Dexamethasone-induced flares of Trichophyton rubrum masquerading as docetaxel cutaneous toxicity: a case report

Abstract

Docetaxel chemotherapy is increasingly used in the treatment of castration-resistant prostate cancer. Cutaneous toxicity is common with docetaxel, occurring in up to 75% of cases. We present an unusual case of castration-resistant prostate cancer in which our patient developed recurrent but transient episodes of skin rash following each cycle of docetaxel. Initially, the rash was attributed to docetaxel cutaneous toxicity however a microbiological diagnosis of Trichophyton rubrum was subsequently made. We postulated that dexamethasone pre-medication transiently suppressed anti-fungal immunity, and indeed further flares were prevented by significantly reducing the dose of dexamethasone while continuing treatment with docetaxel.

Majocchi’s granuloma: current perspectives

“…Therefore, therapeutic immunosuppression causes lower cellular immunity and ingestion/killing rate of fungal spores. 31 …”

Tinea hidden by a vemurafenib‐induced phototoxic reaction in a patient with metastatic melanoma taking dexamethasone

“…3 Glucocorticoids affect cell-mediated immunity, impairing the function of macrophages and neutrophils, and reducing T helper 1-mediated immunity, which plays an important role in the complete resolution of fungal infections. 4 BRAF inhibitors, such as vemurafenib, are novel drugs that target an important mutation that is present in about 50% of metastatic melanomas. They have secondary effects on skin, such as development of multiple cutaneous squamous cell carcinomas, verrucal keratoses and a variable degree of photosensitivity.…”