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Ringworm causing childhood preseptal cellulitis.

A 4-year-old girl had redness and swelling of the left upper eyelid of 1 week's duration. She had been treated with topical fusidic add and oral flucloxacillin without resolution. Ophthalmic examination showed a diffuse, erythematous, tender lesion affecting the entire upper eyelid. There was a central area of skin ulceration with marked bleeding and discharge. Also found were small vesicles under the left eyebrow. The child's mother had noticed a scaly rash on her own forearm. Examination under anesthesia was carried out to assess the globe and to obtain samples for microbiology investigation. Microbiology scrapings showed fungal hyphae of the Dermatophyte group. Treatment with Griseofulvin was commenced, and complete resolution of the lesion occurred. To our knowledge there is only one similar case reported in the literature describing ring-worm as a cause of preseptal cellulitis. This case highlights the importance of considering alternative diagnoses when standard antibiotic treatment has failed.

Antifungal Agents↗

A case of black dot ringworm attributable to Trichophyton violaceum: a simple method for identifying macroconidia and microconidia formation by Fungi-Tape and MycoPerm-Blue.

An 85-year-old Japanese woman sought a dermatologic consultation for evaluation of a walnut-sized alopecia with pityroid desquamation in the parietal region of her scalp. She had been admitted to a nursing home about three months earlier, and, at that time, a thumb-tip-sized, scaly alopecia was noted. Several hairs at the site were eroded in a black dot. Direct KOH microscopy of affected hair showed large spore endothrix infection. To isolate macro- and microconidia for fungal identification, we incubated the affected hair and scales and obtained giant colonies in a special enriched medium. Using Fungi-tape and MycoPerm-Blue, we were able to collect and identify Trichophyton violaceum macro- and microconidia from the white, powdery, fluffy colony that slowly developed after about six weeks of growth on enriched medium. Over the past 20 years, only about 20 cases of tinea capitis caused by T. violaceum have been reported in Japan, and macroconidia have been identified in only 4 cases, including this one.

Aged↗

A Chinese-Japanese boy with black dot ringworm due to Trichophyton violaceum.

A 4-year and 8-month-old Chinese-Japanese boy, who had been visiting Dalian, China frequently, developed multiple alopecia lesions 1 year previously. At his initial visit to our department, multiple patchy alopecia with black dots was observed in the parietal scalp area. Multiple erythematous macules were also seen on the face, nape and right dorsum of the hand. A diagnosis of tinea capitis and tinea corporis was obtained on the basis of potassium hydroxide (KOH) microscopic examination of hair and scales from the lesions. Colonies grown on Sabouraud cycloheximide-chloramphenicol agar culture were examined using Fungi-Tape and MycoPerm-blue, and numerous microconidia and a small number of macroconidia were observed. Trichophyton violaceum was identified as the causative organism on the basis of colony morphology, microscopic morphology and molecular biology technique. As T. violaceum infection is not often seen in Japan, we suspected that the patient was infected by T. violaceum during his stay in Dalian. Conidia formation is rarely observed with T. violaceum, and only five cases with T. violaceum macroconidia formation have been reported in Japan (including this case). We also report the method for visualizing conidia formation of T. violaceum using Fungi-tape and MycoPerm-blue.

Asian People↗