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Clobetasol/teriflunomide Invasive dermatophytosis secondary to Trichophyton rubrum: case report A 55-year-old woman developed invasive dermatophytosis secondary to Trichophyton rubrum following immunosuppressive treatment with teriflunomide and its subsequent exacerbation during clobetasol treatment. The woman, who had a history of multiple sclerosis and onychomycosis, presented for assessment of the lesions which were thought to be vasculitis. She had itchy and scaly sores on her lower right leg for 1 year. Her lesions had aggravated during treatment with clobetasol [clobetasol propionate; dosage and route not stated] under zinc oxide [zinkoxide] bandage. Further investigations revealed that, she had been treated with immunosuppressive therapy of teriflunomide [teriflunomid; dosage and route not stated] for multiple sclerosis for two years. Her physical examination showed scaly erythematous/violaceous skin with sharply demarcated lesions mainly on the right foot and on anterior side of the lower right leg. Ulcers of less than one centimetre diameter depth were also seen. Dermatophytosis was suspected considering erythematous scaling border of the lesions. A direct and fluorescence microscopy revealed numerous hyphae. She underwent a skin scraping for further mycological examination. The woman started receiving oral and topical terbinafine for treatment of tinea which was attributed to clobetasol and teriflunomide treatments. Her laboratory findings showed Trichophyton rubrum growth confirming the diagnosis of dermatophytosis. After 30 days of the treatment, an examination showed improvement with no growth of T. rubrum. Author comment: "The patient was started on a combination of oral terbinafine 250 mg daily combined with topically terbinafine (day0) for the treatment [for] tinea incognito due to the usage of [teriflunomide] and [clobetasol]." "The lesions were exacerbated during treatment with [clobetasol] under [zinc oxide] bandage. The patient had been treated with the immunosuppressive drug [teriflunomide] for multiple sclerosis for two years." Bouazzi D, et al. Invasive dermatophytosis mimicking vasculitis. Medical Mycology Case Reports 26: 67-68, Dec 2019. Available from: URL: http:// 803438372 doi.org/10.1016/j.mmcr.2019.10.008 - Denmark

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Reactions 7 Dec 2019 No. 1782