A Strange Umbilical Rash in a Newly Diagnosed HIV-Positive Man: A New Clinical Description of a Trichosporon Spp Dermatosis
Journal Title: Journal of Dermatology Research - Year 2022, Vol 3, Issue 1
Abstract
Trichosporon is a basidiomycete yeast of tropical origin that is also opportunistic in the immunocompromised. It is characterized by irregular nodules attached to the hair called white piedra. Trichosporon spp has been reported as the 2nd most common agent of disseminated, potentially fatal fungemia [1]. Nevertheless, no pure cutaneous manifestation had been reported. We report a single case of Trichosporon spp causing an umbilical papulonodular rash in a newly diagnosed HIV-positive subject. A 25-year-old patient, with a history of homosexuality and unprotected sexual intercourse, presented with a one-week-old asymptomatic reddish rash associated with umbilicated papular lesions of the trunk and lower back, which were pruritic and concomitant in appearance. Dermatological examination revealed scattered copper-red papules on the face, trunk and limbs, palmo-plantar papular lesions surrounded by a thin circular whitish collar, with large papules and nodules with an umbilicated center, pruritic and eroded, located in the sacral region and pre-pectoral area (Fig. 1 and 2). Demoscopy revealed a star-like appearance with an erythema in the center, whitish lines in a radial arrangement surrounded by a crown of vessels in points (Fig. 3). Mucosal examination revealed a syphilitic chancre on the glans and the lymph nodes were free. The rest of the examination was unremarkable. HIV and syphilitic serology were positive with a VDRL titre of 1/64. The lumbar puncture was sterile. A biopsy of the umbilical lesions was performed, which revealed sheets of inflammatory cells made essentially of macrophages forming nodules around the vascular structures of the superficial and deep dermis, microscopic yeasts were present within the macrophagic cytoplasm. The mycological study on the collected tissue revealed the presence of Trichosporon SPP. The diagnosis of an opportunistic infection with Trichosporon SPP in an HIV-positive and syphilitic subject in the 2nd bloom phase was accepted. The patient was being treated with late penicillin for syphilis and antiretroviral treatment was recommended after a normal pre-treatment workup. Three weeks later, the syphilis disappeared and the nodular lesions subsided. Demoscopy of the lesions revealed the disappearance of the star-like appearance with the presence of vessels in points and the attenuation of the erythema.
Authors and Affiliations
Ryme Dassouli1*, Zakia Douhi1, Kenza Tahiri Joutei1, Hanane BayBay1, Sara Elloudi1, Khaoula Abdellaoui2, Laila Tahiri2, Hinde El Fatemi2, Fatima Zahra Mernissi1
Keywords
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- EP ID EP703201
- DOI https://doi.org/10.46889/JDR.2022.3106
- Views 79
- Downloads 0
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