title: A Unique Clinicopathological Manifestation of Fungal Infection: A Case Series of Deep Dermatophytosis in Immunosuppressed Patients.
abstract: BACKGROUND
  Dermatophytes are the most common cause of superficial fungal infections in humans. Deep dermatophytosis, however, is rare, described to date only in isolated case reports, usually in the setting of systemic immunosuppression.
  
  
  OBJECTIVE
  To present the 15-year experience of a tertiary dermato-mycology clinic with the diagnosis and treatment of deep dermatophytosis.
  
  
  METHODS
  Patients were identified by database search. Clinical, mycological, histological, and treatment data were collected from the medical files.
  
  
  RESULTS
  Ten patients were identified: nine after solid-organ transplantation and one undergoing chemotherapy, all diagnosed within 3 years after beginning immunosuppression (average 7.5 months). The infective agent in nine cases was Trichophyton rubrum. All patients presented with concurrent superficial fungal infections. Complete resolution was noted in response to systemic antifungal agents. There was no histological evidence of hair-follicle involvement.
  
  
  CONCLUSIONS
  The limitations of the study were the retrospective design and the small cohort size.
  
  
  CONCLUSIONS
  This case-series study suggests that deep dermatophytosis is a separate entity, distinct from Majocchi's granuloma. It occurs only in immunocompromised patients and is characterized by discrete nodules, an indolent course, the absence of follicular invasion, and proximity to a superficial dermatophyte infection. Systemic antifungal treatment leads to complete resolution. The urgent need for the treatment of superficial fungal infections in immunocompromised patients is emphasized.
authors.affiliation: Department of Dermatology, Rabin Medical Center - Beilinson Hospital, 39 Jabotinski St., Petach Tikva, 4941492, Israel.
authors.forename: Ruben
authors.initials: R
authors.lastname: Kershenovich
authors.affiliation: Department of Dermatology, Rabin Medical Center - Beilinson Hospital, 39 Jabotinski St., Petach Tikva, 4941492, Israel. shanyshnush@gmail.com.
authors.forename: Shany
authors.initials: S
authors.lastname: Sherman
authors.affiliation: Department of Dermatology, Rabin Medical Center - Beilinson Hospital, 39 Jabotinski St., Petach Tikva, 4941492, Israel.
authors.forename: Ofer
authors.initials: O
authors.lastname: Reiter
authors.affiliation: Department of Dermatology, Rabin Medical Center - Beilinson Hospital, 39 Jabotinski St., Petach Tikva, 4941492, Israel.
authors.forename: Shiran Reiss
authors.initials: SR
authors.lastname: Huss
authors.affiliation: Institute of Pathology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Elena
authors.initials: E
authors.lastname: Didkovsky
authors.affiliation: Department of Dermatology, Rabin Medical Center - Beilinson Hospital, 39 Jabotinski St., Petach Tikva, 4941492, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Daniel
authors.initials: D
authors.lastname: Mimouni
authors.affiliation: Department of Dermatology, Rabin Medical Center - Beilinson Hospital, 39 Jabotinski St., Petach Tikva, 4941492, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Emmilia
authors.initials: E
authors.lastname: Hodak
authors.affiliation: Department of Dermatology, Rabin Medical Center - Beilinson Hospital, 39 Jabotinski St., Petach Tikva, 4941492, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Rina
authors.initials: R
authors.lastname: Segal
mesh_terms: D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use*; D005260:Female; D018859:Hair Follicle / Q000473:pathology; D006801:Humans; D016867:Immunocompromised Host / Q000276:immunology*; D007165:Immunosuppression Therapy / Q000009:adverse effects*; D015994:Incidence; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation / Q000009:adverse effects; D012189:Retrospective Studies; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D014005:Tinea / Q000188:drug therapy / Q000453:epidemiology / Q000276:immunology* / Q000382:microbiology; D014249:Trichophyton / Q000276:immunology* / Q000302:isolation & purification
chemical_list: D000935:Antifungal Agents
keywords: Dermatophytosis; Fluconazole; Hair Follicle; Invasive Aspergillosis; Terbinafine