Recurrent Dermatophytosis (Majocchi granuloma) Associated With Chemotherapy-Induced Neutropenia

Lourdes, Laura S.; Mitchell, Christina L.; Glavin, Frederick L.; Schain, Denise C.; Kaye, Frederic J.

doi:10.1200/jco.2012.47.3330

Cited by 11 publications

(7 citation statements)

References 8 publications

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“…Some published cases were compatible with deep or extensive dermatophytosis but lacked mycological confirmation [ 31 , 93 , 94 ]. In other published cases, there was no identified predisposing condition [ 28 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 , 104 , 105 , 106 , 107 , 108 , 109 , 110 ].…”

Section: Underlying Conditions Responsible For Severe Dermatophytsmentioning

confidence: 99%

Severe Dermatophytosis and Acquired or Innate Immunodeficiency: A Review

Rouzaud

Hay

Chosidow

et al. 2015

JoF

108

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Dermatophytes are keratinophilic fungi responsible for benign and common forms of infection worldwide. However, they can lead to rare and severe diseases in immunocompromised patients. Severe forms include extensive and/or invasive dermatophytosis, i.e., deep dermatophytosis and Majocchi’s granuloma. They are reported in immunocompromised hosts with primary (autosomal recessive CARD9 deficiency) or acquired (solid organ transplantation, autoimmune diseases requiring immunosuppressive treatments, HIV infection) immunodeficiencies. The clinical manifestations of the infection are not specific. Lymph node and organ involvement may also occur. Diagnosis requires both mycological and histological findings. There is no consensus on treatment. Systemic antifungal agents such as terbinafine and azoles (itraconazole or posaconazole) are effective. However, long-term outcome and treatment management depend on the site and extent of the infection and the nature of the underlying immunodeficiency.

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Section: Underlying Conditions Responsible For Severe Dermatophytsmentioning

confidence: 99%

Severe Dermatophytosis and Acquired or Innate Immunodeficiency: A Review

Rouzaud

Hay

Chosidow

et al. 2015

JoF

108

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“…El tratamiento debe ser con antimicóticos sistémicos, ya que los medicamentos tó-picos son ineficaces por la localización profunda de la infección (6,18). Existen opciones terapéuticas como el itraconazol en dosis de 200 mg/día por 20 a 30 días o dos pulsos de 200 mg dos veces al día durante una semana con dos semanas de intervalo entre ambos pulsos; también pueden emplearse ketoconazol, en dosis de 200 mg/día por 30 a 90 días o la terbinafina oral a dosis de 250-500 mg/día por 30 días, que, por las altas concentraciones que alcanza en el sebo, folículo piloso y estrato córneo, es una opción apropiada de tratamiento (24)(25)(26).…”

Section: Discussionunclassified

Granuloma de Majocchi: una forma de infección dermatofítica invasiva

R.¹,

Sañudo²,

Calle³

et al. 2017

CES Med.

