Introduction

Dermatophytosis is a fungal infectious disease caused by dermatophytes, which produce protease and keratinase to digest keratin, leading to the colonization, invasion, and infection of the stratum corneum of the skin, hair shafts, and nails. Trichophyton interdigitale belongs to Trichophyton mentagrophytes complex, which is the common pathogen causing dermatophytosis. Fungal keratitis, also called keratomycosis, is an infectious disease of cornea. 

Case

We report a case of simultaneous dermatophytosis and keratomycosis caused by Trichophyton interdigitale. A 67-year-old man presented with extensive erythema all over the body since 4 years ago, fungal infection of left eye for 2 years, and loss of vision in the eye. These symptoms had become aggravated in the last month. Dermatological examinations showed extensive erythematous plaques with clear borders and scales, scattered red papules with ulceration, and scabs throughout the body. Onychomycosis was observed on the nails of left hand, conjunctival infection with secretion and loss of vision were noted in left eye. Hyaline septate hyphae were observed under direct microscopic examination, fungal culture and internal transcribed spacer sequencing revealed T. interdigitale. Histopathological examination suggested infectious granuloma. A diagnosis of dermatophytosis and keratomycosis caused by T. interdigitale with loss of vision in left eye was made. The patient was treated with luliconazole cream (two applications per day) and itraconazole (100 mg, BID, PO). Complete clinical remission was achieved after 1 month. Subsequently, the patient underwent left eye enucleation in the ophthalmology department. 

Conclusion

In the present study, we report a case of simultaneous dermatophytosis and keratomycosis caused by T. interdigitale. Tinea corporis is a common type of dermatophytosis that infects smooth skin, except for the scalp, hair, palms, nails, and genital area. When the pathogens invade the stratum corneum of the skin, they cause a mild inflammatory reaction, consisting of erythema, papules, and blisters, followed by ringworm lesions with obvious scales.

Early diagnosis and prompt treatment may help improve the management and outcomes. Potassium hydroxide examination is a rapid, simple, and essential investigation for this condition. Mycological culture not only further confirms the diagnosis but also provides credible evidence to correct assertions when the result of potassium hydroxide microscopy is negative. Early diagnosis and aggressive medical treatment are of the utmost importance to improve therapeutic outcomes.

References

Wang F, Li L, Dou X, Ma L, Fang L, Zhang Q, et al. Adult tinea capitis, tinea corporis and acute corneo-conjunctivits caused by Microsporum canis: a case report. J Clin Dermatol. 2009;38:175 –7. 

Sharma Y, Jayachandran JS. Keratomycosis: Etiology, Risk Factors and Differential Diagnosis- A Mini Review on Trichophyton spp. J Clin Diagn Res. 2014;8:Dd01 –2.