Majocchi’s Granuloma in a Healthy Adult Man – a Case Report

Open access

Abstract

Majocchi’s granuloma was first described by Domenico Majocchi in 1883, as a deep chronic dermatophyte infection of hair follicles, in which dermatophytes penetrate the dermis through hair canals, forming granulomatous changes in the dermis and/or hypodermis. Majocchi’s granuloma has two different clinical variants: the first is a small perifollicular papular type, seen in otherwise healthy individuals, that occurs secondary to trauma (e.g. in women with chronic tinea pedis that extends to the legs and who shave their legs); the second is a type with deep plaques or nodular lesions in immunocompromised hosts. The diagnosis is primarily made using direct microscopy of unstained specimens and fungal cultures, while additional diagnostics (histology, PCR) are generally not necessary. It is most commonly caused by Trichophyton rubrum.

We present a 26-year-old otherwise healthy man exhibiting blue erythematous patches over the skin of his abdomen on clinical examination, which agglomerated to form slightly raised plaques with irregular ovoid contours, spreading from umbilicus to the pubic region; they were covered with multiple red-blue, erythematous partly coalescing scales, eroded, firm papules and nodules. On pressure, some nodules excreted viscid and turbid sero-purulent content. The lesions were slightly itchy. The patient was previously unsuccessfully treated during at least 4 weeks with a topical steroid cream prescribed by his physician. Direct microscopy for fungi of skin scrapings and pus mounted in potassium hydroxide was negative. Cultures of the contents and scrapings were performed on Sabouraud’s glucose agar and Trichophyton rubrum was isolated. The diagnosis of Majocchi’s granuloma was made, and the patient was treated with itraconazole (200 mg daily) for eight weeks, when all lesions resolved and fungal culture was negative.

Misapplication of topical corticosteroids over a long period, as in our case, can produce Majocchi’s granuloma. When assessing skin lesions of unusual appearance, especially if aggravated by corticosteroids, dermatologists and general practitioners should consider tinea incognito, which may appear in its invasive form of Majocchi’s granuloma. The available world literature shows that Majocchi’s granuloma presenting as tinea incognito caused by topical corticosteroids has been reported extremely rarely.

1. Radentz WH, Yanase DJ. Papular lesions in an immunocompromised patient. Arch Dermatol 1993;129:1189-90.

2. Chastain MA, Reed RJ, Pankey GA. Deep dermatophytosis: report of 2 cases and review of the literature. Cutis 2001;67:457-62.

3. Gupta S, Kumar B, Radotre BD, Rai R. Majocchi’s granuloma trichophyticum in an immunocompromised patient. Int J Dermatol 2000;39:140-1.

4. Wilson JW, Plunkett OA, Gregfersen A. Nodular granulomatous perifolliculitis of the legs caused by Trichophyton rubrum. AMA Arch Derm Syphilol 1954;69:258-77.

5. Majocchi D. Sopra una nuova tricofizia (granuloma tricofitico), studi clinici e micologici. Bull R Acad Med Roma 1883;9:220-3.

6. Yasuhara M, Fukaura H, Hashimoto T. Granuloma trichophyticum Majocchi: a case report. Skin Res 1968;10(5):643-54.

7. Bae BG, Kim HJ, Ryu DJ, Kwon YS, Lee KH. Majocchi granuloma caused by Microsporum canis as tinea incognito. Mycoses 2010;54:361–2.

8. Gill M, Sachdeva B, Gill PS, Arora B, Deep A, Karan J. Majocchi’s granuloma of the face in an immunocompetent patient. J Dermatol 2007;34:702-4.

9. Jacobs PH. Majocchi’s granuloma (due to therapy with steroid and occlusion). Cutis 1986;38:23.

10. Elgart ML. Tinea incognito: an update on Majocchi granuloma. Dermatol Clin 1996;14:51-5.

11. Lourdes LS, Mitchell CL, Glavin FL, Schain DC, Kaye FJ. Recurrent dermatophytosis (Majocchi granuloma) associated with chemotherapy-induced neutropenia. J Clin Oncol 2014;32(27):e92-4.

12. Meehan K. A growing, pruritic plaque on the thigh. Majocchi’s granuloma with secondary tinea incognito. JAAPA 2002;15:16, 65.

13. Mayser PA. Majocchi granuloma. Advantages of optical brightener staining in a case report. Hautarzt 2014;65:721–4.

14. Burg M, Jaekel D, Kiss E, Kliem V. Majocchi’s granuloma after kidney transplantation. Exp Clin Transplant 2006;4:518-20.

15. Brod C, Benedix F, Röcken M, Schaller M. Trichophytic Majocchi granuloma mimicking Kaposi sarcoma. J Dtsch Dermatol 2007;5:591-3.

16. Steiner UC, Trueb RM, Schad K, Kamarashev J, Koch S, French LE, et al. Trichophyton rubrum – induced Majocchi’s granuloma in a heart transplant recipient. A therapeutic challenge. J Dermatol Case Rep 2012;6(3):70-2.

17. Gong JQ, Liu XQ, Xu HB, Zeng XS, Chen W, Li XF. Deep dermatophytosis caused by Trichophyton rubrum: report of two cases. Mycoses 2007;50:102-8.

18. Hironaga M, Okazaki N, Saito K, Watanabe S. Trichophyton mentagrophytes granulomas. Unique systemic dissemination to lymph nodes, testes, vertebrae, and brain. Arch Dermatol 1983;119:482-90.

19. Seebacher C, Bouchara JP, Mignon B. Updates on the epidemiology of dermatophyte infections. Mychopathologia 2008;166:335-52.

20. Gupta AK, Groen K, Woestenborghs R, De Doncker P. Itraconazole pulse therapy is effective in the treatment of Majocchi’s granuloma: a clinical and pharmacokinetic evaluation and implications for possible effectiveness in tinea capitis. Clin Exp Dermatol 1998;23:103-8.

21. Elgart ML, Warren NG. The superficial and subcutaneous mycoses. In: Moschella SL, Hurley HJ, editors. Dermatology. 3rd ed. Philadelphia: WB. Saunders Company; 1992. p. 869-912.

22. Gupta AK, Prussick R, Sibbald RG, Knowles SR. Terbinafine in the treatment of Majocchi’s granuloma. Int J Dermatol 1995;34:189.

23. Bressan AL, Silva RS, Fonseca JC, Alves Mde F. Majocchi’s granuloma. An Bras Dermatol 2011;84:797-8.

Serbian Journal of Dermatology and Venereology

The Journal of Serbian Association of Dermatovenereologists (SAD)

Journal Information

Metrics

All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 66 66 27
PDF Downloads 9 9 5