[CIS PIDD] [cis-pidd] Majocchi granuloma in a patient with chronic granulomatous disease

[Safa baris]

use steriod for the lesion. l have one patient with skin lesion like this treated successfully by topical and systemic steroid..
best regards..
safa Baris, MD.
Marmara University, Division of lmmunology, Turkey.

From: ScurlockAmyM at uams.edu
To: cis-pidd at lists.clinimmsoc.org
Subject: [cis-pidd] Majocchi granuloma in a patient with chronic granulomatous disease
Date: Tue, 2 Apr 2013 16:09:29 +0000









Dear Colleagues:
 
I would appreciate your thoughts and input on a patient in our practice with CGD and a new diagnosis of Majocchi granuloma.  The details of the case are as follows: 

 
SM is a 24 y/o male with CGD on chronic sporanox, Bactrim and IFN therapy. He presented over one year ago with a small 1 cm dark purple patch on his left thigh. The lesion was non-pruritic; however, due to patient’s underlying developmental
 delay (and propensity to pick at any skin lesions) the lesion was periodically excoriated with small amount of scab formation. Overtime, the lesion grew to its maximum size of 4.5 cm and remained deeply violaceous and eroded. The lesion has been biopsied several
 times with results being inconclusive and 2 separate fungal cultures that grew penicillium species.  Anti-fungal treatment was switched from sporanox to a 3 month course of Lamisil (per ID) from Oct-Dec 2012. He was hospitalized in Jan 2013 for community-acquired
 pneumonia and during the hospitalization, both Derm and ID were consulted for another assessment of the lesion. His antifungal therapy was subsequently switched to Voriconazole. He was on Vori for >10 weeks without change in the lesion. At a recent Derm appt,
 Majocchi granuloma was diagnosed and surgery was consulted. The lesion was completely excised by the surgical team last week. Cultures and biopsy results are pending.  The agent in most cases is trichophyton rubrum but that has not yet been identified in our
 patient.
 
I would appreciate your thoughts regarding long-term treatment following resection and any other experience or recommendations. 

 
Kindest regards,
Amy
 
Amy M. Scurlock, M.D., F.A.A.P
Associate Professor, Department of Pediatrics
Division of Pediatric Allergy/Immunology
University of Arkansas for Medical Sciences
Arkansas Children's Hospital
13 Children's Way, Slot 512-13
Little Rock, Arkansas 72202
Phone: (501) 364-1060
Fax: (501) 364-3173
 

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