Letter to the Editor
Kerion Celsi with erythematous tumefaction on the groin due to Trichophyton mentagrophytes
Querion de Celso con tumefacción dolorosa en la ingle por Trichophyton mentagrophytes
Elisabeth Gómez Moyano
, Leandro Martínez Pilar, Silvestre Martinez Garcia, Vicente Crespo Erchiga
Corresponding author
Servicio de Dermatología, Complejo Hospitalario Universitario de Málaga, Malaga, Spain
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The patient had low-grade fever, general malaise and bilateral adenopathy. He had recently had unprotected sexual intercourse, and he remembered that the woman had a cutaneous lesion in the genital area. Serology for syphilis, HCV, HBV, HIV, and HSV were negative.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Microscopic examination of the purulent exudate was undertaken, revealing the presence of multiple hyphae (KOH, 400×) (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). <span class="elsevierStyleItalic">Trichophyton mentagrophytes</span> was isolated in culture (<a class="elsevierStyleCrossRefs" href="#fig0015">Figs. 3 and 4</a>). Colonies on Sabouraud dextrose agar had a granular texture, with a white to cream color on the front and a yellowish one on the reverse. Microconidia were round and organized in closely rebranched clusters; macroconidia were multiseptate with thin and small walls. Urease test was positive. Hair perforation test was positive. On Potato dextrose agar the colonies were white on the reverse.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The patient was treated with a 6-week course of oral terbinafine, 250<span class="elsevierStyleHsp" style=""></span>mg/day, with complete remission of the symptoms and no recurrences during the following year. Kerion Celsi is an inflammatory variant of <span class="elsevierStyleItalic">tinea capitis</span> or <span class="elsevierStyleItalic">tinea barbae</span> which is usually caused by zoophilic species.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> It is often confused with bacterial abcesses and its course may be favored by wrong treatments.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> The gold standard—fungal culture—plays a crucial role in the early recognition of any dermatophyte infection. Kerion Celsi on the genital area<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,4–6,8,10</span></a> or on the pubis<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,5,8</span></a> is an exceptional location and it may represent a rare sexually transmitted condition, requiring early diagnosis. The involvement of pubic and/or genital areas in dermatophytoses is usually linked to the spreding of tinea cruris lesions.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3,7</span></a> However, recently published case series by Luchsinger et al. described <span class="elsevierStyleItalic">tinea genitalis</span> as a new entity of sexually transmitted infection.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> Connubial <span class="elsevierStyleItalic">tinea gladiatorum</span><a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> have been reported recently among commercial sex workers.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> On the basis of the patient's history, an indirect route of transmission can be hypothesized in our case.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Dermatophytic suppurative lesions may be easily misdiagnosed as bacterial infections. Differential diagnosis of adenopathy and tumefaction on the groin should include chancroid, lymphogranuloma venereum, and granuloma inguinale. However, suppurative lesions, fever, adenopathies and alopecia in the pubic area should lead to the suspicion of Kerion Celsi (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). In the distinction with Majocchi's granuloma it is useful the intradermal reaction with trichophytin, which is strongly positive in the Kerion Celsi and weak in the Majocchi's granuloma. The histology shows granulomatous inflammation, with few fungal elements in Majocchi's granuloma, and abundant fungal elements in Kerion Celsi.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Oral administration of terbinafine for 4–6 weeks is the preferred treatment in immunocompromised and non-immunocompromised patients. Systemic administration of antifungal agents is mandatory because topical application alone is usually ineffective. In order to avoid irreversible scarring alopecia, prompt initiation of antifungal treatment is essential along with an adequate isolation and identification of the pathogen.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interest</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors have not conflict of interest</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflict of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1282 "Ancho" => 1708 "Tamanyo" => 478476 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Erythematous tumefaction of the groin with pustules and bald areas.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1282 "Ancho" => 1709 "Tamanyo" => 253809 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Multiple hyphae observed on direct microscopy (KOH, 400×).</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1282 "Ancho" => 1708 "Tamanyo" => 307607 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Trichophyton mentagrophytes</span> isolate on Sabouraud dextrose agar (25<span class="elsevierStyleHsp" style=""></span>°C, 7 days).</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Fig. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1282 "Ancho" => 1709 "Tamanyo" => 330850 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Club-shaped macroconidias and numerous round microconidias on clustered branches (Cotton blue, 400×).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatment of 2 cases of kerions with griseofulvin and oral steroids" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. 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| 2021 December | 59 | 13 | 72 |
| 2021 November | 44 | 8 | 52 |
| 2021 October | 49 | 11 | 60 |
| 2021 September | 52 | 11 | 63 |
| 2021 August | 61 | 9 | 70 |
| 2021 July | 50 | 17 | 67 |
| 2021 June | 35 | 10 | 45 |
| 2021 May | 68 | 15 | 83 |
| 2021 April | 175 | 68 | 243 |
| 2021 March | 84 | 84 | 168 |
| 2021 February | 52 | 65 | 117 |
| 2021 January | 56 | 59 | 115 |
| 2020 December | 67 | 27 | 94 |
| 2020 November | 80 | 11 | 91 |
| 2020 October | 53 | 8 | 61 |
| 2020 September | 66 | 15 | 81 |
| 2020 August | 76 | 11 | 87 |
| 2020 July | 72 | 3 | 75 |
| 2020 June | 59 | 10 | 69 |
| 2020 May | 66 | 10 | 76 |
| 2020 April | 57 | 2 | 59 |
| 2020 March | 63 | 7 | 70 |
| 2020 February | 68 | 5 | 73 |
| 2020 January | 44 | 4 | 48 |
| 2019 December | 85 | 6 | 91 |
| 2019 November | 30 | 4 | 34 |
| 2019 October | 54 | 4 | 58 |
| 2019 September | 56 | 2 | 58 |
| 2019 August | 27 | 2 | 29 |
| 2019 July | 38 | 13 | 51 |
| 2019 June | 66 | 27 | 93 |
| 2019 May | 169 | 45 | 214 |
| 2019 April | 44 | 13 | 57 |
| 2019 March | 12 | 7 | 19 |
| 2019 February | 18 | 4 | 22 |
| 2019 January | 17 | 9 | 26 |
| 2018 December | 7 | 2 | 9 |
| 2018 November | 6 | 5 | 11 |
| 2018 October | 8 | 15 | 23 |
| 2018 September | 12 | 5 | 17 |
| 2018 August | 3 | 11 | 14 |
| 2018 July | 2 | 4 | 6 |
| 2018 June | 6 | 3 | 9 |
| 2018 May | 7 | 7 | 14 |
| 2018 April | 5 | 1 | 6 |
| 2018 March | 3 | 6 | 9 |
| 2018 February | 15 | 1 | 16 |
| 2018 January | 21 | 1 | 22 |
| 2017 December | 1 | 0 | 1 |
| 2017 November | 3 | 0 | 3 |
| 2017 August | 0 | 1 | 1 |
Show all
