Clinical case of Majocchi's granuloma

Abstract

Fungal infections of the skin, due to their variety of clinical presentations, often cause difficulty in making a diagnosis. Majocca's granuloma (GM) is a rare form of fungal skin infection that is caused by dermatophytes in over 95% of cases. Long-term superficial dermatophyte, systemic or local immunosuppression, and disruption of the integrity of the skin barrier are risk factors for developing Majocca granulomas. Improper treatment with topical glucocorticosteroids and antibiotics can worsen the condition. We present the case of a ten-year-old immunocompetent boy who developed Majocca granulema after mechanical skin injury. Late diagnosis and incorrect treatment tactics using local glucocorticosteroids at the prehospital stage probably led to the progression of manifestations in the primary focus and further dissemination of the pathogen, with the development of folliculitis and skin lesions. Due to low sensitivity of GM laboratory tests, even after skin microscopy using potassium hydroxide (KOH) and genome-wide double sequencing, no etiological agent could be identified in our patient. The patient was discharged from hospital with clinical improvement after taking systemic antifungal drugs. Against the background of a break in treatment and a violation of the care recommendations, the patient developed a recurrence of the disease, which was prevented by long-term administration of terbinafine.