Kerion Due to Microsporum Gypseum in a 1-Month-Old Infant
A 3-month-old, otherwise healthy infant was brought with an inflamed plaque on the scalp, that had first developed when he was 1 month old. There was no history of any discomfort or pain. He had been treated with multiple courses of systemic antibiotics and a steroid-antibiotic cream topically, without response. The child had been referred to the Pediatric Surgery Department for a scalp biopsy and his parents had been advised a dermatology consultation before the procedure. His mother had a hyperpigmented annular plaque on the dorsum of the right hand, which was subsiding after application of terbinafine cream.\nOn examination, there was a round, tender, boggy plaque 7 cm in diameter on the vertex of the scalp, with almost total loss of hair, with multiple pin-head sized erosions and exudation of pus from some of the follicular orifices [].\nRoutine investigations were all within the normal limits. Wood's lamp examination of the scalp showed no fluorescence. Light microscopic examination of the scanty, easily pluckable hair on the plaque after addition of 30% potassium hydroxide (KOH), revealed small ectothrix spores. Fluorescent microscopy of the hair revealed accentuation of auto-fluorescence of the affected hair with destruction of the normal architecture of the cortex towards the hair root [Figure –].\nFungal culture in modified Sabouraud's dextrose agar medium showed brown colonies with white cottony centers, which were yellow on the reverse. Microscopic examination of the colony morphology with lactophenol cotton blue, revealed symmetrical, ellipsoidal, thin-walled, six-celled maroconidia with rounded ends [Figure –]. KOH examination and fungal culture from the mother's lesion were negative.\nA diagnosis of kerion due to M. gypseum was made. The patient was treated with ultra-micronized griseofulvin in a dose of 10 mg/kg body weight/day, in two divided doses. The lesion healed completely in 6 weeks with near complete regrowth of hair [] and a repeat fungal culture of the hair was negative.