Chiaki Nishiyama

A case of generalized granuloma trichophyticum

A 59-year-old man visited our hospital. The patient had suffered from generalized tinea superficialis for thirty years, had been treated with several topical antifungal preparations and was administered griseofulvin at another hospital. Clinical manisfestations were as follows: There were large pigmentations on the chest, abdomen, and lower extremities. He had several irregular shaped ulcers on the back, left forearm, and right axilla, and glossy granular lesions on the dorsum of the left foot. Generalized eruptions consisting of indurative pustules, red papules, scars, atrophies and depigmentations were also visible. The biopsy specimens taken from the ulcers, the indurative pustules and granular lesions of the dorsum of the left foot were cultured and Trichophyton rubrum was isolated. Laboratory studies showed slight eosinophilia, Mantoux reaction 56×40 mm, Trichophytin reaction 5×5 mm, IgE 4000 IU/dl. Histological findings were as follows: Fungal elements were observed in the horny layer, in the spindle cell layer, and in the dermis. Histologic features were both abscesses and granulomas with giant cells. According to the pathologic features of the lesions, the parasitic forms of the fungus changed. Abscesses and granulation tissues containing histiocytes and many multinucleated giant cells were observed in the dermis. Various sizes of arthrospores and various shapes of hyphae were stained by PAS. Most of these fungal elements dissolved in the abscesses and granulomas. However, a few survived.

STUDIES ON THE PARASITIC FORMS OF TRICHOPHYTON RUBRUM ISOLATED FROM PATIENTS WITH GRANULOMA TRICHOPHYTICUM USING THE “AGAR-IMPLANTATION METHOD”

We studied the conversion of T. rubrum from hyphae to spherical cells using the agar‐implantation method. Thirteen cultures of T. rubrum were isolated from tinea superficialis and granuloma trichophyticum and they were implanted into the peritoneal cavities of ddY male mice. The cultures were divided into three groups according to their parasitic forms. The first group consisting of two cultures were isolated from tinea unguium and tinea pedis (hyperkeratotic type); they were destroyed in the peritoneal cavities of mice by the sixth week. The eight cultures in the second group were isolated from tinea cruris, tinea circinata and tinea pedis (vesicular type); they converted to spherical cells and survived for 16 weeks. The three cultures of the third group were isolated from granuloma trichophyticum; they survived and grew as hyphal forms in the peritoneal cavities of mice for over 26 weeks without spherical cell conversion. In conclusion, the parasitic forms of the three cultures isolated from granuloma trichophyticum differed from the cultures isolated from tinea superficialis.