VDE266.

fm Page 51 Saturday, February 9, 2002 2:19 PM

Veterinary Dermatology 2002, 13, 51 54

Case report

Blackwell Science, Ltd

Dermatophyte granulomas caused by Trichophyton

mentagrophytes in a dog
ROBERT L. BERGMAN,* LINDA MEDLEAU,* KEITH HNILICA*
and ELIZABETH HOWERTH
*Department of Small Animal Medicine, College of Veterinary Medicine, University of Georgia,

Athens, GA 30602-7390, USA

Department of Pathology, College of Veterinary Medicine, University of Georgia, Athens,

GA 30602-7390, USA
(Received 22 November 1999; accepted 27 April 2001)

Abstract Multiple, dermal and subcutaneous nodules developed in a young female Manchester Terrier dog that
had a chronic history of superficial dermatophytosis. Skin biopsy specimens of the nodules revealed granulomatous inflammation in the deep dermis and subcutis with branching fungal organisms. Cultures of multiple biopsy
specimens from the nodules all yielded Trichophyton mentagrophytes. The lesions in this dog were similar to granulomatous dermatophytosis, a skin disease that has been reported in Persian cats and one Yorkshire Terrier dog.
Keywords: canine, dermatophyte granuloma, dermatophytosis, dog, Trichophyton sp.

INTRODUCTION
A dermal dermatophyte infection is an uncommon
sequela of superficial dermatophytosis that occurs
when the dermatophyte invades the dermis of the skin.
If the dermatophyte forms grains within the dermis,
the lesion is called granulomatous dermatophytosis
(pseudomycetoma).1,2 Dermatophyte granulomas have
been reported in Persian cats and in one dog; Microsporum canis was the causative agent in all cases.36
The purpose of this report is to describe the dermal and
subcutaneous lesions of granulomatous Trichophyton
mentagrophytes in a dog.

CASE STUDY
A 5-month-old female Manchester Terrier dog weighing 4.4 kg, presented to the University of Georgia
Veterinary Teaching Hospital for evaluation of chronic
skin problems. A single, nonpruritic, 2 cm circular
area of alopecia was present on the caudal aspect of
the dorsum when the dog was purchased at 8 weeks of
age from a breeder. One person in the household had
been treated successfully for dermatophytosis that
developed shortly after the puppy was acquired. There
were no other pets in the house. The puppys dam and
Correspondence: Linda Medleau. Department of Small Animal
Medicine, College of Veterinary Medicine, University of Georgia,
Athens, GA 30602-7390, USA. E-mail: lmedleau@calc.vet.uga.edu
2002 Blackwell Science Ltd

sire had a few small focal areas of alopecia but no other

littermates were affected. The puppys skin disease progressed to multifocal areas of alopecia, at which time
dermatophytosis was diagnosed by the referring veterinarian. In spite of treatment with griseofulvin, lime
sulfur baths and cephadroxil, the skin condition worsened.
Approximately 1 month prior to presentation the dog
developed multiple enlarged nodules on the trunk.
On physical examination the dog had several nonpainful, nonpruritic, firm dermal and subcutaneous
nodules, 12 cm diameter, on the dorsum of its back
and in the left axillary region (Fig. 1). Some of these
nodules were ulcerated and had draining tracts. Both
superficial cervical lymph nodes and the left inguinal
lymph node were enlarged. Deep skin scrapes were
negative for ectoparasites and the hair over the lesions
did not fluoresce under Woods light examination.
A haemogram indicated a nonregenerative anaemia
(HCT 0.285 L L1, 0.350.57 L L1) based on a normochromasia (342 g L1, 320363 g L1), absence of
reticulocytosis (0.2%, 0.01.0%) and a microcytosis
(MCV 64.3 fl; 6677 fl).7 The white blood cell count
was within the normal range (6.2 109 L1, 5.100
13.0 109 L1), however, immature neutrophils were
increased at (8.68 109 L1, 04.5 109 L1). Serum
chemistry indicated a hypoalbuminemia (17 g L1, 22
35 g L1), and an increased alkaline phosphatase
(308 u L1, 1114 u L1).
Cytology of fine-needle aspirates of cutaneous
nodules revealed neutrophilic inflammation and septate fungal hyphae. Skin biopsy specimens of three
51

VDE266.fm Page 52 Saturday, February 9, 2002 2:19 PM

52

R. L. Bergman et al.

Figure 2. Diffuse granulomatous inflammation with numerous

multinucleated giant cells. Foci of degenerate neutrophils are also
present. H&E stain, final magnification 125, bar = 80 m.

