A case of Majocchi's granuloma (MG) and onychomycosis caused by Trichophyton rubrum in a renal transplant recipient

Abstract

Abstract:

We report a case of Majocchi's granuloma (MG) and onychomycosis caused by Trichophyton rubrum in a renal transplant recipient. The 73-year-old female patient had undergone left renal transplantation six years earlier for uremia and had been immunosuppressed with low daily doses of tacrolimus and azathioprine. While under this treatment, she presented with a one-month history of painful blue-red papules and nodules on an erythematous base on her left leg and both feet. She also had onychomycosis on toenails for ten years, which worsened post transplantation. We performed physical, pathological and mycological examination. The clinical diagnosis concluded that the disease was MG, onychomycosis and tinea pedis caused by Trichophyton rubrum. Further investigation demonstrated that the three strains isolated from the deep and superficial areas were identical. Oral intake of terbinafine tablets (500 mg/d) and topical application of terbinafine cream for 12 wks completely cured the lesions in the skin and nails.

Key words: Trichophyton rubrum, Majocchi's granuloma, kidney transplantation, terbinafine

CLC Number:

R756

HU Xiao-ping, GAO Lu-juan, YOU Li-ping, LI Ruo-yu. A case of Majocchi's granuloma (MG) and onychomycosis caused by Trichophyton rubrum in a renal transplant recipient[J]. Chinese Journal of Mycology, 2018, 13(4): 241-243.

References

[1] Ma L, Li R, Yu J,et al. Majocchi's granuloma in a liver transplant recipient caused by a Trichophyton spp., phenotypically consistent with Trichophyton rubrum var.raubitschekii[J].MedMycol, 2009, 47(3): 312-316.
[2] Jackson CJ, Barton RC, Kelly SL, et al. Strain identification of Trichophyton rubrum by specific amplification of subrepeat elements in the ribosomal DNA nontranscribed spacer[J].J ClinMicrobiol, 2000, 38(12):4527-4534.
[3] Gupta AK, Prussick R, Sibbald RG, et al. Terbinafine in the treatment of Majocchi'sgranuloma[J]. Int J Dermatol, 1995, 34(7): 489.
[4] Smith KJ,Welsh M,Skelton H.Trichophyton rubrum showing deep dermal invasion directly from the epidermis in immunosuppressed patients[J].Br J Dermatol, 2001, 145(2):344-348.
[5] Burg M,Jaekel D,Kiss E,et al.Majocchi'sgranuloma after kidney transplantation[J].ExpClin Transplant, 2006, 4(2):518-520.
[6] Mahajan R, Dogra S, De D, et al. Multiple nodules on the forearms[J]. ClinExpDermatol, 2010, 35(8): 929-930.
[7] 尹斌, 曹泸丹, 王倩,等. 下肢深静脉血栓形成继发溃疡性皮肤曲霉菌病1例[J]. 中国真菌学杂志, 2009, 4(1): 35-38.
[8] 季福玲, 刘素琴, 余德厚,等. 伴有传染性软疣样皮损的儿童播散性隐球菌病一例[J]. 中华皮肤科杂志, 2006, 8(3): 485.
[9] 李彩霞, 蔡晴, 葛一平,等. 真菌性肉芽肿的诊断与治疗[J]. 中华皮肤科杂志, 2011,44(8): 608-610.
[10] Rezaei-Matehkolaei A, Mirhendi H, Makimura K, et al. Nucleotide sequence analysis of beta tubulin gene in a wide range of dermatophytes[J]. Med Mycol, 2014,52(7):674-688.
[11] Kwon KS,Jang HS,Son HS,et a1.Widespread and invasive Trichophyton rubrum infection mimicking Kaposi's sarcoma in a patient with AIDS[J].J Dermatol, 2004, 31(10):839-843.
[12] 弓娟琴, 刘训荃, 曾学思,等.播散性红色毛癣菌肉芽肿一例[J]. 国际皮肤性病学杂志, 2006, 32(6):340-342.

