Trichophyton indotineae ( 2 фото )

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A previously healthy 30-year-old man presented to the dermatology clinic with a 6-month history of an extensive, itchy rash. He had migrated to the United States from Turkey by way of several countries. During his travels, the rash had worsened despite previous treatment with antifungal and glucocorticoid creams. No oral antifungal medications had been prescribed. The physical examination was notable for erythematous, annular, scaly plaques on the right shoulder and inner arm (Panel A), as well as the lower abdomen, groin, and thighs (Panel B). A potassium hydroxide preparation of a skin scraping showed fungal hyphae. Owing to the finding of extensive tinea in an immunocompetent patient who had recently traveled, genetic sequencing of fungal isolates was performed, and Trichophyton indotineae was identified. A final diagnosis of tinea corporis and tinea cruris caused by T. indotineae was made. T. indotineae is an emerging dermatophyte with resistance to topical antifungals and oral terbinafine and with decreased responsiveness to fluconazole and griseofulvin. Clinicians should consider testing for the presence of T. indotineae when managing treatment-refractory or extensive tinea corporis, tinea cruris, and tinea faciei, especially in patients who have traveled in South Asia (although the organism is now reported worldwide). Genetic sequencing is required for species confirmation. After a 6-week course of itraconazole, the rash resolved.
Ziyang Xu, M.D., Ph.D., and Avrom S. Caplan, M.D.
Published November 9, 2024
N Engl J Med 2024;391:1837
DOI: 10.1056/NEJMicm2409010
VOL. 391 NO. 19


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