Dermatophyte abscesses caused by Trichophyton rubrum in a patient without pre-existing superficial dermatophytosis: a case report.
Trichophyton usually causes a superficial skin infection, affecting the outermost layer of the epidermis, the stratum corneum. In immunocompromised patients, deeper invasion into the dermis and even severe systemic infection with distant organ involvement can occur. Most cases of deeper dermal dermatophytosis described in the literature so far involved pre-existing superficial dermatophytosis.



We report a 68-year-old woman presented to our clinic with a 3-month history of palpable nodules on the right ankle without pre-existing superficial dermatophytosis. Magnetic resonance imaging showed multiple, well-demarcated, cystic lesions around the lateral malleolus, located in the subcutaneous or dermal layers. The sizes varied from 0.5 cm to 4 cm in diameter. The patient underwent complete excision of the lesions. Fungal culture yielded Trichophyton rubrum on Sabouraud dextrose agar. Histopathology showed organizing abscesses with degenerated fungal hyphae. After the 12-week oral itraconazole therapy, the lesions were completely resolved.



Dermatophytes should be considered as a possible cause of deep soft tissue abscesses in immunocompromised patients, even though there is no superficial dermatophytosis lesion.
Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Incheon St. Mary's Hospital, 56 Dongsu-ro, Bupyeong-gu, Incheon, 403-720, Republic of Korea.
Si-Hyun
SH
Kim
Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Incheon St. Mary's Hospital, 56 Dongsu-ro, Bupyeong-gu, Incheon, 403-720, Republic of Korea.
Ik Hyun
IH
Jo
Department of Pathology, College of Medicine, The Catholic University of Korea, Incheon St. Mary's hospital, Incheon, Republic of Korea.
Jun
J
Kang
Department of Orthopedic Surgery, College of Medicine, The Catholic University of Korea, Incheon St. Mary's Hospital, Incheon, Republic of Korea.
Sun Young
SY
Joo
Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Incheon St. Mary's Hospital, 56 Dongsu-ro, Bupyeong-gu, Incheon, 403-720, Republic of Korea. cmcjh@catholic.ac.kr.
Jung-Hyun
JH
Choi
D000038:Abscess / Q000382:microbiology*; D000842:Ankle; D000935:Antifungal Agents / Q000627:therapeutic use; D005260:Female; D006801:Humans; D017964:Itraconazole / Q000627:therapeutic use; D008875:Middle Aged; D014005:Tinea / Q000175:diagnosis*; D014249:Trichophyton / Q000302:isolation & purification*
D000935:Antifungal Agents; D017964:Itraconazole
Abscess; Dermatophyte; Soft tissue; Trichophyton