[1]	ZHU Hong-mei, WEN Hai. Clinical application of terbinafine in the treatment of subcutaneous and deep mycosis [J]. Chinese Journal of Mycology, 2020, 15(6): 374-377.
[2]	ZHU Hong-mei, WEN Hai. Clinical application of terbinafine in the treatment of superficial mycosis [J]. Chinese Journal of Mycology, 2020, 15(5): 297-303.
[3]	TAN Jing-wen, XU Hong, SONG Jin-feng, GAO Zhi-qin, YANG Hong, YANG Lian-juan, WEN Hai. In vitro antifungal susceptibility of polyhexamethylene biguanide against common superficial fungal species [J]. Chinese Journal of Mycology, 2020, 15(2): 93-96.
[4]	XING Zhao-jing, CAI Hong, LIU Wei. The role of oxidative stress in the treatment of onychomycosis with the 1064-nm long pulse Nd: YAG laser [J]. Chinese Journal of Mycology, 2020, 15(2): 106-110.
[5]	XIONG Ying, CHEN Ting, CHAI Bao, ZENG Fei-peng, SUN Wen-wen, WU Bo. In vitro evaluation of inhibitory effect and mechanism of various lasers on Trichophyton rubrum under different energies [J]. Chinese Journal of Mycology, 2019, 14(5): 292-296.
[6]	ZHAOYing, LI Li, CHEN Lian-jun, ZHU Jun-hao, ZHANG Qiang-qiang. Majocchi's granuloma due to autoinoculation of Trichophyton rubrum and review of literature [J]. Chinese Journal of Mycology, 2019, 14(4): 210-216.
[7]	WU Qiong, QIAN Cheng-feng, GAO Zhi-qin, JU Qiang, YANG Lian-juan, CAI Qing. A case of Majocchi granuloma misdiagnosed as cutaneous metastasis clinically [J]. Chinese Journal of Mycology, 2018, 13(6): 357-360.
[8]	WU Yan, KONG Jian, YUAN Hai-long, ZHANG Fu-cheng. Histopathological observation of terbinafine hydrochloride gel against dermatophytes infection [J]. Chinese Journal of Mycology, 2017, 12(5): 283-287.
[9]	WEI Guan-jing, LIANG Ling, CAO Cun-wei, ZHENG Dong-yan, LIN Bing. Analysis of superficial mycosis and pathogensin 10 042 cases [J]. Chinese Journal of Mycology, 2017, 12(1): 23-28.
[10]	LEI Wen-zhi, DU Lin, WEI Feng-lian, LIAO Wan-qing, WEN Hai. A randomized,double-blind,controlled study with luliconazle cream (1%) versus terbinafine cream (1%) in patients with tinea cruris [J]. Chinese Journal of Mycology, 2017, 12(1): 38-41.
[11]	ZHU Min, SU Hui-lin, LI Li, CHENG Ben-lin, ZHU Jun-hao, ZHANG Qiang-qiang. Evaluation of efficacy and safety of 1% luliconazole cream in the treatment of tinea corporis and tinea cruris [J]. Chinese Journal of Mycology, 2017, 12(1): 42-44.
[12]	CHENG Ben-lin, ZHU Min. Research progress on genotyping technology for Trichophyton rubrum [J]. Chinese Journal of Mycology, 2017, 12(1): 62-64,48.
[13]	YAN Wen-liang, HU Wen-xing, LIU Fang, LIU Hai-bo, KONG Qing-tao, ZHANG Min, SHEN Yong-nian, LV Gui-xia, SANG Hong. First successful treatment of refractory facial Majocchi granuloma with voriconazole and literature reviewed [J]. Chinese Journal of Mycology, 2016, 11(5): 265-268.
[14]	GAO Fei, CAO Ping. Study of 1% luliconazole cream and 1% terbinafine cream in the treatment of tinea pedis:a randomized controlled,single-blind trial [J]. Chinese Journal of Mycology, 2016, 11(5): 304-306.
[15]	ZHANG Jing, CAI Wen-ying, XIAO Xing, MA Jian-chi, XI Li-yan. Evaluation of efficacy and safety of 1% luliconazole cream in the treatment of tinea pedis [J]. Chinese Journal of Mycology, 2016, 11(1): 48-50.