Clinical and mycological study of 42 cases of dermatophytic granuloma (Majocchi granuloma)

Abstract

Dermatophytes are keratinophilic fungi, which cause superficial mycoses that often remain limited to the stratum corneum. Local or general immunosuppressed environments predispose to deep tissue invasion and development of diseases such as Majocchi granuloma, dermatophytic granuloma (DG), deep dermatophytosis, disseminated dermatophytosis (Hadida's disease) and pseudomycetoma [1][2][3].Dermatophytic granuloma, also known as granulomatous nodular perifolliculitis, is the most frequent manifestation of dermatophyte invasion [1,4]. It has been associated with underlying diseases, e.g. type 2 diabetes or diseases in immunosuppressed patients, although immunocompetent cases have also been reported [2]. The infection affects the dermis or deeper tissues, and a biopsy is essential to confirm the diagnosis [2]. In recent years, DG cases have been reported relatively frequently, probably due to the increased incidence of predisposing factors (type 2 diabetes, hematologic diseases, and chronic use of topical or systemic corticosteroids) [3,5,6].We performed a retrospective study of 42 cases of DG from a period of 27 years in our dermatology department. The cases were confirmed by mycological tests (direct examination and culture). Cultures were carried out in Sabouraud dextrose agar media with and without antibiotics. The dermatophytes were subsequently identified according to their macro-and microscopic characteristics; all patients underwent a trichophyton skin test. Few cases required molecular identification such as ITS-based PCR or DNA sequencing. A biopsy and staining with hematoxylin/eosin (HE) and periodic acid-Schiff (PAS) staining was performed in all cases [7,8].Demographic and clinical data are shown in Table 1. The average age of the patients was 32 years. The frequency was higher in women (64 %), although previous studies found a higher frequency among men (61-71 %) [1,3,5,7,9]. The elapsed time from clinical symptoms to diagnosis was 4.3 months; according to the literature, a long disease evolution is reported in most cases of DG. The histopathological classifications were: suppurative granuloma 35 (83.3 %), tuberculoid granuloma 2 (4.7 %) and mixed granuloma

Majocchi's granuloma—A multicenter retrospective cohort study

“…In 2018, a comprehensive review of published cases of MG from 1883 to 2017 revealed a total of 112 reported cases worldwide. 1 Since then, <20 additional cases have been reported in addition to 2 centers describing their cases of MG. 6 , 15 To date, our study is the single largest cohort of patients with MG in the literature.…”