engleski

Unrecognised dermatophyte infection in a patient with CREST Syndrome

Introduction: Tinea incognita is an initially unrecognized dermatophyte infection, usually modified by the inappropriate topical or systemic corticosteroid therapy. We report case of an extensive tinea incognita caused by zoophylic dermatophyte Trichophyton mentagrophytes (var. granulosa) in a patient with CREST syndrome. Materials and Methods: Forty-nine-year-old female patient has been referred to our Department due to the extensive erythematous, not well demarcated lesions on the trunk, neck and arms. Ichtyosiform scales and excoriations were observed, as well. Prior to this visit, the lesions had been unsuccessfully treated with topical betamethasone cream. Very intensive pruritus urged the patient to visit dermatologist. Fifteen years before, the patient was diagnosed with CREST syndrome, with biliary cirrhosis and had been continuously receiving systemic steroids, 10 mg of prednisone daily. The physical examination revealed also sclerodactyly and calcinosis of the fingers, with yellowish discoloration of the nails. Numerous teleangiectasias were spread over the face, neck, upper trunk and even lips. Results: Direct microscopic potassium hydroxide examination of the skin scrapings was positive revealing fungal hyphae and Trichophyton mentagrophytes (var. granulosa) was confirmed by culture on the Sabouraud medium. Direct examination and fungal culture of the nails were negative. The topical treatment with terbinafine cream was initiated. Systemic antimycotic therapy was not administered because of the very good response on the topical therapy and because of high level of liver enzymes, as well. After the four weeks of treatment, a complete clinical and mycological regression was observed. Conclusion: Immunocompromized patients are susceptible to dermatophyte infections with atypical clinical presentation. Therefore, close monitoring and mycological skin examination is recommended in order to avoid misdiagnosis and to give the patient the best chance of cure.

Tinea incognita ; CREST Syndrome

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