Journal of Clinical and Translational Endocrinology: Case Reports 19 (2021) 100079

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Journal of Clinical and Translational

Endocrinology: Case Reports
journal homepage: www.elsevier.com/locate/jctecasereports.com

Trichophyton mentagrophytes tinea faciei in acromegaly patient: Case report

Yassine Merad a, b, *, Hichem Derrar c, Mohamed Hadj Habib d, Malika Belkacemi e,
Kheira Talha d, Mounia Sekouhi d, Zoubir Belmokhtar f, Haiet Adjmi-Hamoudi a
a
Parasitology-mycology Department, “Hassani Abdelkader” University Hospital, Sidi-Bel-Abbès, Algeria
b
Laboratoire de synthèse de l’information environnementale, UDL, Sidi-Bel-Abbès, Algeria
c
Department of Pulmonary and Lung Diseases, ‘Hassani Abdelkader’ University Hospital, UDL, Sidi-Bel-Abbès, Algeria
d
Endocrinology Department, “Hassani Abdelkader” University Hospital, Sidi-Bel-Abbès, Algeria
e
Department of Hemobiology and Blood Transfusion, “Hassani Abdelkader” Hospital, UDL, Sidi-Bel-Abbès, Algeria
f
Department of Biology and Biotechnology, UDL, Sidi-Bel-Abbes, Algeria

A R T I C L E I N F O A B S T R A C T

Keywords: Tinea corporis, also known as ringworm, is a superficial current fungal infection, especially for child, it has been
Acromegaly largely described in diabetes mellitus but it has never been documented before in adult patient with acromegaly.
Mycosis We report on a 48-year-old acromegaly patient with a history of facial erythematous plaques on the face,
Tinea faciei
managed by topic corticosteroids medication.
Trichophyton mentagrophytes
Case report
During his admission, patient described persisting symptoms of itching and examination revealed annular skin
lesions with erythema, scaling and red papules on the right side of the face.
Skin scraping specimens were collected and examined by direct microscopy and Sabouraud’s culture revealing
Trichophyton mentagrophytes.
This case suggests that corticosteroid medication is not always recommended without biological evidence,
especially in the presence of underlying disease like acromegaly. Hence, dermatophytes should be considered.

1. Introduction common cause of athlete’s foot, fungal infection of the nail, and ring-
worm [5], Mycoses can occurs in adults when underlying disease [6].
Tinea corporis, also known as ringworm, is a superficial fungal Several morphological characteristics are used in differentiation and
infection (dermatophytosis) especially on glabrous skin. Trichophyton identification of Trichophyton species. Typical isolates of Trichophyton
genus is a dematophytic fungus in the phylum Ascomycota. It has several have macroconidia, when present, are smooth-walled and narrowly cub-
species. Most common are Trichophyton mentagrophytes, Trichophyton shaped, although most isolates lack macroconidia. Microconidia are
rubrum, Trichophyton violaceum, Trichophyton tonsurans, Trichophyton often the predominant type of conidia produced by Trichophyton, they
verrucosum and Trichophyton schoenleinii [1]. are typically numerous, one celled, globose, solitary, along hyphae, or in
Acromegaly is a disorder that results from excess growth hormone clusters. Some Trichophyton species may be sterile and the use of spe-
(GH) after the growth plates have closed. Features that may result from cific media is required to induce sporulation [7].
high level of GH or expanding tumor include: Generalized expansion of The differential diagnosis of tinea facei includes seborrheic derma-
the skull at the fontanelle. Soft tissue swelling visibly resulting in titis, rosacea, discoid lupus erythematosus, psoriasis and contact
enlargement of the hands, feet, nose, lips, ears, general thickening of the dermatitis [8], mycological examination is important to rule out sys-
skin, maxillary widening and teeth spacing [2]. temic or hereditary skins disorders, and avoid unjustified corticosteroid
Complication of the disease may include type 2 diabete [3], Car- overuse.
diomyopathy, problems with bones and joints, including osteoarthritis,
nerve compression syndrome [2], Thyroid nodules or thyroid cancer [4], 2. Case report
and Hypogonadism [2].
Trichophyton colonize the upper layers of the skin, and is the most This report covers the case of a 48-year-old male with an Acromegaly

* Corresponding author. Parasitology-mycology Department, “Hassani Abdelkader” University Hospital, Sidi-Bel-Abbès, Algeria.
E-mail address: yassinemerad8@gmail.com (Y. Merad).

