Dermatophytoma caused by terbinafine‐resistant Trichophyton rubrum treated with fosravuconazole
Abstract
Dear Editor, Terbinafineresistant dermatophyte strains have increased over the past decade worldwide. We successfully treated a patient with tinea unguium caused by a terbinafineresistant Trichophyton rubrum (Phe397Leu substitution in squalene epoxidase; SQLE).1 Therewith, dermatophytoma was described in 1998 as a unique type of tinea unguium seen in some distal and lateral subungual onychomycosis, characterized by densely packed clump of dermatophyte hyphae and large arthroconidia, or both, compacted and forming a fungal ball.2 Definitive diagnosis is made microscopically by observation of fungal conglomerate via KOH method. Dermatophytomas are recalcitrant to standard oral antifungal medications.2 Herein, we treated a patient with dermatophytoma caused by terbinafineresistant T. rubrum with oral fosravuconazole. An 81yearold male farmer with type 2 diabetes (hemoglobin A1c, 7.0%) presented to our clinic with tinea corporis (buttocks) in June 2020. He was taking aspirin, amlodipine, and olmesartan regularly. The isolate was identified as terbinafineresistant T. rubrum
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