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CORRESPONDENCE
Year : 2020  |  Volume : 65  |  Issue : 1  |  Page : 76-78
Tinea corporis bullosa secondary to trichophyton verrucosum: A newer etiological agent with literature review


1 Department of Dermatology, Venereology and Leprology, Pt. B D Sharma, University of Health Science, Rohtak, Haryana, India
2 Department of Microbiology, Pt. B D Sharma, University of Health Science, Rohtak, Haryana, India
3 Department of Pathology, Pt. B D Sharma, University of Health Science, Rohtak, Haryana, India

Date of Web Publication13-Jan-2020

Correspondence Address:
Surabhi Dayal
Department of Dermatology, Venereology and Leprology, Pt. B D Sharma, University of Health Science, Rohtak, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijd.IJD_483_19

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How to cite this article:
Sahu P, Dayal S, Mawlong PG, Punia P, Sen R. Tinea corporis bullosa secondary to trichophyton verrucosum: A newer etiological agent with literature review. Indian J Dermatol 2020;65:76-8

How to cite this URL:
Sahu P, Dayal S, Mawlong PG, Punia P, Sen R. Tinea corporis bullosa secondary to trichophyton verrucosum: A newer etiological agent with literature review. Indian J Dermatol [serial online] 2020 [cited 2020 Jan 25];65:76-8. Available from: http://www.e-ijd.org/text.asp?2020/65/1/76/275766




Sir,

A 45-year-old female presented with multiple itchy patchy skin lesions with scaling all over the body since 2 months. It was followed by itchy fluid-filled lesions with raw areas and crusting on bilateral thighs, chest, back, and abdomen since one month. She had a history of contact with cows and buffalos. There was no history of trauma, insect bite, or recent intake of medicine. On cutaneous examination, there were multiple bullous lesions filled with clear fluid, which ruptured within 2–3 days to leave behind erosions and crust over an erythematous background, involving approximately 50% of the body surface area (BSA) [Figure 1]. The surrounding area was associated with multiple erythematous, polycyclic plaques with scaling which were severely pruritic. These lesions were symmetrically distributed on the chest, axillae, back, buttocks, arms, and legs. There was no mucosal, palm, sole, and nail involvement.
Figure 1: Multiple bullous lesions (Red arrow) with crusting and erosions (Green arrow) on erythematous plaque and multiple polycyclic lesions with scaling on the surrounding areas

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Family and past history were unremarkable. Nikolsky and bulla spread signs were negative. Both Tzanck smear and potassium hydroxide preparation revealed hyphal elements. All other hematological and biochemical investigations were within normal limits. Serology for HIV, hepatitis B (HBV), and hepatitis C (Hep C) were negative.

Histopathology showed subepidermal bulla with fungal hyphae present in the stratum corneum [Figure 2]. Direct-immunofluorescence (DIF) from perilesional skin was negative. Dermatophytes in stratum corneum were also confirmed on periodic acid–Schiff (PAS) stain. Fungal culture on Sabouraud dextrose agar (SDA) was positive for Trichophyton verrucosum. As the patient had already taken tablet fluconazole without any response, she was started on tablet terbinafine and clotrimazole cream. After 1 month of treatment, there was recurrence, so she was started on capsule itraconazole 100 mg twice daily with topical luliconazole cream for 2 months, which led to complete clearance of lesions.
Figure 2: (a) Histopathology reveals subepidermal bulla with inflammatory infiltrate in the upper dermis (H and E, ×40) (b) Fungal hyphae in stratum corneum (marked with a green arrow) (H and E, ×100) (c) Direct immunofluorescence of perilesional skin was negative (x100)

