Majocchi’s Granuloma After Kidney Transplantation

Abstract

Mycosis may follow an atypical course in an individual undergoing immunosuppressive therapy. We describe a patient with a fungal infection that was manifested as a bilateral inguinal granuloma. Owing to suspected inguinal lymphadenopathy characterized by distinct subcutaneous swellings in the groin, a 39-year-old man who had undergone kidney transplantation 14 years earlier was admitted to the Nephrologisches Zentrum in Hann. Muenden, Germany. The results of a clinical examination revealed bilateral, soft, partly fluctuant, indolent swellings in the groin as well as onychomycosis of the right great toe. An ultrasonographic scan showed bilateral hypoechogenic lesions (<= 1.5 cm) in the groin. The lesions were surgically removed, and the results of histologic examination revealed severe granulating pseudocystic inflammation with a distinct foreign body reaction. Dermatophytes of the species Trichophyton rubrum were detected microbiologically. After the lesions had been resected, the wound healed without complications. Immunosuppressive treatment with tacrolimus 8 mg/d and steroids 7.5 mg/d was not changed. Local antimycotic treatment of the onychomycosis with ciclopirox cream was initiated. At the patient’s 2-year follow-up examination, there was no evidence of recurrence. In transplant recipients, local fungal infections should be treated as a matter of course, because dermatophytosis is present in almost every other such patient. In patients with a suspicious inguinal lesion, an atypical form of dermatophytosis must be considered. T rubrum, the most frequently occurring dermatophyte, causes 80% of the dermatophytosis that develops in immunosuppressed patients.