Figure 1. Dorsal cervical regions demonstrating the dermal nodules

(1 2 cm) with ulceration and crusting.

cutaneous nodules and the right cervical lymph node

were submitted for histopathological examination.
Tissue sections were stained with haematoxylin and
eosin (H&E), Lillie-Twort Gram stain for bacteria, and
periodic acid Schiff reaction (PAS) and Gomoris
methenamine silver (GMS) stain for fungus.
The skin had extensive granulomatous inflammation
that extended from the superficial dermis into the subcutis or was restricted to the deep dermis and subcutis.
In the superficial dermis the inflammation was primarily perifollicular, whereas in the deep dermis and
subcutis it was either diffuse or formed large nodules.
The infiltrating cells were primarily epithelioid macrophages and multinucleated giant cells with scattered
small accumulations of neutrophils (Fig. 2). The granulomatous areas also had multiple perivascular infiltrations of plasma cells and lymphocytes and large
areas of liquefactive necrosis containing a few degenerate neutrophils. In areas of perifollicular inflammation the epidermis was slightly hyperkeratotic and
acanthotic and follicles were filled with keratin and cellular debris. In these areas, septate, branching, 35 m
in diameter, fungal hyphae with parallel walls were
seen in the keratin of the epidermis and hair follicles.
Massive numbers of fungal hyphae, both free and
within macrophages, were also seen throughout the
granulomatous inflammation (Fig. 3). The lymph node
architecture was obliterated by inflammation, areas of
necrosis and fungal hyphae growth.
2002 Blackwell Science Ltd, Veterinary Dermatology, 13, 51 54

Figure 3. Dermatophyte granuloma demonstrating branching

fungal hyphae and large globose structures. GMS stain, final
magnification 125, bar = 80 m.

Several skin biopsy and lymph node specimens were

collected aseptically and submitted for culture to the
Athens Diagnostic Laboratory, University of Georgia.
All yielded Trichophyton mentagrophytes.
A diagnosis of dermatophyte granulomas caused by
T. mentagrophytes was made. Treatment with oral itraconazole and surgical removal of the largest nodules
was discussed, but the dog died suddenly 3 days later.
Necropsy was not performed.

DISCUSSION
Dermatophyte granulomas caused by Microsporum
canis have been reported in several cats and one dog.3 6,8
The lesions were characterized by firm nodules that
ulcerated and drained, and were most commonly
found on the dorsal trunk and tail base.3 In humans,
dermatophyte granulomas are caused by Microsporum
and Trichophyton species, and tend to be characterized
by nodular lesions on the scalp.1,9,10
In humans and cats, dermatophyte granulomas
usually result as a sequela to superficial dermatophytosis.1,3,9,10 It is speculated that the pathogenesis of

VDE266.fm Page 53 Saturday, February 9, 2002 2:19 PM

Dermatophyte granuloma
dermatophyte granulomas may be related to hair
follicle rupture with the spread of the organism into
the adjacent dermis.10 A subsequent granulomatous
response occurs as a hypersensitivity reaction to the
dermatophyte which results in deposition of amorphous material around the fungus.10
Typical histological lesions of dermatophyte granuloma include a pyogranulomatous to granulomatous
panniculitis;5 the lesions may be nodular to diffuse.
The inflammatory response is characterized by the
presence of neutrophils, macrophages, epithelioid cells
and multinucleated cells. Fibroplasia may surround
the granulomas. There may not be detectable fungi in
the hair shafts and epidermis.5 The fungi present as
broad, hyalin, septate hyphae and chain-like pseudohyphae and large chlamydospore-like cells within
grains or granules.2 Also, there may be a granulomatous amorphous eosinophilic material present with
irregularly shaped aggregates of distorted septate
hyphae and thick-walled embedded fungal cells.5
Dermatophyte granulomas are often a chronic
condition that may have a poor outcome.6 Different
therapeutic modalities have been used for these granulomas in cats. Itraconazole together with surgical
excision has been advocated.5 Other therapies in cats
have included griseofulvin, ketoconazole and surgical
excision alone.3,5,8 In humans treatment also has consisted of surgical excision and antifungal agents.1,9,10
There is only one case report of dermatophyte
granulomas in a dog, which was caused by Microsporum canis. The dog was a 3-year-old female, spayed
Yorkshire Terrier with a long history of superficial
dermatophytosis. Lesions included subcutaneous
inguinal masses, and superficial cervical lymphadenomegaly and onychyomycosis. The dog did not respond
to treatment with griseofulvin, ketoconazole or itraconazole, and was eventually euthanized.6
The dog in this case report was infected with
T. mentagrophytes, which caused lesions clinically
resembling dermatophyte granulomas. However, the
lesions in this case were different to what has been
reported previously; histologically, fungal hyphae
were found scattered diffusely throughout the dermis,
and did not form grains or granules within the tissue.
This case is of interest because T. mentagrophytes
has not previously been reported to cause dermatophyte granulomas in dogs or cats.

