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A Case of Superficial Mycoses in a Patient with Systemic Lupus Erythematosus

Summary

A 52-year-old woman with lupus developed severe fungal skin infections that were initially mistaken for worsening lupus symptoms. Her condition improved after 6 months of treatment with two antifungal medications (terbinafine and itraconazole). This case reminds doctors that patients taking immunosuppressive medications for lupus are at high risk for fungal infections, which can be misdiagnosed as lupus flares.

Background

Superficial mycoses are fungal infections of keratinized tissues affecting 20-25% of the global population. Patients with systemic lupus erythematosus (SLE) on long-term immunosuppressive therapy have increased susceptibility to fungal infections. This case presents a 52-year-old woman with a 10-year history of SLE who developed extensive superficial mycosis.

Objective

To document and describe the clinical presentation, diagnosis, and treatment of superficial mycosis in an SLE patient with immunosuppressive therapy. The case aims to alert clinicians to the possibility of fungal infections being misdiagnosed as SLE manifestations.

Results

Fungal microscopy showed positive mycelia and culture revealed Trichophyton tonsurans on the scalp and Candida tropicalis on the face. After 6 months of combined treatment with terbinafine (0.25g daily) and itraconazole (0.2g twice daily), the rash subsided, hair regrew, nails normalized, and fungal microscopy became negative with no recurrence at 6-month follow-up.

Conclusion

Special attention must be paid to immune status and fungal infection risk in SLE patients on immunosuppressive therapy. Appropriate diagnostic measures and treatment selection based on infection site and fungal type are essential to prevent disease deterioration. This case emphasizes the importance of considering fungal infections in SLE patients with persistent skin manifestations.
  • Published in:Clinical, Cosmetic and Investigational Dermatology,
  • Study Type:Case Report,
  • Source: 10.2147/CCID.S496301; PMID: 39872226
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