Immunosuppressed patients with pemphigus vulgaris are at high risk of severe dermatophyte infection. 2 case reports
Danka Svecova, Nada Chmurova, Alena Pallova
CaseRepClinPractRev 2007; 8:349-352
Background: Pemphigus vulgaris is an autoimmune blistering disease requiring life perpetuity of immunosuppressive therapy. Affected patients are at risk of developing of common superfi cial and systemic fungal infection as well as bacterial, viral infection and parasitic infestation that may have a severe and prolonged course and could cause serious morbidity in immunosuppressed host especially if the infection is not early recognized.
Case Report: Case 1. A 66-year-old female with pemphigus vulgaris suffered from itchy patches on the skin misdiagnosed as an allergic reaction to alendronate administered for corticosteroid induced osteoporosis. Systemic antihistamines and topical corticosteroid ointment were administered for treatment of allergy. The lesions were spreading with deep invasion in one patch. T.rubrum was isolated in all samples. Systemic terbinafi ne therapy was administered frequently because of reinfection in the course of 9 months together. The treatment was affective with a 12-months follow- up period.
Case 2. A 84 –year- old female with one month history of bullous and erythematous eruption on the body confi rmed as pemphigus foliaceus. The therapy was commenced on prednisone and azathioprine and after 3 weeks dissemination started from obscure fungal infection on the calf spreading on the large area of the body. T.rubrum was confi rmed by culture. Systemic antifungal therapy with terbinafi ne in the course of 3 months was affective with a 12-months follow- up period.
Conclusions: A search for probable dermatophytosis should be done in subjects with pemphigus vulgaris or those undergoing immunosuppressive therapy before and during therapy. This should be done periodically to prevent probable dissemination of any dermatophytic infection as it is routinely done for Candida species.
Keywords: pemhigus, Immunosuppression, dermatophytes, therapy