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Institute of Dermatology, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing 210042, China

Objective To report a case of disseminated Trichophyton rubrum granuloma, and to evaluate the therapeutic effect of itraconazole. Methods The following evaluations were performed: clinical data, mycological and histopathological examinations, and effect of therapy. Results The patient was a 46-year-old woman, presented with erythema and scaling on the trunk, hands and feet for 30 years, as well as nodules and ulceration on the scalp, trunk and upper limbs for 2 years. Physical examination revealed purple-red infiltrated plaques and nodules on the scalp, neck, trunk and arms. Exudates, crusts and ulcers were noticed on the surface of some of the lesions. Direct microscopic examination of skin lesion aspiration and nail scrapings showed the presence of hyaline hyphae; fungal culture showed the growth of Trichophyton rubrum. Examination of the skin biopsy specimen revealed an epitheliod granuloma in the dermis infiltrated with several multinucleate giant cells, lymphocytes and eosinophils, the central area of which was necrotic and surrounded by nodular-like epithelioid cell masses. The periodic acid Schiff (PAS) staining was positive for fungal hyphae in the dermis. A diagnosis of disseminated Trichophyton rubrum granuloma was made. The patient was treated with a 3 month course of itraconazole; this resulted in the resolution of the lesions with atrophic scars. No side effects were observed during the treatment. Conclusion Disseminated Trichophyton rubrum granuloma is a rare disease, and itraconazole is effective for it.