Arthroderma vanbreuseghemii infection in three family members with kerion and tinea corporis

We present a familial infection caused by Arthroderma vanbreuseghemii. The proband is a 4-year-old boy, who had played with rabbits at his rabbit-farm neighbor. He complained of pruritus and pain in his scalp, which displayed redness, alopecia and painful cysts and eventually discharged pus and scabbed. Several erythema on his face and abdomen were also presented. He was diagnosed as having impetigo but antibacterial agents were not effective and his clinical condition did not improve. Several days later, his parents also developed facial erythema and scaling. The development of a kerion in the boy and tinea corporis in his parents were diagnosed based on the positive KOH examination. Morphologic and biochemical characteristics confirmed that their infections were caused by the zoophilic Trichophyton mentagrophytes, while sequencing of the internal transcribed spacer (ITS) 1/4 polymerase chain reaction products, amplified from primary culture isolates, established its Arthroderma vanbreuseghemii lineage. Random amplified polymorphic DNA (RAPD) analysis indicated these isolates might be the same strain and that infectio cruciata occurred in this family. Semi-quantitative analysis of these strains indicated multiple and main enzymatic activities of alkaline phosphatase, beta-glucosaccharase. The boy was cured through treatment with itraconazole 100 mg/day orally in combination with topical washes with 2% ketoconazole shampoo, and his parents were successfully treated by topical application of terbinafine cream.