Widespread Majocchi's Granuloma Caused by Multidrug-Resistant Trichophyton rubrum Successfully Treated With Amphotericin B and Posaconazole
Abstract
We encountered a 60-year-old Japanese female patient with disseminated dermatophytosis caused by terbinafine-resistant Trichophyton rubrum with mutant SQLE (Leu393Phe substitution). Histopathology showed fungus in the dermis, indicating Majocchi granuloma. Oral fosravuconazole and topical luliconazole were administered for 18 months, resulting in invasive dermatophytosis with a high β-d-glucan level of 7320 pg/mL. The MICs of amphotericin B, posaconazole, griseofulvin, itraconazole, voriconazole, ravuconazole, and terbinafine were 0.5, 0.5, 8, 16, 8, 16, and 32 μg/mL, respectively. Amphotericin B for 6 months followed by oral posaconazole for another 6 months cured the disease. Posaconazole may be a promising agent for the treatment of multidrug-resistant dermatophytes. We present the first reported case of multiazole-resistant T. rubrum resulting from prolonged fosravuconazole treatment.
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