Acta Dermato-Venereologica 99-10CompleteContent | Page 28

925 SHORT COMMUNICATION Tinea Barbae due to Trichophyton mentagrophytes Contracted from Calves Ayako ITO 1 , Nanako YAMADA 1 , Ryoko KIMURA 1 , Kazushi ANZAWA 2 , Takashi MOCHIZUKI 2 and Osamu YAMAMOTO 1 1 Division of Dermatology, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, Tottori University, 86 Nishi-cho, Yonago, 683-8503, and 2 Department of Dermatology, Kanazawa Medical University, Ishikawa, Japan. E-mail: [email protected] Accepted Jun 25, 2019; E-published Jun 26, 2019 Tinea barbae is a rare form of dermatophytosis that af- fects hair and hair follicles of the beard and moustache. It occurs in two modalities: a mild superficial type, very similar to the common tinea, and a deep type, which typically causes pustular folliculitis or severe kerion-like inflammation (1, 2). Generally, the former is caused by anthropophilic dermatophytes, and the latter by zoophilic dermatophytes and may be confused with other bacterial facial infections due to the severe inflammation (3). The latter is usually caused by occupational exposure to infected animals. Although, the most frequent causative agent of dermatophytosis from infected cattle is Tricho­ phyton verrucosum (4), T. mentagrophytes was identified from our patient and one of his calves by a molecular biological technique. A 69-year-old Japanese man who was a cattle farmer was refer- red to us with a one-month history of multiple follicular papules and pustules in his beard area. He had been treated with topical and oral antibiotics for 2 weeks before presenting to our hospital. Physical examination revealed multiple follicular papules, multiple pustules with purulent exudate and superficial yellowish crusts, and painful subcutaneous nodules in the beard area. His face was slightly swollen and hairs from the lesion could be plucked easily (Fig. 1a). He was otherwise in a good general health. We performed a biopsy from the cheek lesion and fungal culture from CASE REPORT the specimen. Histopathological examination showed a dense perifollicular mixed-cellular inflammatory infiltration with some granulomatous foci in the dermis extending into the subcutaneous tissue. Periodic acid-Schiff (PAS) staining revealed chains of arthro­conidia within and on the hair shafts (Fig. 1b). Culture of the biopsied specimen resulted in cream-white and rapidly growing colonies with a powdery surface (KMU 9922) that de- veloped after 2 weeks of incubation on Sabouraud dextrose agar at 27°C. The reverse side of a colony was yellowish-brown (Fig. 1c). Slide culture of the isolate showed thin-walled macroconidia, spiral hyphae and many grape-like clusters of microconidia (Fig. 1d), suggesting T. mentagrophytes. The isolate KMU 9922 was identified as Arthroderma vanbreuseghemii by sequence analysis of the internal transcribed spacer (ITS) regions of ribosomal DNA genes with 99.8% (643/644) homology to that of the type strain for the fungus previously named A. vanbreuseghemii (RV27960, Gen Bank Accession number AF170452) and were completely identical to T. mentagrophytes under the revised classification (IMF62865, Gen Bank Accession number LC317440)(IMF62865, Gen Bank Accession number LC317440) (Appendix S1 1 ). Two weeks after the initial visit, some calves on his farm were found to have multifocal lesions of alopecia with thick crusts on their heads (Fig. 2a, b). An isolate from a crust of one of the calves (KMU 9923) showed identical mycological findings as those of the patient (Fig. 2c, d). The sequence of the isolate from the calf (KMU 9923) showed 100% (644/644) homology to that from the patient (KMU 9922) by sequence analysis of ITS regions of ribosomal DNA genes. Based on these findings, we made a diag- nosis of tinea barbae due to T. mentagrophytes infection from the https://www.medicaljournals.se/acta/content/abstract/10.2340/00015555-3247 1 Fig. 1. a) Multiple follicular papules, multiple pustules and painful subcutaneous nodules on the bearded area of the patient. b) Chains of arthroconidia within and on the hair shafts (periodic acid-Schiff stain x400). c) The isolate from the biopsy specimen (KMU 9922). The surface of a colony after 14 days of incubation on Sabouraud dextrose agar at 27°C. d) Slide culture after 14 days of incubation (Cotton-blue stain). This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2019 Acta Dermato-Venereologica. doi: 10.2340/00015555-3247 Acta Derm Venereol 2019; 99: 925–926