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Dermatophytic infection may rarely be present with unusual manifestations, one of them is tinea corporis bullosa. On extensive search of English literature, we found only 11 cases of tinea corporis bullosa. It was first reported by Costello in 1952.[1],[2] Then, in 1970, Cullen and Loannides reported 3 cases.[2] Terragni etal. coined the term “tinea corporis bullosa” for such a rare presentation.[3] The literature review is given in [Table 1].[3–6] Previously, it was called tinea corporis bullosa annularis in which vesicobullous lesions were limited to the borders of the plaque. But, in our case, the bullous lesions were distributed all over the plaque, which is different from other previously described cases and is similar to the case described by Padhiyar et al.[4]
Table 1: Characteristics of patients diagnosed with Tinea corporis bullosa

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In our case, the causative organism was Trichophyton verrucosum

. This organism is distributed globally and is usually associated with dermatophyte infection of cattle,[7] also called “cattle ringworm disease.” Transmission to the human is rare and is more frequent among humans who are in close contact with animals, especially cows. In our case, the patient had a long history of contact with animals, such as cows and buffalo. It is a zoophilic dermatophyte, which may produce an inflammatory response in the affected areas. This inflammatory response may lead to hypersensitivity reactions to the dermatophyte, which might be implicated in bulla formation accompanied by dermal infiltrate.[3] This may be the reason for the unique characteristic widespread distribution of the bullous lesions all over the affected areas in our patient.

There are two important facts in our case. First, after a detailed search of the literature, this may be the first case of tinea corporis bullosa due to T. verrucosum. Secondly, dermatophytic infections caused by T. verrucosum are usually localized. There are only a few case reports of extensive tinea corporis caused by T. verrucosum, of which the first patient was HIV positive,[8] the second patient had a history of use of corticosteroids,[9] and the third patient was a 3-year-old boy.[7] Our patient did not have any history of immunosuppression or the use of steroids. Thus, probably this may be the first report of extensive tinea corporis due to T. verrucosum in an adult immunocompetent patient.

Keeping in view of the recent alarming increase in the incidence of dermatophytosis in our country, it is mandatory that the dermatologist fraternity be made aware of the unusual presentations of dermatophytosis secondary to T. verrucosum.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Costello MJ. Vesicular trichophyton rubrum (purpureum) infection simulating dermatitis herpetiformis. Arch Dermatol Syphilol 1952;66:653-4.  Back to cited text no. 1
    
2.
Cullen SI, Ioannides G. Bullous dermatophyte infections. Cutis 1970;6:661-8.  Back to cited text no. 2
    
3.
Terragni L, Marelli MA, Oriani A, Cecca E. Tinea corporis bullosa. Mycoses 1993;36:135-7.  Back to cited text no. 3
    
4.
Padhiyar JK, Patel NH, Gajjar T, Patel B, Chhibber A, Buch M. A distinct clinicopathological presentation of cutaneous dermatophytosis mimicking autoimmune blistering disorder. Indian J Dermatol 2018;63:412-4.  Back to cited text no. 4
[PUBMED]  [Full text]  
5.
Mareş M, Năstasă V, Apetrei IC, Suditu GC. Tinea corporis bullosa due to Trichophyton schoenleinii: Case report. Mycopathologia 2012;174:319-22.  Back to cited text no. 5
    
6.
Aalfs AS, Jonkman MF. Tinea corporis bullosa due to Microsporum canis mimicking linear IgA bullous dermatosis. Eur J Dermatol 2012;22:805-6.  Back to cited text no. 6
    
7.
Jiang Y, Zhan P, Al-Hatmi AMS, Shi G, Wei Y, van den Ende AH, et al. Extensive tinea capitis and corporis in a child caused by Trichophyton verrucosum. J Mycol Med 2019;29:62-6.  Back to cited text no. 7
    
8.
Menon T, Ranganathan S. Extensive tinea corporis caused by T verrucosum in a patient of HIV infection. Indian J Dermatol Venereol Leprol 1996;62:126-7.  Back to cited text no. 8
[PUBMED]  [Full text]  
9.
Balighi K, Lajevardi V, Barzegar MR, Sadri M. Tinea corporis with photosensivity. Indian J Dermatol 2009;54:57-9.  Back to cited text no. 9
  [Full text]  


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