Invasive Trichophyton Rubrum Infection Occurring with Infliximab and Long-Term Prednisone Treatment

• Published in: Journal of cutaneous medicine and surgery Vol. 11; no. 2; pp. 84 - 88
• Main Authors: Lowther, Abigail L., Somani, Ally-Khan, Camouse, Melissa, Florentino, Frances T., Somach, Stephen C.
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01-03-2007; Decker; SAGE PUBLICATIONS, INC
• Subjects: Antibodies, Monoclonal - therapeutic use; Biological and medical sciences; Dermatology; Fatal Outcome; Female; Glucocorticoids - administration & dosage; Glucocorticoids - therapeutic use; Human mycoses; Humans; Immunocompromised Host; Infectious diseases; Infliximab; Medical sciences; Middle Aged; Mycoses; Mycoses of the skin; Prednisone - administration & dosage; Prednisone - therapeutic use; Tinea - etiology; Tinea - immunology; Tinea - physiopathology; Tumor Necrosis Factor-alpha - adverse effects; Antineoplastic agent; Corticosteroid; Trichophyton rubrum; Dermatology; Cytokine; Antiinflammatory agent; Prednisone; Monoclonal antibody; Long term; Fungi; Immunomodulator; Infection; Treatment; Infliximab; Anticytokine; Adrenal hormone; Fungi Imperfecti; Immunosuppressive agent; Tumor necrosis factor α; Dermatophyte; Thallophyta
• ISSN: 1203-4754; 1615-7109
• DOI: 10.2310/7750.2007.00009

Background:
A 64-year-old woman presented with erythematous plaques, tender nodules, and pustules of the dorsal right hand and both legs following long-term treatment with systemic steroids and infliximab. Skin biopsy demonstrated dermal inflammation with foci of necrosis and multinucleated giant cells containing fungal spores. Tissue culture grew Trichophyton rubrum.
Objective:
To report a case that demonstrates the pathophysiology of invasive T. rubrum infection, the mechanisms of action and uses of tumor necrosis factor α (TNF-α)-inhibiting drugs, and how these drugs may increase patients' risk of invasive dermatophytosis.
Conclusion:
Dermatophytes such as T. rubrum rarely cause invasive disease. This unusual presentation of invasive T. rubrum occurred with immunosuppression by infliximab and systemic steroids. Patients should have a thorough examination for signs of latent infection before TNF-α inhibitors are prescribed, including inspection of the skin and nails for signs of dermatophytosis.