hanna
authors.initials: H
authors.lastname: Sprecher
authors.forename: Eli
authors.initials: E
authors.lastname: Sprecher
authors.forename: Andrea
authors.initials: A
authors.lastname: Gat
mesh_terms: D000368:Aged; D000505:Alopecia / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology; D000935:Antifungal Agents / Q000627:therapeutic use; D003881:Dermatomycoses / Q000188:drug therapy / Q000382:microbiology* / Q000473:pathology; D005148:Facial Dermatoses / Q000188:drug therapy / Q000382:microbiology* / Q000473:pathology; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D008864:Microsporum / Q000302:isolation & purification*; D008271:Mycetoma / Q000188:drug therapy / Q000382:microbiology* / Q000473:pathology; D009894:Opportunistic Infections / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology; D012535:Scalp / Q000382:microbiology* / Q000473:pathology
chemical_list: D000935:Antifungal Agents