Disseminated dermatophytic pseudomycetomas arising in an immunocompromised patient

Conflicts of interest: none declared. Sir, Skin infections due to dermatophytes are common and are generally associated with a low degree of morbidity in normal hosts. However, in immunocompromised patients dermatophyte infections are more extensive and often present an atypical clinical picture. Dermatophytes frequently invade the dermis1–3 and even disseminate to internal organs.4 We report a case of disseminated dermatophytic pseudomycetomas, arising in an immunocompromised patient, as a result of an infection with a common dermatophyte –Trichophyton mentagrophytes. A 32‐year‐old woman presented with a 4‐year history of a widespread nodular cutaneous eruption. Her medical history was significant for a thymectomy and severe myasthenia gravis, controlled over the past 12 years with dexamethasone, azathioprine and cholinesterase inhibitors. Physical examination revealed multiple, sharply demarcated, erythematous to violaceous dermal nodules disseminated over the arms, trunk and lower extremities. Upon palpation, some of the nodules were firm, while others demonstrated anetoderma‐like herniation. None of them was draining or ulcerated (Fig. 1a). The second, third and fourth fingernails of the right hand were opaque and dystrophic. Side‐effects of prolonged therapy with potent systemic corticosteroids, such as cushingoid subcutaneous fat redistribution, hypertrichosis and marked striae distensae, were also observed.