Cases reported "Tinea"

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1/112. A case of Unna-Thost disease accompanied by epidermophyton floccosum infection.

    We report herein a case of 61-year-old man with Unna-Thost disease (nonepidermolytic hereditary palmoplantar keratoderma) who had been suffering from refractory dermatophyte infection. Diffuse palmoplantar hyperkeratosis developed in his infancy. Coarse scaling, fissures, marked erythema, and nail deformities appeared in his early adult life. Microscopic examination revealed fungal elements in scales and nail particles. Cultures of those scales isolated epidermophyton floccosum. Genealogical study demonstrated that his mother, sister, brother, daughter, and niece had had similar tylosis, and all of the affected individuals except his daughter had been proved to have E. floccosum or trichophyton rubrum infection. Oral itraconazole (100mg/day) was highly effective in treating his dermatophytosis without any adverse effects. Scaling, fissures and underlying erythema disappeared within four months.
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2/112. Acute infection with trichophyton rubrum associated with flares of atopic dermatitis.

    trichophyton rubrum has been implicated as a potential trigger in flares of atopic dermatitis. We describe a patient with atopic dermatitis who presented with a history of multiple flares and concurrent acute tinea pedis and onychomycosis. Symptoms of atopic dermatitis and culture-positive acute infection with T. rubrum resolved during each flare using systemic antifungals. Flares of atopic dermatitis may be triggered by acute T. rubrum infections. Antifungal therapy should be considered in these patients.
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3/112. Microbiological and molecular diagnosis of deep localized cutaneous infection with trichophyton mentagrophytes.

    We describe a healthy young woman with a localized deep dermal infection on the right side of the chest wall. It was caused by the dermatophyte trichophyton mentagrophytes, and resolved after two pulses of oral itraconazole 200 mg twice daily for 1 week. As cultural and microscopic features did not enable a precise identification of the fungus, molecular investigation was undertaken. Patterns of HaeIII restriction digests of genomic dna from the culture matched those from Arthroderma incurvata and A. benhamiae, which is the teleomorph of T. mentagrophytes var. mentagrophytes.
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4/112. Tinea incognito due to microsporum gypseum in three children.

    Tinea incognito is a dermatophytosis of atypical clinical character due to the absence of classic features of ringworm. It is caused by prolonged use of topical steroids, sometimes prescribed as a result of incorrect diagnosis. The cases reported in the literature have different clinical presentations and have generally been in adults. We report three children with tinea incognito in whom the lesions were psoriasis-like, eczema-like, and lichenoid, respectively. diagnosis was confirmed by mycologic examination, which led to the identification of microsporum gypseum, a geophilic dermatophyte which is an infrequent agent of mycotic infection in humans.
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5/112. Extensive and deep dermatophytosis caused by trichophyton mentagrophytes var. interdigitalis in an hiv-1 positive patient.

    BACKGROUND: Cutaneous infections are common in hiv-1 positive patients and are usually severe, recurrent, and caused by microorganisms that are unusual in immunocompetent patients. OBJECTIVE: We report a case of an hiv-1-positive 23-year-old male, with a history of intravenous drug use, in stage C-II (CDC '86), with a cd4 lymphocyte count of 335 cells/mm3. He had multiple, large erythematous, circinate and pustular plaques on his abdomen, back, arms and legs. RESULTS: We isolated trichophyton mentagrophytes var. interdigitalis from the lesions. The biopsy showed suppurative deep dermatophytosis and folliculitis. The patient satisfactorily responded to itraconazole (100 mg/d for 14 days). CONCLUSION: This is the first reported case of deep dermatophytosis caused by T. mentagrophytes in an HIV-positive patient.
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6/112. A case of black dot ringworm with a review of Japanese cases.

