|LETTER TO EDITOR
|Year : 2022 | Volume
| Issue : 1 | Page : 93-94
Co-localization of dermatophytosis with bt hansen in a child: A paradox
Ishan Agrawal, Maitreyee Panda, Ajaya Kumar Jena, Arunima Ray
Department of Dermatology, IMS and SUM Hospital, Siksha 'O' Anusundhan University, Bhubaneswar, Odisha, India
|Date of Submission||22-May-2021|
|Date of Acceptance||10-Nov-2021|
|Date of Web Publication||31-Dec-2021|
Department of Dermatology, IMS and SUM Hospital, Siksha 'O' Anusundhan University, Bhubaneswar - 751 003, Odisha
Source of Support: None, Conflict of Interest: None
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
Dermatophytosis is globally prevalent with increasing incidence in India. Despite aggressive initiatives by the government, like the National Eradication Programs, leprosy is still endemic in pockets of our country. 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. The possibility of superficial fungal infection in lepromatous leprosy may be explained by the general immunocompromised state of the patients.
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., 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. 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.
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.
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Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]