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Case Report: Disseminated Vegetating Plaques Occurring over Chronic Recalcitrant Dermatophytosis in an Immunocompromised Patient

Namrata ChhabraDepartment of Dermatology, All India Institute of Medical Sciences, Raipur, India

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Saurabh RautDepartment of Dermatology, All India Institute of Medical Sciences, Raipur, India

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Anju George CDepartment of Dermatology, All India Institute of Medical Sciences, Raipur, India

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ABSTRACT.

Blastomycosis-like pyoderma (BLP) is an uncommon tissue response possibly to bacterial infection that presents as vegetative skin lesions usually in immunocompromised patients. Staphylococcus aureus is the most frequent pathogen implicated in BLP. Here, we report the case of a 32-year-old man who had ulcerative vegetating lesions on extremities for 3 months over preexisting recalcitrant tinea lesions. The patient was hypertensive with a history of chronic graft rejection after renal transplantation 8 months earlier and was on long-term immunosuppressants. Investigations revealed anemia, mild hyperglycemia, and elevated serum creatinine. Histopathology showed suppurative and fibrosing perifolliculitis with moderate pseudocarcinomatous hyperplasia and the culture of biopsy specimen demonstrated growth of Escherichia coli and Citrobacter koseri. The diagnosis of BLP overlying dermatophytoses was made. The skin lesions improved completely with parenteral antibiotics. Local immune dysregulation by dermatophytoses along with iatrogenic immunosuppression may have favored this rare pyoderma.

Author Notes

Address correspondence to Namrata Chhabra, Department of Dermatology, All India Institute of Medical Sciences, Raipur 492099, India. E-mail: chhabra.namrata@gmail.com

Authors’ addresses: Namrata Chhabra, Saurabh Raut, and Anju George C, Department of Dermatology, All India Institute of Medical Sciences, Raipur, India, E-mails: namrata81@aiimsraipur.edu.in, drsaurabhraut@gmail.com, and anjugeorgechirayath@gmail.com.

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