[A fatal case of dermatomycoses with retropharyngeal abscess]

Abstract

Background: Dermatophytic disease is a rare chronic infection caused by dermatophytes and characterised by cutaneous and visceral invasion. It is observed in North Africa. It is associated with cellular immunodeficiency and refractoriness to drug treatment.

Case report: We report a new case of dermatophytic disease in a 26-year-old Tunisian woman. The patient's parents were first cousins; no other family members had a similar disease state. At the age of 3 years, the patient developed extensive tinea corporis associated with onychomycosis resistant to the usual antifungal drugs. The patient was hospitalised for multiple subcutaneous vegetative and ulcerative lesions of the scalp, face and chest associated with multiple adenopathies, occasionally fistular, of the axillary, cervical, mammary and inguinal areas. Mycology and histology confirmed the presence of fungal hyphae. Trichophyton violaceum was isolated in cultures of various skin lesion and lymph node biopsy samples. Investigations showed no evidence of immunodeficiency. Although the patient initially responded well to itraconazole (Sporanox, 400 mg/day), her condition worsened with obstruction and dyspnoea due to retropharyngeal pus collection requiring repeated surgical evacuation, and ultimately leading to a fatal outcome.

Discussion: Dermatophytic disease remains a severe disease due to the possibility of potentially life-threatening visceral involvement and antifungal drug resistance.