engleski

Kerion celsi due to Microsporum canis with dermatophytide reaction

INTRODUCTION & OBJECTIVES: Fungal scalp infections caused by Microsporum (M.) canis tend to be noninflammatory, but recently, progressive numbers of cases of tinea capitis characterized with highly inflammatory infection caused by M. canis and M. gypseum, have been registered. We present case of highly inflammatory tinea capitis, also known as kerion celsi with dermatophytide reaction caused by M. canis. MATERIAL & METHODS: A 6-year-old, otherwise healthy girl, with tender, infiltrated, 6x4 cm large plaque in the occipital region of the scalp, of 2.5 months duration has been examined. Almost complete loss of hair, a few satellite plaques with pustules on the surface, and exudation from some of the follicular orifices could be observed. Multiple annular lesions spread over the neck and shoulders. In addition, papular exanthema of the trunk and bilateral cervical lymphadenopathy were present. The patient was in a good condition, and routine investigations were all within the normal limits. Fungal culture on modified Sabouraud dextrose agar medium, revealed flat, white to creamy colonies with cottony surface and golden brownish-yellow reversed pigment. Diagnosis of kerion due to M. canis was established. M. canis has been confirmed in the isolate by the use of the molecular methods (PCR-RFLP), as well. Thus, ITS1 and ITS4 universal primers were used to amplify ITS1-5.8s rDNA-ITS2 region. By the RFLP analysis of the PCR product of the isolated strain and reference strain of M. canis ATCC 36299, using Hinf1 restriction enzyme a unique pattern for M. canis has been revealed. Mycological examination of the papular lesions of the trunk was negative, so these lesions were considered as dermatophytide reaction. The treatment with oral terbinafine 125 mg/day had been prescribed together with topical gyrodalate ointment and triamcinolone acetonide cream followed with miconazole cream. Systemic prednisolone, 10 mg/day for 7 days has been also administered in order to relive symptoms of “ide” reaction and to prevent scarring. After 12 weeks of therapy, complete clinical and mycological regression was observed. CONCLUSIONS: Changes in epidemiology and clinical pattern of fungal infections due to M. canis have become significant in the recent years. M. canis, thus not only Trichophyton spp. as previously reported can also be responsible for kerion and dermatophytide reactions. Greater awareness is needed in order to establish proper diagnosis and successful treatment strategy for those patients.

Kerion Celsi ; dermatophytide reaction, Microsporum canis

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