Unusual aspects of granulomatous dermatophytosis

Described are three male patients showing bizarre manifestations of granulomatous dermatophytosis, all in the hand region. One had a small infiltrated nodular lesion near the thumb which was mistaken for a common insect bite. The second had a violaceous-yellowish plaque, also on the thumb, composed of 2–3 small subcutaneous nodules. The third case had five reddish intracutaneous nodules on the dorsum of the hand. Puncture of these nodules revealed the presence of fungal elements and culture yielded T. rubrum in all cases. Each patient was also found to have a fingernail affected by the same agent. Histologic sections in each case showed granulation tissue in the dermis and hypodermis, mainly in the vicinity of hair fragments with spores. These lesions appeared to be variants of Majocchi's granuloma trichophyticum.