Portal de Periódicos da CAPES

NEONATAL TINEA CAPITIS

1998; Lippincott Williams & Wilkins; Volume: 17; Issue: 3 Linguagem: Inglês

10.1097/00006454-199803000-00021

1532-0987

William L. Weston, Joseph G. Morelli,

Oral Health Pathology and Treatment

Tinea capitis may be seen in a variety of morphologic patterns including circumscribed areas of scalp hair loss, diffuse scaling, black dots, follicular pustules, dermatitis and single or multiple kerions.1 Tinea capitis rarely occurs in newborns.2-7 We report a novel case of unsuspected and severe pustulonodular tinea capitis in a newborn. Case report. A 5-week-old infant was referred to Pediatric Dermatology for scalp pustules and nodules rapidly spreading for 3 weeks. The Guatemalan-Mexican baby weighed 3.12 kg at birth, 3.43 at 2 weeks and 4.56 at 5 weeks. The baby was bottle-fed and otherwise thriving. When pustules first appeared a 10-day course of cephalexin was given. Despite this therapy more scalp pustules and nodules appeared and a 10-day course of amoxicillin-clavulanate was given. Despite oral antibiotics the condition worsened and intravenous antibiotic therapy was considered. Both mother and child were HIV-negative. A complete blood count was normal and further immune system evaluation was considered by the pediatrician pending the dermatology evaluation. At the Pediatric Dermatology clinic visit at 5 weeks of age there were dozens of discrete, 5- to 15-mm follicular pustules, crusted boggy 15- to 25-mm plaques and 10- to 20-mm red nodules on the right half of the scalp and the right lateral and anterior neck (Fig. 1). There was loss of most of the scalp hair on the right side of the head. There was prominent right anterior and posterior cervical lymphadenopathy. With an 18-gauge needle broken hairs were plucked from the pustules and by microscopic examination chains of hyphae within the broken hair were demonstrated. Fungal culture yielded Trichophyton tonsurans. The baby was treated with griseofulvin 20 mg/kg/day. There was remarkable clearing at 2 weeks and the scalp was clinically and mycologically cleared at 4 weeks. The source of infection was not identified.Fig. 1: Many follicular pustules and inflammatory nodules on the scalp and neck with loss of parietal and occipital hair in a 3-week-old baby.Discussion. This baby is unusual because in addition to follicular pustules and multiple kerions, he had deep red nodules, reminiscent of those observed in Majocchi's granuloma.8 In Majocchi's granuloma, the dermatophytes invade deeply into hair follicles. It is mostly observed in children with cancer, receiving immunosuppressive drugs, in immunodeficiency states or after the use of superpotent topical steroids. The reported baby may have had relative immune immaturity but was thriving at the onset of the infection and during the time the infection was spreading. He was HIV-negative. After antifungal therapy he continued to thrive and had had no further infections at 9 months of age. The tinea capitis in this infant mimicked bacterial infection of the scalp, and two antibiotic regimens failed. Clinicians should recognize that the dermatophytes responsible for tinea capitis can produce deep nodules and large pustules that mimic bacterial infection. Plucking broken hairs from a follicular pustule for laboratory examination is a helpful diagnostic strategy. Griseofulvin has been used previously in newborns and tolerated well.2-4 We did not use steroids for the multiple kerions as recommended by Honig et al.9 William L. Weston, M.D. Joseph G. Morelli, M.D. Departments of Dermatology and Pediatrics; University of Colorado School of Medicine; Denver, CO