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LETTER TO EDITOR
Year : 2022  |  Volume : 23  |  Issue : 1  |  Page : 93-94

Co-localization of dermatophytosis with bt hansen in a child: A paradox


Department of Dermatology, IMS and SUM Hospital, Siksha 'O' Anusundhan University, Bhubaneswar, Odisha, India

Date of Submission22-May-2021
Date of Acceptance10-Nov-2021
Date of Web Publication31-Dec-2021

Correspondence Address:
Arunima Ray
Department of Dermatology, IMS and SUM Hospital, Siksha 'O' Anusundhan University, Bhubaneswar - 751 003, Odisha
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijpd.ijpd_71_21

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  Abstract 


Co-localization of fungal infections in preexisting BT Hansen's patches is rare. Previously, co-localization of dermatophytic infection with BT Hansen has never been reported. Pathologically, it is a paradox, because tuberculoid leprosy has an increased expression of Langerhans cells and dendritic cell, which are the primary mediators of first-line cutaneous mediators of immunity. Since superficial fungal infections such as pityriasis versicolor and tinea favor skin appendages, it may explain why such co-localization is not seen even when both disease entities, tinea and Hansen, are highly prevalent in certain regions of India.

Keywords: BT Hansen, co-localization, dermatophytosis


How to cite this article:
Agrawal I, Panda M, Jena AK, Ray A. Co-localization of dermatophytosis with bt hansen in a child: A paradox. Indian J Paediatr Dermatol 2022;23:93-4

How to cite this URL:
Agrawal I, Panda M, Jena AK, Ray A. Co-localization of dermatophytosis with bt hansen in a child: A paradox. Indian J Paediatr Dermatol [serial online] 2022 [cited 2022 Jan 16];23:93-4. Available from: https://www.ijpd.in/text.asp?2022/23/1/93/334677



Sir,

Dermatophytosis is globally prevalent with increasing incidence in India.[1] Despite aggressive initiatives by the government, like the National Eradication Programs, leprosy is still endemic in pockets of our country.[2] Although both diseases are common in the present scenario, concurrent presence of both infections and their co-localization has never been reported. We report a child presenting with leprosy patches co-localized with tinea.

A 13-year-old thin-built girl, weighing 30 kg, presented with multiple well-defined hypopigmented, hypoesthetic patches with appendageal loss, patch size ranged from 1 cm × 1 cm to 5 cm × 6 cm, distributed over the entire trunk, bilateral upper limbs [Figure 1]a. The patches had been progressively increasing in size over the past year. In addition, in the past 2 months, there was the appearance of multiple itchy annular plaques, with a raised popular border, mostly over the lower abdomen [Figure 1]b. Annular plaques showed centrifugal spread, and few were present over the previously existent hypopigmented patches [Figure 1]c and [Figure 1]d. Our clinical diagnosis of tinea was confirmed by potassium hydroxide mount, which showed thin septate hyaline fungal hyphae, and culture growth showed Trichophyton mentagrophytes [Figure 2]a. For the patches, we made a preliminary diagnosis of borderline tuberculoid leprosy, substantiated by biopsy finding of well ill-defined clusters of perivascular and perineural chronic inflammatory cells comprised lymphocytes, histiocytes, and epithelioid cells, with focal nerve destruction. The presence of few bacilli was seen with Wade–Fite staining [Figure 2]b.
Figure 1: (a and b) Multiple (<20) well-defined hypopigmented patches over the trunk, and presence of multiple annular scaly plaques, (c and d) Co-localization of annular plaques over the hypopigmented patches of BT Hansen

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Figure 2: (a) Trichophyton mentagrophytes on fungal culture with KOH showing thin septate hyphae (inset). (b) Histopathology showing perivascular and perineural inflammatory cells including lymphocytes, histiocytes, and epithelioid cells. Acid-fast bacilli on Wade–Fite stain (inset)

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The patient was started on recommended multidrug therapy (MDT) with rifampicin, clofazimine, and dapsone for Hansen's and antifungal therapy with oral itraconazole and topical eberconazole. Follow-up visit after 4 weeks showed visible clearing of tinea plaques.

By themselves, both dermatophytosis and leprosy are highly prevalent, but co-localized infection in an untreated Hansen's patient has never been reported. Dermatophytic infections may be a late iatrogenic effect of antileprotic and corticosteroid therapy in treated patients.[3] The possibility of superficial fungal infection in lepromatous leprosy may be explained by the general immunocompromised state of the patients.[2]

Ideally, the tuberculoid form of leprosy shows an increased expression of Langerin and dendritic cells in the epidermis, which is also noted in the areas adjacent to the infiltrate, which makes the co-localization of tinea paradoxical since the primary defense against dermatophytes is by the epidermal Langerhans cells.[3],[4] This may be a possible explanation why both the diseases rarely occur concurrently and their anatomical co-localization is not yet reported.

Thangaraju et al. reported a case of tinea barbae in a Hansen's patient, after release from treatment. It did not show co-localization but emphasizes the possibility of superficial and deep fungal infections due to the patient's immunocompromised state.[2] Narang et al. reported a case with co-localization of pityriasis versicolor in a BT Hansen's patch, elaborating the pathological paradox of presence of lipophilic yeast in an area with almost complete destruction of appendages including sebaceous glands.[5]

However, both cases feature patients who were either undergoing treatment or fully treated with MDT and steroids. Our case demonstrates a rare co-localization of superficial dermatophytoses in preexisting patches in an untreated patient of BT Hansen, which has never been reported before.

Consent for publication

The authors certify that they have obtained appropriate patient consent. The patient has given her consent for her images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Dash M, Panda M, Patro N, Mohapatra M. Sociodemographic profile and pattern of superficial dermatophytic infections among pediatric population in a tertiary care teaching hospital in Odisha. Indian J Paediatr Dermatol 2017;18:191-5.  Back to cited text no. 1
  [Full text]  
2.
Thangaraju P, Giri V, Singh H, Kumar V, Ali S. Tinea barbae: In released from treatment (RFT) Hansen's disease patient. J Clin Diagn Res 2014;8:YD01-2.  Back to cited text no. 2
    
3.
Tavares Rodrigues F, Pereira Cardozo MR, da Costa Nery JA. Widespread dermatophytosis in a patient treated for leprosy type II reactional state after MDT/WHO-MB release. Am J Trop Med Hyg 2018;99:813-4.  Back to cited text no. 3
    
4.
Brasch J. Pathogenesis of tinea. J Deutsch Dermatol Ges 2010;8:780-6.  Back to cited text no. 4
    
5.
Narang T, Dogra S, Kaur I. Co-localization of Pityriasis versicolor and BT Hansen's disease. Int J Lepr Other Mycobact Dis 2005;73:206-7.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2]



 

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