Images of Infectious Diseases
This is GMS stain and culture of a skin biopsy from a patient’s leg.
Who is the host? What is the syndrome? Name the pathogen. How to treat?
#MayoIDQ and case details to follow...
This is GMS stain and culture of a skin biopsy from a patient’s leg.
Who is the host? What is the syndrome? Name the pathogen. How to treat?
#MayoIDQ and case details to follow...
2/
66M. 4 mo after heart Tx: painless leg nodules that spread distally x 5 weeks. No pain. No fever.
PE unremarkable except lesions in left leg / foot + tinea pedis
Biopsy: GMS fungal elements in dermis. Culture: Trichophyton rubrum
What is true of this condition?
66M. 4 mo after heart Tx: painless leg nodules that spread distally x 5 weeks. No pain. No fever.
PE unremarkable except lesions in left leg / foot + tinea pedis
Biopsy: GMS fungal elements in dermis. Culture: Trichophyton rubrum
What is true of this condition?
3/
Case diagnosis:
#Majocchi’s Granuloma due to #Trichophyton rubrum
Histopath shows fungal elements (GMS) - not sufficient for identification.
Important: Send specimen for culture identification!!!
Treatment: Itraconazole Rx
Case diagnosis:
#Majocchi’s Granuloma due to #Trichophyton rubrum
Histopath shows fungal elements (GMS) - not sufficient for identification.
Important: Send specimen for culture identification!!!
Treatment: Itraconazole Rx
4/
What is #Majocchi granuloma?
Pathology: inflammatory / granulomatous fungal infection of the dermis / subcutaneous tissues - mainly caused by dermatophytes (>95%)
Occurs in immunocompetent and compromised hosts!
Location: mostly lower extremities but can occur anywhere
What is #Majocchi granuloma?
Pathology: inflammatory / granulomatous fungal infection of the dermis / subcutaneous tissues - mainly caused by dermatophytes (>95%)
Occurs in immunocompetent and compromised hosts!
Location: mostly lower extremities but can occur anywhere
5/
#Majocchi granuloma
Risks:
- Trauma such as shaving and scratching - most common - allows fungus invasion
- Topical steroids and conditions with immunosuppression
- Preexisting dermatophytosis
- Animal contact
ncbi.nlm.nih.gov
#Majocchi granuloma
Risks:
- Trauma such as shaving and scratching - most common - allows fungus invasion
- Topical steroids and conditions with immunosuppression
- Preexisting dermatophytosis
- Animal contact
ncbi.nlm.nih.gov
6/
#Majocchi granuloma pathogens
Dermatophytes >95%
- Most common: T. rubrum
- Others: T. mentagrophytes, T. violaceum, T. tonsurans, Microsporum, Epidermophyton
Non-dermatophytes
- Aspergillus
- Phoma
ncbi.nlm.nih.gov
#Majocchi granuloma pathogens
Dermatophytes >95%
- Most common: T. rubrum
- Others: T. mentagrophytes, T. violaceum, T. tonsurans, Microsporum, Epidermophyton
Non-dermatophytes
- Aspergillus
- Phoma
ncbi.nlm.nih.gov
8/
#Majocchi granuloma
Topical Rx - does not penetrate deeper dermis! Not recommended as sole Rx.
Systemic Rx is recommended
Options:
- Terbinafine
- Itraconazole
- Others
#Majocchi granuloma
Topical Rx - does not penetrate deeper dermis! Not recommended as sole Rx.
Systemic Rx is recommended
Options:
- Terbinafine
- Itraconazole
- Others
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