梅本 尚可

Trichophyton rubrum is a well-known causative agent of superficial dermatophytosis that is typically confined to the stratum corneum. However, in rare cases, it can infiltrate the dermis and cause disseminated dermatophytosis, particularly in immunocompromised patients. Here, we report a case of disseminated trichophytosis with vascular invasion that led to the dissemination of the pathogen to distant skin sites. A 51-year-old Japanese woman with a history of tinea corporis three years earlier and systemic lupus erythematosus, treated with long-term methylprednisolone, developed multiple subcutaneous nodules, abscesses, and ulcers in both lower extremities. Histopathological examination revealed extensive necrosis in the dermis and subcutaneous tissue, with clusters of filamentous fungi exhibiting asymmetric branching infiltrating both within and outside the vascular walls. Culture and genetic analyses identified Trichophyton rubrum, leading to the diagnosis of disseminated trichophytosis. Invasive aspergillosis was initially suspected, and the patient was treated with voriconazole; however, the treatment proved ineffective. Ultimately, the patient succumbed to gastrointestinal hemorrhage due to malignant lymphoma. Here, we present a case report and literature review of disseminated trichophytosis.

Cutaneous arteritis (CA) is a rare cutaneous manifestation of Crohn's disease. A 50-year-old woman with a 15-year history of CA was admitted to our hospital with a fever, abdominal pain, and hematochezia. Based on these symptoms and increased C-reactive protein levels, systemic vasculitis was considered. However, emergency colonoscopy revealed multiple longitudinal ulcers throughout the colon, thus suggesting Crohn's disease. Prednisolone (60 mg/day) was administered intravenously. A histopathological examination of the biopsied colonic mucosa revealed epithelioid granulomas, which confirmed the diagnosis of Crohn's disease. Because the systemic evolution of CA is rare, other comorbidities should be considered when patients with CA experience systemic manifestations.