Background Zoofilic dermatophytes have the ability to infect keratinised tissue and cause highly inflammatory cutaneous injuries. Culture of Trichophytun verrucosum can take 3 weeks, and therefore a high index of clinical suspicion is essential for accurate diagnosis.
Purpose Description of a case of kerion celsi in a girl infected with T verrucosum.
Material and methods We report a case of a 2-year-old patient who attended the emergency room for a scalp abscess caused by trauma on the occipitoparietal region with a haematoma at that level. After exploration, an abscess with spontaneous drainage holes was observed.
Results The patient was first treated with amoxicillin/clavulanate (250/32.5 mg/8 h) orally for 7 days. She was admitted into hospital for worsening injury and was treated with antibiotics again, although bacteriological cultures were negative. Cefuroxime axetil 250 mg/12 h orally was given first followed by clindamycin 30 mg/kg/day intravenously.
The patient’s lesion deepened and spread to 0.5–1 cm plates in the left frontoparietal region.
Empirical antifungal therapy for kerion suspicion, griseofulvin 125 mg/8 h, was initiated and also systemic costicosteroid (prednisone 1 mg/kg /day) to prevent tissue destruction. Biopsy of the lesion was studied to exclude gangrenous pyoderma or lymphoma.
At 10 days, an unidentified fungus grew so therapy was changed to amphotericin B-liposomal IV (5 mg/kg/day) as a broad spectrum antifungal. 3 days later, the fungus T verrucosum was identified and so antifungal therapy was replaced by topical and systemic terbinafine (125 mg/24 h, tablets of 250 mg were split) as this is the treatment of choice for this fungus. Liver tests (AST, ALT and LDH) were carefully performed and showed normal results as terbinafine is off-label for children younger than 4 years. Wounds healed in the operating room under sedoanalgesia.
36 days after admission, she was discharged with weekly outpatient visits.
Conclusion The grandfather of the girl, who lives in a rural area and is a farmer, developed a lesion on his hand, then the mother and finally the girl. Transmission to humans usually occurs by direct contact with infected animals, but can also be spread through contact between people or by sharing personal items.
No conflict of interest.
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