A Case of Disseminated Trichophytosis With Vascular Invasion and Multiple Ulcers: Case Report and Literature Review

Trichophyton rubrum is a well-known causative agent of superficial dermatophytosis that is typically confined to the stratum corneum. However, in rare cases, it can infiltrate the dermis and cause disseminated dermatophytosis, particularly in immunocompromised patients. Here, we report a case of disseminated trichophytosis with vascular invasion that led to the dissemination of the pathogen to distant skin sites. A 51-year-old Japanese woman with a history of tinea corporis three years earlier and systemic lupus erythematosus, treated with long-term methylprednisolone, developed multiple subcutaneous nodules, abscesses, and ulcers in both lower extremities. Histopathological examination revealed extensive necrosis in the dermis and subcutaneous tissue, with clusters of filamentous fungi exhibiting asymmetric branching infiltrating both within and outside the vascular walls. Culture and genetic analyses identified Trichophyton rubrum, leading to the diagnosis of disseminated trichophytosis. Invasive aspergillosis was initially suspected, and the patient was treated with voriconazole; however, the treatment proved ineffective. Ultimately, the patient succumbed to gastrointestinal hemorrhage due to malignant lymphoma. Here, we present a case report and literature review of disseminated trichophytosis.