Majocchi's Granuloma

A 40-year-old farmer had been complaining for 3 weeks of a tender, red, itchy, scaling plaque with papulopustules on one knee. A potassium hydroxide examination of the scale revealed fungal hyphae. Drs Charles E. Crutchfield III and Humberto Gallego of St Paul made the diagnosis of Majocchi's granuloma.

Drs Crutchfield and Gallego add that a dermatophyte infection commonly affects the cutaneous stratum corneum but, occasionally, the infection can invade hair follicles, producing an erythematous, boggy plaque that is studded with follicular papules and pustules, similar to a kerion. This is known as a Majocchi's granuloma, or a trichophytic granuloma. Although this granuloma can occur in any hair-bearing area, it most commonly erupts on the legs.

Zoophilic dermatophyte infections generally produce a much more inflammatory cutaneous reaction in humans than anthropophilic fungal species. This farmer's fungal culture grew the zoophilic organism Trichophyton verrucosum, a dermatophyte species commonly associated with cattle.

Majocchi's granuloma cannot be treated with topical antifungal preparations alone. Itraconazole, 100 mg bid for 15 days, cured this patient's infection.