Thread by @MayoClinicINFD

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...

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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?

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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

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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

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#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/pmc/articles/P…

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#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/pmc/articles/P…

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#Majocchi granuloma in transplant
- Indolent course: nodules, papules, plaques, pustules, abscess
- Lower extremity most common; dissemination rare
- Preexisting tinea common
- T. rubrum most common pathogen
- Systemic Rx: terbinafine, Itraconazole

doi.org/10.1111/j.1399…

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#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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#Majocchi granuloma #Pearls
1. Fungal infection of dermis and subQ; most common T. rubrum and other dermatophytes
2. Competent and compromised hosts
3. Localized mostly to lower extremity; rare dissemination
4. Dx: pathology and culture
5. Rx: Oral antifungal Rx recommended