Majocchi’s granuloma (MG) is atypical and rare presentation of dermatophytid infection involving the invasion of dermal and subcutaneous tissue and is one of four forms of deep dermatophytid infections. MG has two types: perifolliculitis and subcutaneous nodules 3. The latter type usually happen in patients with immunosuppressed and is characterized by firm or fluctuant nodules on the scalp, face or hands and forearms 4. In this paper, we reviewed the literatures on MG caused by T. rubrum to help clinicians and researchers recognize MG.
All published case reports and retrospective analyses onMG caused by T. rubrum were identified through an extensive search of the PubMed, MEDLINE, Web of science databases by using different sets of key words, viz. Trichophyton rubrum and Majocchi’s granuloma.
After removing duplicate reports, we had a total of 21 articles with 21 patients, published between 2009 and 2024 (Table 1). Summarizing the clinical information of all the cases presented here. Among the cases, 17 were males (80.95%) and 4 were female (19.05%). The mean age of the patients was 52.9 years (range 11-80 years). On physical examination, the clinical findings could be categorized as nodules (Case 25, 36, 47, 68, 89, 1110, 1211, 1412, 1513, 1614, 1715, 2016, 2117) or non-nodules (Case 118, 519, 720, 921, 1022, 1323, 1824, 1925). The sites of involvement were genital area (3 cases, 14.29%), extremity (10 cases, 47.62%) and face (10 cases, 47.62%). Remarkably, lesions of a 65-years old male appeared on generalized subcutaneous (case 12). In five patients (23.81%), they had received organ transplant. While in the remaining 10 cases (47.62%), although they had not received transplant, some of them been in immunosuppressed. Five cases (23.81%) had a history of other dermatosis. Four patients (19.05%) had metabolic disorders. Itraconazole was been used treat for ten patients (47.62%). Itraconazole is the most commonly used for MG in clinical. Terbinafine (8 cases, 38.10%), voriconazole (2 cases, 9.52%), griseofulvin (1 cases, 4.76%), were among the frequently used systemic antifungals with excellent treatment outcomes. A 66-year male who received a kidney transplant chose a combination of terbinafine and voriconazole. Adalimumab was chosen for treatment, especially for a patient with psoriasis. Biological preparation also provided new therapeutic possibilities for refractory invasive deep fungal infections.
In this report, the patient had up to five years of untreated diabetes and was in a state of hyperlipidemia and hyperuricemia for a long time. The MG was caused by superficial fungi without obvious trauma, which was closely related to the long-term increase of blood glucose and immunosuppression 26. Due to increased sugar content in diabetic skin tissue and accumulation of glycation end products (AGEs) 27, AGEs could cause their functional disorder by affecting the normal life activities of cells, further leading to the occurrence of local skin damage.
Healthy people frequently get dermatophytid infections, while immunocompromised patients are more vulnerable. It's important to remember that people with diabetes can develop mycosis. Patients having a history of diabetes for an extended period of time should be closely monitored for an increased risk of invasive fungal infection.
The incidence of diabetes is increasing year by year worldwide. Doctors should be alert to the occurrence of dermatophytid in diabetic patients, early diagnosed and treatment of this infection in patients with diabetes prevent widespread cutaneous disease and fungal septicemia.