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Comparte ResumenEl granuloma de Majocchi es una forma de infección atípica por dermatofitos con invasión de la dermis y el tejido celular subcutáneo, favorecida por el trauma de los folículos pilosos o la inmunosupresión del huésped. Siendo una infección poco común, se destaca en este artículo el caso de una paciente que luego de usar esteroides tópicos presentó pápulas y pústulas en vulva, sitio inusual de granuloma de Majocchi, siendo este el cuarto reporte a nivel mundial.Palabras clave: Granuloma, Dermatofitos, Foliculitis, Majochi. AbstractMajocchi granuloma is a form of atypical infection by dermatophytes with invasion of the dermis and subcutaneous tissue, favored by the trauma of hair follicles or host immunosuppression. Being a rare infection, in this article highlights the case of a patient with papules and pustules on the vulva after using topical steroids, an unusual site Majocchi granuloma, which is the fourth global report.Keywords: Granuloma, Dermatophytes, Folliculitis, Majochi. IntroducciónLos dermatofitos comprenden tres géneros: Epidermophyton, Trichophyton y Microsporum. Son queratinofílicos en humanos y animales y están usualmente restringidos a capas cornificadas de la epidermis, sin invadir más allá de ella (1). En un huésped inmunocompetente son incapaces de penetrar tejidos viables, pero bajo condiciones de inmunosupresión adquieren la habilidad de invadir la dermis y diseminarse a nivel sistémico. Existen cuatro formas de infecciones invasivas de dermatofitos: el granuloma de Majocchi, la dermatofitosis profunda, la diseminada, y el micetoma o pseudomicetoma por dermatofitos (2). Caso clínicoSe trataba de una paciente de 14 años quien consultó a un hospital local por un cuadro de un mes de evolución que consistía en pápulas eritematosas, vesículas y pústulas en la piel del abdomen, del cual se hizo un diagnóstico inicial de eccema y se ordenaron esteroides tópicos. Posteriormente, las lesiones se extendieron hacia la vulva y región inguinal izquierda, por lo que fue remitida a un hospital de la ciudad.

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“… 8 Both immunocompetent and immunocompromised patients may develop Majocchi's granuloma with different clinical presentations (Table 1 ). 5 , 6 , 8 – 10 In immunocompetent patients, trauma such as scratching or leg shaving, and local immunosuppression such as topical steroid use are predisposing factors to Majocchi's granuloma. Topical steroids, which are potent inhibitors of T-lymphocyte proliferation that modify the functions of epidermal/dermal cells and leukocytes, are well-known agents that increase the risk of dermatophyte infection.…”

Section: Discussionmentioning

confidence: 99%

“…Dermatophytosis may respond slowly to therapy at first and have a tendency to relapse. 8 Cryotherapy can be considered in refractory cases. 5 …”

Section: Discussionmentioning

confidence: 99%

A Case Report of Majocchi's Granuloma Associated with Combined Therapy of Topical Steroids and Adalimumab

Chou

Hsu

2016

Medicine

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Currently, tumor necrosis factor alpha (TNF-alpha) inhibitors are widely used for many autoimmune disorders. However, they cause an immunocompromised status that sometimes leads to many cutaneous side effects including atypical infections. Herein, we report the first case of adalimumab-related Majocchi's granuloma.A 43-year-old Taiwanese male patient with chronic plaque-type psoriasis developed numerous tender nodules 1 month after adalimumab injection. The nodules responded poorly to bacterial folliculitis treatment. After repeated skin biopsies for pathology and tissue fungal culture, Majocchi's granuloma was confirmed. Adalimumab was withheld, and 12 weeks of terbinafine treatment was given. On completion of treatment, the nodular skin lesions and dystrophic nail lesions improved dramatically.The information, including time span, clinical features, histological findings, and improvement following withdrawal of adalimumab and treatment with an oral antifungal agent, indicates that Majocchi's granuloma was adalimumab-related. Psoriasis patients are more susceptible to dermatophyte infection due to local and systemic immunosuppressant therapy. It is important to perform a thorough examination for latent dermatophyte infection, including skin and nail lesions, before treatment with TNF-alpha inhibitors and during traditional psoriasis treatment. When atypical presentation together with treatment failure is noted in psoriasis patients prescribed biologics, clinicians should investigate evidence of dermatophyte infection and provide proper treatment. Sometimes, multiple skin biopsies and tissue fungal cultures are required to establish a correct diagnosis.

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Recurrent Dermatophytosis (Majocchi granuloma) Associated With Chemotherapy-Induced Neutropenia

Cited by 11 publications

References 8 publications

Severe Dermatophytosis and Acquired or Innate Immunodeficiency: A Review

Severe Dermatophytosis and Acquired or Innate Immunodeficiency: A Review

Granuloma de Majocchi: una forma de infección dermatofítica invasiva

A Case Report of Majocchi's Granuloma Associated with Combined Therapy of Topical Steroids and Adalimumab

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