    Black dot ringworm (BDR), caused by trichophyton violaceum var. glabrum (T. glabrum), was observed in a 28-year-old Japanese female who had been treated with prednisolone (22.5 mg/day) for systemic lupus erythematosus. It was successfully treated with oral terbinafine (125 mg/day) for 12 weeks. The causative fungus was identified by molecular analysis as well as morphological and biochemical examination. The chitin synthase 1 (CHS1) gene cleavage pattern of the clinical isolate with restricted enzyme HinfI was identical to that of T. violaceum. We reviewed previous reports of BDR to determine the historical trend of this infection in japan. Since 1974, 93 Japanese cases have been reported. The age distribution was bi-modal: the higher peak consisted of children (aged 0-15 years), and the lower peak was composed of the elderly (aged 60-75 years). In the elderly group, females were predominant (M:F=1:22, p<0.001). T. violaceum, including T. glabrum, was identified as the most common causative fungus of BDR (75.3%). Sixty percent of cases showed slight erythema. In 8 families, 16 cases were found to be intrafamilial infections. A history of previous steroid treatment was described in about 40%.
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7/112. Recalcitrant trichophytic granuloma associated with NK-cell deficiency in a SLE patient treated with corticosteroid.

    Although deep trichophytic infection often occurs in immunocompromised patients, the immune deficiency in such patients has not been clarified. A 28-year-old man who suffered from recalcitrant trichophytic granuloma and tinea universalis during treatment for SLE with corticosteroid is described here to define the immunological abnormalities. In addition to routine immunological tests, we evaluated the patient's innate and specific immune functions to dermatophytes, including T cell, natural killer (NK) cell and neutrophil functions and activation of the complement cascade. We measured the minimum inhibitory concentration (MIC) of itraconazole for the isolated fungus and its concentrations in the patient's serum and pus. trichophyton (T.) rubrum was constantly isolated from the exudates of the patient's skin lesions, although the concentrations of itraconazole in his serum (198 ng/ml) and lesions (210 ng/ml) were sufficient to inhibit the growth of the isolated fungus in vitro. Specific cell-mediated immune responses, determined by T cell stimulation and IFN-gamma production, were evoked following stimulation with trichophytic antigens. The patient's innate immunity, assessed by activation of the complement cascade and neutrophil-mediated phagocytosis, was not impaired. The number of circulating NK cells was markedly decreased (0.2% of the peripheral blood mononuclear cells), and was associated with low NK cell activity against K-562 cells even though lymphopenia had improved. The deficiency of innate immunity mediated by NK cells might be responsible for a part of the persistence of trichophytic granuloma in our case. Dermatophytes usually affect the horny layer of the skin and do not invade the living layers because the host immune system uses various mechanisms to eliminate the fungi. Both specific T cell-mediated immunity and nonspecific immunological mechanisms provide host defense against fungal infections. An adaptive immune response is usually preceded by innate immune responses mediated by neutrophils, NK cells, and circulating proteins such as complement components and anti-microbial peptides. However, in patients with localized or systemic immunological defects, granulomatous cutaneous infection of dermatophytes mostly caused by trichophytic fungi may occur [1]. Trichophytic granuloma includes Majocchi's granuloma [2] and disseminated trichophytic granuloma [3]. Recently, we experienced a patient with trichophytic granuloma and tinea universalis caused by trichophyton (T.) rubrum infection during treatment with corticosteroid for systemic lupus erythematosus (SLE). We describe the clinical details of this patient, focusing on his immunological defects which led to the persistence of the fungal infection.
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8/112. Penile dermatophytosis.

    Dermatophyte infections of the penis and scrotum are relatively rare compared with those involving the groin. Four cases of penile tinea due to trichophyton rubrum are described. All patients had associated foci of fungal infection, but only one had crural involvement. Treatment with oral antifungal agents led to complete resolution of penile dermatophytosis.
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9/112. Deep dermatophytosis: report of 2 cases and review of the literature.

    skin infections due to dermatophytes are common and generally associated with a low degree of morbidity in normal hosts. Rare cases have been reported in which the dermatophyte invaded the deep dermis, subcutis, or even internal organs. Two patients, each of whom had clinical and histological findings of a deep or locally invasive dermatophyte infection, are described. This condition typically presents as a nodular eruption that is characterized histologically by suppurative granulomatous inflammation and deposition of organisms in the reticular dermis. Recognition of the potential of dermatophytes for local invasion in susceptible hosts will help ensure proper diagnosis and timely intervention in these cases.
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10/112. Terbinafine treatment of trichophyton equinum infection in a child.

    A case of tinea faciae caused by trichophyton equinum affecting a 5-year-old boy is described. The boy had ridden a pony a month earlier and responded to a 6-week course of treatment with oral and topical terbinafine.
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