Vol 50, No 3 (2012)
Original paper
Published online: 2012-10-08
Trichophyton mentagrophytes-associated Majocchi’s granuloma treated with cryotherapy
DOI: 10.5603/FHC.2012.0068
Folia Histochem Cytobiol 2012;50(3):486-489.
Abstract
We here report the case of a woman with dermatophytosis of the thighs due to Trichophyton mentagrophytes
where an unusual clinical picture posed considerable diagnostic and therapeutic problems. She presented numerous
skin lesions located on the dorsolateral face of the left thigh and the medial surface of the right calf. The initial lesions
consisted of small itchy pustules that evolved to exfoliation after scratching. Results of histopathologic examination of
a skin biopsy were consistent with dermatophytosis, although the negativity of PAS staining did not allow confirmation
of this diagnosis. Direct microscopic examination with 10% KOH was negative; however, skin cultures on BioMerieux
media revealed Tr. Mentagrophytes. Following the diagnosis of Trichophyton infection, the patient was treated with
a combination of isoconazole nitrate and difluocortolone valerate. After therapy, both direct microscopic mycologic
examination and culture on BioMerieux medium were negative; however, the lesions persisted, assuming a completely
different aspect. Cryotherapy with liquid nitrogen was started. This led to a spectacular improvement: the surface of
the skin became almost normal, merely showing slight discoloration. An unusual clinical presentation and non-responsiveness
to treatment should prompt revision of the primary diagnosis. A negative result of direct microscopy
should not exclude the diagnosis of dermatophytosis. Cryotherapy should be considered in cases that do not respond
to conventional antifungal medication.
where an unusual clinical picture posed considerable diagnostic and therapeutic problems. She presented numerous
skin lesions located on the dorsolateral face of the left thigh and the medial surface of the right calf. The initial lesions
consisted of small itchy pustules that evolved to exfoliation after scratching. Results of histopathologic examination of
a skin biopsy were consistent with dermatophytosis, although the negativity of PAS staining did not allow confirmation
of this diagnosis. Direct microscopic examination with 10% KOH was negative; however, skin cultures on BioMerieux
media revealed Tr. Mentagrophytes. Following the diagnosis of Trichophyton infection, the patient was treated with
a combination of isoconazole nitrate and difluocortolone valerate. After therapy, both direct microscopic mycologic
examination and culture on BioMerieux medium were negative; however, the lesions persisted, assuming a completely
different aspect. Cryotherapy with liquid nitrogen was started. This led to a spectacular improvement: the surface of
the skin became almost normal, merely showing slight discoloration. An unusual clinical presentation and non-responsiveness
to treatment should prompt revision of the primary diagnosis. A negative result of direct microscopy
should not exclude the diagnosis of dermatophytosis. Cryotherapy should be considered in cases that do not respond
to conventional antifungal medication.
