Trichophyton mentagrophytes granulomas. Unique systemic dissemination to lymph nodes, testes, vertebrae, and brain

A man had Trichophyton mentagrophytes infection that ultimately involved the lymph nodes, testes, vertebrae, and CNS. It was associated with anergy and defective lymphocyte transformation to T mentagrophytes antigen. The patient was also anergic to repeated delayed skin testing with PPD and dinitrochlorobenzene. His lymphocyte responsiveness, as demonstrated by lymphocyte transformation to phytohemagglutinin and PPD, was substantially decreased. However, the results of an in vitro leukocyte migration inhibition assay showed that his lymphocytes were responsive to T mentagrophytes antigen as well as to PPD. The patient's serum IgE level was increased, but serum transferrin levels were persistently abnormal. Therapeutic attempts, including the systemic administration of griseofulvin, amphotericin B, clotrimazole, and transfer factor failed, and the patient died five years after systemic disease onset.