Severe Adult Kerion Celsi With Rapid Improvement During Systemic Antifungal and Adjunctive Secretome Therapy: A Case...

Kerion celsi is a severe inflammatory form of tinea capitis that is uncommon in adults and may mimic bacterial furunculosis, abscess, or cellulitis, resulting in delayed diagnosis and antibiotic-only treatment. We report a 48-year-old woman with a one-month history of a painful, purulent, crusted lesion on the left temporal and retroauricular scalp, localized alopecia, and ipsilateral periorbital edema. She reported close exposure to 10 cats daily and did not improve after treatment for presumed furunculosis. Potassium hydroxide examination demonstrated fungal elements. Fungal culture and lactophenol cotton blue morphology were consistent with Microsporum canis. Histopathology demonstrated dense suppurative follicular and perifollicular inflammation, follicular destruction, and granulomatous inflammation; fungal organisms were not identified on hematoxylin and eosin staining. The patient received oral griseofulvin, topical miconazole, structured wound care, empirical ciprofloxacin for clinically suspected secondary bacterial infection, and adjunctive intramuscular administration of a human umbilical cord-derived mesenchymal stromal cell conditioned-medium secretome preparation. Periorbital edema markedly decreased by day 2. By day 14, lesion dimensions remained approximately 8 × 5 cm, while pain and pruritus had decreased from 6/10 to 0/10 and exudation, pustulation, crusting, erythema, and scalp edema were substantially reduced. This improvement was temporally associated with the combined regimen. Because several interventions were initiated concurrently, the specific contribution of secretome could not be determined. Systemic antifungal therapy remains the cornerstone of treatment, and the safety and efficacy of secretome in active inflammatory dermatophyte infection require further study.