Myeloperoxidase deficiency manifesting as pustular candidal dermatitis

Myeloperoxidase deficiency is the most common neutrophilic lysosomal enzyme deficiency. Case studies indicate that individuals with myeloperoxidase deficiency are not susceptible to serious infection in the absence of coexisting conditions such as diabetes mellitus. We present a case of myeloperoxidase deficiency manifesting as disseminated pustular candidal dermatitis in a nondiabetic male. Ceftriaxone therapy was administered to the patient for 8 days after he received a closed head injury and before the development of fever and pustular dermatitis. Candida albicans was isolated from the skin lesion. His neutrophils demonstrated a qualitative lack of myeloperoxidase. Patients who develop rapidly disseminated fungal dermatitis while they are receiving antimicrobial therapy that is relatively limited in coverage should be evaluated for myeloperoxidase deficiency.