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INTRODUCTION
Tinea capitis is an infection caused by dermatophyte fungi that affects the scalp and hair; the main pathogens are species of the genera Microsporum and Trichophyton [1-3]. According to Sarabi and Khachemoune, it can be classified as anthropophilic (T. rubrum, T. tonsurans, M. audouinii, T. violaceum), zoophilic (M. (M. gypseum, M. fulvum) [2]. It is almost exclusively in children and rarely occurs after puberty [4].
Inflammatory tinea capitis, also known as kerion celsi, is a less common variety, about 13-15% of dermatophytosis of the scalp, usually caused by zoophilic dermatophytes like M. canis, T. mentagrophytes var. mentagrophytes [2,5], T. verrucosum, T. megninii (T. rosaceum), T. violaceum and T. soudanense; however, T. tonsurans has been documented which may be related to the geographic distribution of microorganisms [4,6]. It is clinically characterized by a solitary and usually very painful well-circumscribed inflammatory lesion, with broken-off hair, and purulent discharge from multiple openings [7].
The inflammation is caused by immunological mechanisms; the lesions may be secondarily infected with bacteria (S. aureus) [2] and also, lymphadenopathy [3] may be present.
CASE REPORT
Case 1
A 5 year old boy, presented on the parietal region a 4X4 cm indurated, erythematous scaling plaque with alopecia, and sharp edges; he previously used sulfur soap without improvement. In addition, the patient reported itching and denied fever (Fig. 1 [See PDF]).
Figure 1 [See PDF]
Case 1. Inflammatory tinea capitis (kerion celsi).: scaling and pustules.
A superficial scraping of the lesion was performed with a #15 scalpel blade for direct examination with potassium hydroxide and dimethylsulfoxide (KOH-DMSO) where hyaline hyphae and ectothrix hair invasion were visualized.
Mycosel® agar culture (Sabouraud with cycloheximide and chloramphenicol) showed a powdery beige colony, suggestive of Microsporum gypseum and was confirmed by microscopic examination (Fig. 2 [See PDF]).
Figure 2 [See PDF]
Microscopic aspect of Microsporum gypseum: characteristic macroconidia.
The patient was treated with griseofulvin (10 mg/kg), with complete resolution, after 45 days. Gastrointestinal symptoms associated to the drug, were the reason to reduce the dose, and increasing the duration of treatment.
Case 2
A 7 year old boy with a lesion on the occipital region of his scalp, characterized by an erythematous plaque of 2.5 cm in diameter, indurated, with alopecia, yellowish scales, with well-defined edges, itchy, and...