[Tinea capitis profunda due to Trichophyton verrucosum with cMRSA superinfection in an infant]

Hautarzt. 2012 Aug;63(8):648-52. doi: 10.1007/s00105-012-2326-y.
[Article in German]

Abstract

A 28-month-old boy developed a cutaneous and subcutaneous lesion of the scalp together with alopecia. Treatment with sulfadiazine silver ointment and oral administration of cefaclor failed. The boy lived on a farm where cows and calves were present. He presented with a 5 cm erythematous, erosive, edematous, and sharply defined lesion with yellow crusts and circumscribed alopecia on the temporoparietal scalp. Peripheral hairs were easily epilated. Swabs from the wound revealed cMRSA (community acquired methicillin-resistant Staphylococcus aureus, Panton Valentine Leukocidin [PVL] toxin negative). There was no improvement after treatment with cefuroxime intravenously over 3 days. Therapy was changed to vancomycin and fosfomycin. Because of the purulent abscess, surgical incision was performed. PCR (polymerase chain reaction)-Elisa assay detected Trichophyton (T.) interdigitale-DNA from wound secretion and skin biopsy. Because of the clinical and molecular diagnosis of tinea capitis, oral antifungal therapy with fluconazole 5 mg kg(-1) body weight was started, along with cotrimoxazole and fosfomycin for the cMRSA. After 4 weeks incubation, the causative agent T. verrucosum was grown on culture and its identity confirmed by sequencing of the "internal transcribed spacer" (ITS) region of the ribosomal DNA. After 4 weeks of fluconazole, the lesion was nearly healed.

Publication types

  • Case Reports
  • English Abstract

MeSH terms

  • Antifungal Agents / therapeutic use
  • Child, Preschool
  • Fluconazole / therapeutic use*
  • Humans
  • Male
  • Methicillin-Resistant Staphylococcus aureus
  • Scalp Dermatoses / diagnosis*
  • Scalp Dermatoses / drug therapy*
  • Staphylococcal Skin Infections / diagnosis*
  • Staphylococcal Skin Infections / drug therapy*
  • Tinea Capitis / diagnosis*
  • Tinea Capitis / drug therapy*
  • Treatment Outcome

Substances

  • Antifungal Agents
  • Fluconazole