Invasive dermatophytosis with lymph node involvement in an immunocompetent patient

Area of Science:

• Dermatology
• Mycology
• Infectious Diseases

Background:

• Chronic, progressive skin lesions can indicate deep fungal infections.
• Trichophyton verrucosum is a zoophilic dermatophyte typically causing tinea capitis or tinea corporis, but extensive cutaneous and lymph node involvement is rare.

Observation:

• A 23-year-old male presented with a 5-year history of itchy, scaly, hyperpigmented plaques, progressing to verrucous papules and nodules.
• The patient also exhibited nontender inguinal and axillary lymphadenopathy.
• Skin and lymph node biopsies revealed granulomatous inflammation with fungal hyphae.

Findings:

• Tissue cultures confirmed the presence of Trichophyton verrucosum.
• The patient was treated with oral itraconazole (100 mg twice daily) for 8 months.
• Complete resolution of skin lesions and lymphadenopathy was achieved.

Implications:

• This case highlights the potential for extensive and persistent dermatophytosis caused by Trichophyton verrucosum in immunocompetent individuals.
• It underscores the efficacy of systemic antifungal therapy, specifically itraconazole, in managing severe and chronic cases.
• Early and accurate diagnosis through biopsy and culture is crucial for effective treatment of recalcitrant fungal infections.