Although dermatophytes are still the main etiologic agents of onychomycosis, some species of nondermatophytic molds and yeasts are also capable of invading the nails. Scopulariopsis (S.) brevicaulis is a nondermatophytic mold which is saprophytic fungus in soil. We report four cases of toenail onychomycosis caused by S. brevicaulis in a 42-year-old male, a 46-year-old male, a 37-year-old male, and a 64-year-old male. Three patients presented with a typical distal subungual onychomycosis and one case was proximal subungual onychomycosis. Direct microscopic examination of scrapings on the potassium hydroxide preparation revealed fungal elements in all cases. Cultures from toenail lesions of the all patients on Sabouraud dextrose agar showed a typical brown colony with powdery surface of S. brevicaulis. Numerous branched conidiophores with chains of lemon-shaped conidia with rough walled were observed in slide culture and scanning electron microscopy (SEM). We confirmed S. brevicaulis by colony, light microscopic morphology and SEM.
Adult ; Agar ; Arthrodermataceae ; Fungi ; Glucose ; Humans ; Male ; Microscopy, Electron, Scanning ; Middle Aged ; Nails* ; Onychomycosis* ; Potassium ; Scopulariopsis* ; Soil ; Spores, Fungal ; Yeasts

Microsporum (M.) gypseum is geophilic and abundant in soil throughout the world. The source of human infection has been traced to soil or animals. But tinea corporis caused by M. gypseum is rare. We report 4 cases of tinea corporis caused by M. gypseum in a 38 year-old female, a 7 year-old girl, a 2 year-old boy, and a 18 year-old female. The lesions were manifested by localized pruritic fine scaly erythematous annular patches on the shin, forearm, neck, and antecubital fossa. Direct microscopic examination of scales on the potassium hydroxide preparation showed hyphae and spores in 3 cases. But cultures from the skin lesion of all patients on Sabouraud dextrose agar showed typical colonies of M. gypseum. The patients were treated with topical ketoconazole application and/or oral antifungal agents.
Adolescent ; Adult ; Agar ; Animals ; Antifungal Agents ; Child ; Child, Preschool ; Female ; Forearm ; Glucose ; Humans ; Hyphae ; Ketoconazole ; Male ; Microsporum* ; Neck ; Potassium ; Skin ; Soil ; Spores ; Tinea* ; Weights and Measures

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Dermatophytosis of the palm of the hands (tinea manus) tends to involve one hand. We encountered a case of bilateral tinea manus in a patient with type 1 diabetes mellitus and bilateral tinea pedis. A 57-year-old man presented for evaluation of hyperkeratotic lesions on both his palms and soles. Skin examination revealed hyperkeratotic scaly lesions on the palmar surfaces of his hands and plantar surfaces of his feet. Yellow discoloration and thickening were observed on both his nails. Fasting venous plasma glucose concentration and hemoglobin A1c levels were 332 mg/dL and 7.5%, respectively. Fungus cultures revealed white colonies with brown color on the reverse side in a 14-day incubation period. Trichophyton rubrum infection was identified using polymerase chain reaction with amplified internal transcribed spacer regions. He was treated with oral fluconazole (150 mg/week) and topical flutrimazole spray. In addition, we examined the frequency of 77 superficial fungal hand infections (age, sex, seasonal distributions and coexisting fungal infections) among patients who visited the dermatologic clinic of Chonbuk University Hospital between January 1997 and December 2016.

Microspoum canis is a zoophilic dermatophyte that is often transmitted to humans from cats and dogs. It has become one of the most important causative agents in tinea capitis ane kerion celsi. Tinea capitis is uncommon in an adult. Moreover, tinea capitis caused by Microspoum canis is rare in an elderly. The location of the lesion and the clinical course of tinea capitis might have led physicians into misdiagnosis as the seborrheic dermatitis. Therefore, we report this case to emphasize the importance of KOH mount and fungal culture of the skin lesions mimicking seborrheic dermatitis. We report a case of tinea capitis caused by Microspoum canis in a 79-year-old woman. The lesions were manifested by fine scaly erythematous patches on the fronto-vertex scalp for 2 weeks. She was diagnosed as seborrheic dermatitis in local clinic and was treated with topical steroid. However, the lesion was not improved. She kept a cat as a pet. Culture from biopsy specimen on Sabouraud's dextrose agar showed typical cottony colonies of Microspoum canis. The nucleotide sequence of internal transcribed spacer for clinical isolate was identical to that of Arthroderma otae strain ATCC 23828 (GenBank accession number AY213657). She was treated with 200 mg of oral itraconazole daily for 12 weeks. The skin lesions improved after treatment, and recurrence has not been observed.

Majocchi's granuloma is a well recognized but uncommon infection of dermal and subcutaneous layers that is caused by fungal organism. It often presents as plaques and papules on areas where trauma is common. Majocchi's granuloma appears usually in immunocompromised patient but can also appear in immunocompetent patient. Tinea incognito appears in various forms of skin diseases, but it is rarely presented as Majocchi's granuloma. We report a case of trichophytic granuloma of the knee caused by Trichophyton(T.) rubrum in a 70-year-old male, who showed a pruritic, 7.0 × 2.0 cm sized, erythematous scaly patches with multiple papules on the right knee for 2 months. Fungal culture of the biopsy specimen grew out typical white cottony colonies of T. rubrum. The nucleotide sequence of internal transcribed spacer for clinical isolate was identical to that of T. rubrum strain ATCC 52013 (GenBank accession number KX092384.1). Histiologic examination showed chronic granulomatous inflammation and fungal elements in the dermis. After one month of itraconazole 200 mg/day and sertaconzole cream treatment, the lesion was completely cleared.

Candida albicans infections of the spine are relatively uncommon in spite of the increasing frequency of predisposing factors. Moreover, late onset spondylodiscitis after bloodstream candidiasis is extremely rare. A 66-year-old woman to have been underwent chemotherapy was diagnosed with candidemia. Antifungal agent was administrated until two weeks after no detection of fungus in the blood culture. The chemotherapy was continued. But, she was hospitalized due to abdominal pain and diarrhea. Pseudomembranous colitis was diagnosed. After metronidazole administration, she was improved and discharged. However, she revisited because of back pain and fever. Spondylitis and discitis on the 10th~11th thoracic spine was shown in magnetic resonance images. Open curettage and spinal stabilization was performed. C. albicans was identified. Antifungal agent was administrated and the patient improved well postoperatively. We present a rare case of late onset Candida spondylodiscitis after candidemia with review of the literatures.

We report a case of Majocchi's granuloma in a 71-year-old immunocompetent male patient, who presented with a 6-month history of mass with multiple erythematous nodules and indurated plaques with scale on the left cheek. Even though the lesion strongly suggested cutaneous tumor, the histopathologic findings were consistent with the Majocchi's granuloma, showing numerous hyphae, perifolliculitis and granulomatous inflammation with central abscess formation in the dermis. Trichophyton rubrum was isolated from the biopsy specimen fungus culture. The cutaneous lesion was treated with oral administration of itraconazole (200 mg/day) and topical lanoconazole cream for 4 weeks, and successfully treated.
Abscess ; Administration, Oral ; Aged ; Biopsy ; Cheek ; Dermis ; Fungi ; Granuloma* ; Humans ; Hyphae ; Inflammation ; Itraconazole ; Male ; Trichophyton