A Case of Granuloma Trichophyticum (Majocchi) Mimicking Leontiasis in Clinical Appearance

Abstract

We report here a case of a healthy 91-year-old woman who presented with papules and erythema accompanied by itching on the face, which began six months ago. We treated her as contact dermatitis, but she stopped consultation. Upon reexamination two months later, several nodules and subcutaneous tumors were present on her forehead, nose and mandible. Several pustules were also on the top of her head. A biopsy specimen showed an infectious granuloma. Hyphae could be seen within the dermis when stained with Grocott's methenamine silver and periodic acid Schiff (PAS) stains. Trichophyton rubrum was identified by the culture of mandible skin. The hyphae could also be seen in the abscess of the head. Tinea was noted in the toenails and fingernails, but the Trichophyton reaction was negative. The patient improved quickly with oral intake of the antimycotic medicine, griseofulvin. The cause of the disease was supposed to be the application of a very strong class steroid ointment for about 2 months which was prescribed by her physician.