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[Universal dermatophytosis (tinea incognito) caused by Trichophyton rubrum]
G Agostini1, B Knöpfel, E M Difonzo
1Istituto di Clinica Dermosifilopatica, Università di Firenze, Italien.
Abstract:
An 84-year-old male presented with a dermatophyte infection that had spread over nearly the entire body surface. The first signs had developed 48 years before. After treatment with galenic and corticosteroid preparations for diagnoses of "eczema" and "psoriasis", the lesions gradually extended over the body and to the nails. The cutaneous symptoms had worsened in recent year after the patient had started systemic cortisone treatment for bronchial asthma. He also developed diabetes mellitus, papulonodular lesions on the face and limbs, thinning of his hair and eyebrows and hyperkeratosis of the soles and palms.
Insights
A chronic, widespread dermatophyte infection, initially misdiagnosed, worsened significantly after systemic cortisone treatment. This case highlights the diagnostic challenges and potential complications of prolonged, undiagnosed fungal infections.
Area of Science:
- Medical Mycology
- Dermatology
- Infectious Diseases
Background:
- A rare case of extensive, chronic dermatophytosis is presented.
- The infection persisted for 48 years, initially misdiagnosed as eczema and psoriasis.
- Treatment with topical and systemic corticosteroids exacerbated the condition.
Observation:
- The patient, an 84-year-old male, exhibited widespread fungal infection affecting skin and nails.
- Cutaneous symptoms worsened after initiating systemic cortisone for bronchial asthma.
- New-onset diabetes mellitus and other symptoms like facial papulonodular lesions, hair thinning, and palmoplantar hyperkeratosis were noted.
Findings:
- The prolonged dermatophyte infection demonstrated resistance to conventional treatments.
- Systemic corticosteroid therapy significantly aggravated the fungal infection and associated symptoms.
- The case illustrates a complex interplay between fungal infection, immune status, and iatrogenic factors.
Implications:
- This case underscores the importance of accurate and timely diagnosis of dermatophytosis.
- It highlights the potential risks of misdiagnosis and prolonged corticosteroid use in fungal infections.
- Further research into managing extensive and treatment-resistant dermatophytosis is warranted.