Ulcerative Tinea Corporis in an Immunosuppressed patient

Worldwide, Trichophyton rubrum is the most common cause of dermatophytosis. Infection is classically superficial, limited to the cornified layers of the skin, and may be accompanied by varying degrees of inflammation. Dermatophyte invasion is limited by multiple host factors, including sebum production, an intact skin barrier, and immunocompetence. We describe a 65 year old gentleman with a history of diabetes mellitus, hypertension, nephrogenic systemic fibrosis, and immunosuppressed status due to renal transplant who presented with a non-healing ulcer of the left dorsal hand. Further examination revealed palmar erythema and scale as well as annular erythematous plaques with peripheral scale on his bilateral knees. Laboratory testing yielded the diagnosis of tinea corporis, with bacterial superinfection of the left dorsal hand. The patient was started on systemic antimicrobials with complete healing of the ulcer along with total clearance of the rash. This case highlights an unusual presentation of invasive Trichophyton rubrum in the setting of immunosuppression and nephrogenic systemic fibrosis.