Majocchi's Granuloma in a High School Wrestler

摘要

A high school wrestler developed a rash on his forearm. The rash was erythematous, raised, mildly pruritic, and had diffuse, dry scale. A physician visually diagnosed the rash as eczema. The topical steroid triamcinolone 0.1% cream was prescribed, with instructions to apply twice daily until clear. The rash increased in size over 1 month, despite treatment. The rash at the 1 month follow-up had less scale, no pruritus, and had developed a shiny, firm appearance (Fig. 1). The wrestler was referred to dermatology, where a punch biopsy of the lesion and culture were obtained. Light microscopy demonstrated features of an inflammatory folliculitis, and Periodic acid-Schiff staining highlighted fungal elements within the surface cornified layer and the follicular lumen. Majocchi's granuloma was diagnosed. Extracted hair shafts grew Trichophyton tonsurans on fungal culture. Antifungal therapy with oral terbinafine 250 mg daily was started. The rash resolved after 3 months of treatment.