Scutular tinea of the scrotum by Candida guilliermondii

ARTICLE

ejd.2011.1613

Auteur(s) : Jiuhong Li¹ lijiuhong2011@126.com, Zhenhai Yang¹, Yilei Li¹, Xiuhao Guan¹, Bo Li¹, Junping Lin¹, Huachen Wei^1,2

¹ Department of Dermatology, No. 1 Hospital of China Medical University, 155N, Nanjing Street, 110001 Shenyang, China

² Department of Dermatology, Mount Sinai Medical Center, New York, USA

Scutula is the characteristic lesion of favus, appearing as a yellow saucer-shaped crust made up of hyphae and spores. Scutula is predominantly caused by Trichophyton schoenleinii, afflicting mostly the scalp. There have been few reports on scutula-like lesions on other sites of the body. In addition, these lesions were usually caused by Microsporum gypseum and T. violaceum, rather than T. schoenleinii [1-5]. Here we present a case of scutula-like tinea on the scrotum. We identified Candida guilliermondii from the lesion, a finding which, to our knowledge, has not been reported in the literature.

An otherwise healthy 78-year-old Chinese male complained of mild pruritic eruptions on the scrotum for 10 days. The patient denied any direct contact with soil, plants, or pets and had no recent history of using topical or systemic medication.

Physical examination showed well-marginated polycyclic scaly plaques on his scrotum. The plaques were formed by coalescence of numerous gray-to-yellowish cup-shaped crusts (scutula). Scutula were more evident in the center of the lesions. The base of the lesion was erythematous and moist, after removal of the crusts. There was a peculiar “mousy” odor from the lesions (figure 1a).

Direct microscopic examination on potassium hydroxide preparation of the crust showed a large number of hyphae and spores. Fungal culture on sabouraud dextrose agar at 25 ̊C yielded flat, smooth, cream-colored colonies with the characteristics of yeast (figure 1b). The germ tube was negative, and microscopic examination of the isolates showed clusters of oval spores and short pseudohyphae. The isolates were identified as C. guilliermondii, based on morphological characteristics and biochemical tests.

The patient was treated with 200 mg itraconazole daily for 2 weeks, and the lesion was resolved. The following laboratory analyses were carried out in an attempt to assess possible immunodeficiency conditions, including tests of complete blood cell count, serum immunoglobulins, serum fasting glucose level, HIV antibodies and counts of peripheral-blood lymphocyte subsets. All the tests were within normal ranges and/or negative. At the 6-month follow-up, there was no relapse of disease, and there was no apparent scarring.

Scutula is the specific lesion of favus caused by T. schoenleinii, classically the favus mostly affects the scalp and is rarely reported in other areas. To date, rare cases outside the scalp and described in the scrotum were caused by M. gypseum and T. violaceum, which produced a scutula-like clinical picture in HIV-infected patients and non-HIV-infected populations [1-5], although in HIV-infected patients the lesions may exhibit different clinical features.

Besides M. gypseum and T. schoenleinii, other etiological agents are seldom responsible for this clinical presentation. C. guilliermondii, a normal flora in human skin and mucosa, is considered as an opportunistic fungal pathogen [6]. The yeast has been infrequently associated with human infections, due to its low pathogenicity.

Our patient had scutular eruptions on the scrotum rather than the scalp. C. guilliermondii was identified from the lesion. To our knowledge, no such case has been reported before. Our patient is unique as the lesions were distinct from favus in their nature and prognosis. There was no skin atrophy or scarring. Systemic antimycotic agents were effective. The patient was in good health and had no immunodeficiency conditions. Why this specific dermatomycosis occurred in this patient remains to be elucidated. We postulate that the ambient and humid anatomical location, superimposed bacterial infection or an unusual inflammatory reaction may lead to this unique clinical manifestation.

Acknowledgements: Financial support: none. Conflict of interest: none

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