A case of generalized granuloma trichophyticum

A 59-year-old man visited our hospital. The patient had suffered from generalized tinea superficialis for thirty years, had been treated with several topical antifungal preparations and was administered griseofulvin at another hospital. Clinical manifestations were as follows: There were large pigmentations on the chest, abdomen, and lower extremities. He had several irregular shaped ulcers on the back, left forearm, and right axilla, and glossy granular lesions on the dorsum of the left foot. Generalized eruptions consisting of indurative pustules, red papules, scars, atrophies and depigmentations were also visible. The biopsy specimens taken from the ulcers, the indurative pustules and granular lesions of the dorsum of the left foot were cultured and Trichophyton rubrum was isolated. Laboratory studies showed slight eosinophilia, Mantoux reaction 56 X 40 mm, Trichophytin reaction 5 X 5 mm, IgE 4000 IU/dl. Histological findings were as follows: Fungal elements were observed in the horny layer, in the spindle cell layer, and in the dermis. Histologic features were both abscesses and granulomas with giant cells. According to the pathologic features of the lesions, the parasitic forms of the fungus changed. Abscesses and granulation tissues containing histiocytes and many multinucleated giant cells were observed in the dermis. Various sizes of arthrospores and various shapes of hyphae were stained by PAS. Most of these fungal elements dissolved in the abscesses and granulomas. However, a few survived.