Invasive Trichophyton Rubrum Infection Occurring with Infliximab and Long-Term Prednisone Treatment

Background: A 64-year-old woman presented with erythematous plaques, tender nodules, and pustules of the dorsal right hand and both legs following long-term treatment with systemic steroids and infliximab. Skin biopsy demonstrated dermal inflammation with foci of necrosis and multinucleated giant ce...

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Bibliographic Details
Published in:Journal of cutaneous medicine and surgery 2007-03, Vol.11 (2), p.84-88
Main Authors: Lowther, Abigail L., Somani, Ally-Khan, Camouse, Melissa, Florentino, Frances T., Somach, Stephen C.
Format: Article
Language:English
Subjects:
Antibodies, Monoclonal - therapeutic use
Biological and medical sciences
Dermatology
Fatal Outcome
Female
Glucocorticoids - administration & dosage
Glucocorticoids - therapeutic use
Human mycoses
Humans
Immunocompromised Host
Infectious diseases
Infliximab
Medical sciences
Middle Aged
Mycoses
Mycoses of the skin
Prednisone - administration & dosage
Prednisone - therapeutic use
Tinea - etiology
Tinea - immunology
Tinea - physiopathology
Tumor Necrosis Factor-alpha - adverse effects
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Summary:Background: A 64-year-old woman presented with erythematous plaques, tender nodules, and pustules of the dorsal right hand and both legs following long-term treatment with systemic steroids and infliximab. Skin biopsy demonstrated dermal inflammation with foci of necrosis and multinucleated giant cells containing fungal spores. Tissue culture grew Trichophyton rubrum. Objective: To report a case that demonstrates the pathophysiology of invasive T. rubrum infection, the mechanisms of action and uses of tumor necrosis factor α (TNF-α)-inhibiting drugs, and how these drugs may increase patients' risk of invasive dermatophytosis. Conclusion: Dermatophytes such as T. rubrum rarely cause invasive disease. This unusual presentation of invasive T. rubrum occurred with immunosuppression by infliximab and systemic steroids. Patients should have a thorough examination for signs of latent infection before TNF-α inhibitors are prescribed, including inspection of the skin and nails for signs of dermatophytosis.
ISSN:1203-4754
1615-7109
DOI:10.2310/7750.2007.00009