https://doi.org/10.1016/j.jecr.2021.100079
Received 11 July 2020; Received in revised form 9 January 2021; Accepted 15 January 2021
Available online 30 January 2021
2214-6245/© 2021 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).
Y. Merad et al. Journal of Clinical and Translational Endocrinology: Case Reports 19 (2021) 100079

known and treated since 1994. The patient presented with skin disorder immunosuppressed individuals increases worldwide. Moreover diabetes
on right cheek that developed over the course of 2 weeks, and was mellitus, cancers and the use of corticosteroids can increase the risk of
initially treated inadequately with corticosteroids, he was referred to dermatophytosis [1,6,9].
our institution for mycological investigation. Tinea can be spread in the following ways: contact with an infected
The initial symptoms seen were Acromegaly features like gigantism humans or animals, exposure to contaminated soil, or exposure to fo-
(1,8 m high and 110 kg of weigh), and typically enlargement of the mites [10,11].
forehead, jaw (prognathism) and nose (Fig. 1), we noticed also The dryness of the skin’s outer layer discourages colonization by
enlargement of the hands and feet associated to teeth spacing. microorganisms, and the shedding of epidermal cells keeps many mi-
Furthermore, patient present symptoms of persisting itching and crobes from establishing residence [12]. However, the skin’s mecha-
show skin annular lesions with erythema, scaling and red papules with nisms of protection may fail because of trauma, irritation, or
central clearing on right side of the face (Fig. 1). maceration. Radiation therapy in acromegaly destroys any lingering
Physical examination did not reveal any other abnormalities. tumor cells and slowly reduces GH levels, but it could be argued that its
Moreover, there were no clinical signs of fungal infection on hands, hair long-term effect include skin fragility and lower resistance to microbes
and nails. aggressions.
The patient is living in urban area, and no animal contact was Furthermore, occlusion of the skin with nonporous materials can
recorded. interfere with the skin’s barrier function by increasing local temperature
Skin scrapings were collected from lesions on sterile Petri dish and and hydration. In acromegaly, oversecretion of sebaceous glands and
were examined with blue lactophenol, and were inoculated on the sur- sweat glands results in oily and sweaty skin, respectively [13,14], which
face of SGA (cyclohexemide and chloramphenicol) then incubated at can facilitate the growth of fungal elements. Skin puffiness due to
27 ◦ C. dermal glycosaminoglycan accumulation is most prominent in the face,
In the present case, the fungi were identified by direct examination hands and feet [13].
(Fig. 2). Furthermore, the species was confirmed after eight days, by its Risk factors of dermatophytosis include using public showers, con-
typical morphological characteristics on culture as shown in Fig. 3. tact sports such as wrestling, excessive sweating, contact with animals,
Ketoconazole was applied directly to the affected area twice a day obesity, and poor immune function [11]. GH/IGF-1 axes have long been
and continued for 4 weeks, and the face lesions resolved completely. supposed to play a role in immunomodulation, and some changes in the
lymphocyte subset pattern have been found in acromegaly [15]. More-
3. Discussion over, some authors have suggested that specific T-cell immunity is
involved in trichophytic infections, but virulence factors of the specific
Ringworm is a contagious fungal infection caused by common mold- pathogen may also be important [16].
like parasites that live on the cells in the outer layer of your skin. Tinea Cutaneous microcirculation is altered leading to an increased vaso-
corporis is common in children and in pre-pubertal age, and rare in constriction in patients with acromegaly [13,14], and a poorly perfused
adults. It remains a significant cause of morbidity as the number of tissue may hinder immune response. Moreover, angiopathy as known in
diabetic foot is a predisposing factor for fungal infection.
Various neoplasms have been reported to occur in acromegaly pa-
tients with a greater than expected incidence [15], and superficial
mycosis seem to be frequent in cancer patients [6].
Tinea is a contagious disease, characterized by a ring-shape, red,
scaly patches with central clearing, scally plaques may rapidly worsen,
especially when wrong topic medication is initiated, as illustrated in this
presentation [10].
Tinea faciei tends to occur in the non-bearded area of the face. The
patient may complain of itching and burning, which become worse after
sunlight exposure. Often, however, red areas may be indistinct, espe-
cially on darkly pigmented skin, and lesions may have little or no scaling
or raised edges. Tinea barbae involves the skin and coarse hairs of the
beard and mustache area. This dermatophyte infection occurs in adult
men and hirsute women [17].
The differential diagnosis includes contact dermatitis, and psoriasis.
T. verrucosum may produce inflammatory disease that can be mistaken
for bacterial infection [18].
Psoriasis clinical presentation includes silvery scale, pitted nails, and
scalp lesions, the inflammatory response tends to be uniform without
central clearing [8].
Cultural features are useful to confirm the diagnosis, especially when
long-term oral therapy is being considered [8].
Rarely, dermatophytes cause a more aggressive and invasive form of
infection, especially in immunosuppressed patients [16,19].
Griseofulvin, once the drug of choice for treatment of dermatophy-
tosis, is now less commonly used due to the availability of more effective
and less toxic drugs. Terbinafine and itraconazole are now commonly
used in treatment of infections due to Trichophyton sp. They are applied
twice a day for two to four weeks. Many of these approved medicines are
safe and effective for children [20].

Fig. 1. Tinea faciei with an active border and central clearing.

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Y. Merad et al. Journal of Clinical and Translational Endocrinology: Case Reports 19 (2021) 100079

Fig. 2. Direct examination 10X and 40X (blue lactophenol mount).

Declaration of competing interest

The authors declare that they have no known competing financial

interests or personal relationships that could have appeared to influence
the work reported in this paper.

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