Introduction:
Dermatophyte infections are characterized by local invasion of
superficial keratinized structures such as skin, hair, and nails by
members of the genera Trichophyton , Microsporum , andEpidermophyton .1,2 Organisms from these genera
infect keratinocytes via arthrospores released from hyphae. Following
attachment to keratinocytes, these arthrospores germinate, and establish
infection in the stratum corneum of the skin.2 These
infections clinically manifest as annular plaques with a collarette of
scale. In humans, these infections are limited to the superficial layers
of the skin due to the keratinophilic nature of the organism as well as
intact cell mediated immunity limiting spread of the infection to deeper
tissues.1,3,4 Uncommonly, when cell mediated immunity
is impaired, these organisms can invade down the hair follicle resulting
in Majocchi granuloma. Rarely deeper invasion may extend into the dermis
and subcutaneous tissue.5,6 With an increasingly large
variety of immunosuppressive medications on the market to treat patients
with autoimmune conditions, malignancies, and solid organ transplants,
there is an increasing population of immunosuppressed patients who may
be at risk for invasive dermatophyte infections. This case presents a
patient with recurrent tinea corporis who developed angioinvasive
dermatophytosis in the setting of ongoing immunosuppressive treatment
for chronic lymphocytic leukemia (CLL) and immune thrombocytopenia
purpura (ITP).