53

ACKNOWLEDGEMENTS
Dr Linda Shell for help in preparation of the manuscript. No outside sources of funding were used.
REFERENCES
1. Rinaldi, M.G., Lamazor, E.A., Roeser, E.H. et al.
Mycetoma or pseudomycetoma?: a distinctive mycosis
caused by dermatophytes. Mycopathologia 1983; 81: 41
8.
2. Scott, D.W., Miller, W.H., Jr, Griffin, C.E. Fungal skin
diseases. In: Muller and Kirks Small Animal Dermatology, 5th edn. Philadelphia: W.B. Saunders, 1995: 330
89.
3. Medleau, L. Recently described dermatoses. Veterinary
Clinics of North America: Small Animal Practice 1990; 20
(6): 162332.
4. Tuttle, P.A. Deep dermatophytosis in a cat. Journal of the
American Veterinary Medical Association 1983; 183:
11068.
5. Medleau, L., Rakich, P.M. Microsporum canis pseudomycetomas in a cat. Journal of the American Animal
Hospital Association 1994; 30: 5736.
6. MacKay, B.M., Johnstone, I., OBoyle, D.A. et al. Severe
dermatophyte infections in a dog and cat. Australian
Veterinary Practitioner 1997; 27: 8690.
7. Duncan, J.R., Prasse, K.W., Mahaffey, E.A. Veterinary
Laboratory Medicine: Clinical Pathology, 3rd edn. Ames:
Iowa State University Press, 1994: 1122.
8. Miller, W.H., Goldschmidt, M.H. Mycetomas in the cat
caused by a dermatophyte: a case report. Journal of the
American Animal Hospital Association 1986; 22: 25560.
9. Chen, A.W.J., Kuo, J.W.L., Chen, J.S. et al. Dermatophyte pseudomycetoma: a case report. British Journal of
Dermatology 1993; 129: 72932.
10. Lee, K.H., Myung, K.B., Lee, S. Pseudomycetoma due
to Trichophyton schoenleinii occurring in two brothers.
Annals of Dermatology 1989; 1: 1026.

ADDENDUM
Since the writing of this case report, two more dogs
with dermatophytic pseudomycetomas, one caused by
M. Canis and the other by an unidentified dermatophyte, have been reported. (Abramo, F. Vercelli, A.,
Mancianti, F. Two cases of dermatophytic pseudomycetoma in the dog: an immunohistochemical study.
Veterinary Dermatology 2001; 12: 2037.)

Rsum Une chienne Manchester Terrier, souffrant de dermatophytose chronique superficielle, a prsent de
nombreux nodules, dermiques et sous-cutans. Des biopsies obtenues partir des nodules ont montr une inflammation granulomateuse du derme profond et du tissu sous-cutan, contenant des organismes fongiques filamenteux. Des cultures fongiques multiples ralises partir de biopsies de ces nodules a permis la pousse de
Trichophyton mentagrophytes. Les lsions de ce chien sont comparables celles rapportes dans la dermatophytose granulomateuse, une entit pralablement dcrite chez le chat Persan et chez un Yorkshire Terrier.

2002 Blackwell Science Ltd, Veterinary Dermatology, 13, 5154

VDE266.fm Page 54 Saturday, February 9, 2002 2:19 PM

54

R. L. Bergman et al.
Resumen Un perro Manchester Terrier, hembra joven, con una historia crnica de dermatofitosis superficial,
desarroll mltiples ndulos drmicos y subcutneos. Las muestras de biopsia cutnea revelaron inflamacin
granulomatosa en la dermis profunda y en el tejido subcutneo, con organismos fngicos ramificados. Los cultivos de mltiples muestras de biopsia de los ndulos produjeron Trichophyton mentagrophytes. Las lesiones en
este perro fueron similares a la dermatofitosis granulomatosa, una enfermedad cutnea descrita en los gatos Persa
y en un perro Yorkshire Terrier.
Zusammenfassung Mehrere dermale und subkutane Knoten entwickelten sich bei einer jungen Manchesterterrierhndin, die eine chronische oberflchliche Dermatophytose hatte. Hautbiopsieproben der Knoten ergaben
eine granulomatse Entzndung in der tiefen Dermis und Subkutis mit verstelten Dermatophyten. Kulturen
von mehreren Knoten ergaben alle Trichophyton mentagrophytes. Die Lsionen bei diesem Hund waren denen
der bei Perserkatzen und bei einem Yorkshireterrier verffentlichten granulomatsen Dermatophytose hnlich.

2002 Blackwell Science Ltd, Veterinary Dermatology, 13, 51 54