부산대학교 도서관

Trichophyton verrucosum is one of the zoophilic dermatophytes that usually infect cattle. When it infects human beings when they have skin contact with cattle, the infection is accompanied by an inflammatory reaction. Pustules coalesce to form elevated erythematous plaques without annular erythema. These unusual clinical features are different from those of common ringworm and may lead to delayed diagnosis. We have experienced two cases wherein steroid ointments were used for different diagnoses, and the clinical courses of the disease were prolonged. Case 1 was that of a 50-year-old male dairy farmer, who had cows, and visited our hospital because of erythema with pustules on his left forearm. He was diagnosed with inflammatory ringworm and was treated with 125 mg/day of itraconazole and neticonazole ointment for 9 weeks. Case 2 was that of a 7-year-old boy. His mother worked in a place with a cowshed. He and his mother did not report any contact with cattle. After he injured his head by hitting it against the doors of the sink shelf, he developed an ulcer on his right temporal area. The ulcer enlarged rapidly and was covered with yellow crusts. The hair strands around the lesion were easily pulled, and hyphae were observed in the hair shafts. He was diagnosed with kerion celsi and was treated with oral terbinafine hydrochloride (60 mg/day) for 4 weeks with no positive outcome. He was then treated with itraconazole (150 mg/day) for 16 weeks without recurrence. Trichophyton verrucosum was identified in the cultures from both patients.