Deep dermatophytoses in association with atopy and diabetes mellitus: Majocchi's granuloma tricophyticum or dermatophytic pseudomycetoma?

Two patients presenting with subcutaneous nodules, plaques, papules and ulceration caused by dermatophytes are described in this report. The first case was atopic and had used low dose systemic corticosteroids intermittently for his asthma. The second case was a poorly controlled and long-standing diabetic patient. The diagnoses were suspected after direct microscopical examinations of the discharge materials which revealed the presence of hyaline hyphae and spores, and histological examination which showed an inflammatory infiltrate with fungal elements in the dermis. Cultures of puncture materials and skin biopsies confirmed the diagnosis identifying Trichophyton rubrum and T. mentagrophytes var interdigitale, in the first and second case respectively. Antifungal therapy with itraconazole was successful in both patients. The cases are presented to emphasize the possibility of this unusual condition in association with atopy and diabetes mellitus as in profoundly immunosuppressed cases. The nomenclature concerning this type of dermatophyte infections is also discussed.