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Surgical management of deep dermatophytosis in a patient with CARD9 deficiency

Summary

A 23-year-old man from North Africa with a genetic immune disorder (CARD9 deficiency) developed a serious fungal skin infection with deep tissue involvement. The infection caused multiple pus-filled pockets and hair loss on his scalp. Doctors treated him with both antifungal medications and surgery to drain the infected areas, resulting in complete healing after two weeks.

Background

Deep dermatophytosis is a dermal infection caused by dermatophytes that can progress to deeper tissues and visceral involvement. CARD9 deficiency is a known risk factor in the Mediterranean region, with the first Moroccan case reported in 1964. This case presents a 23-year-old man with CARD9 mutation presenting with scarring alopecia and subcutaneous abscesses.

Objective

To report a case of deep dermatophytic disease with CARD9 mutation and demonstrate the role of surgical management in combination with medical treatment for recalcitrant cases.

Results

Surgical drainage with Delbet blades was performed on anterior, dorsal, and scalp abscesses, revealing creamy evacuation fluid with multiple septate abscesses. The Delbet blades were removed after 7 days and complete healing was achieved by day 15 with suture removal. The patient had an uneventful postoperative course.

Conclusion

Surgical drainage combined with antifungal therapy and immunological support provides effective management for severe deep dermatophytosis in CARD9-deficient patients. Surgery is warranted in severe cases with multiple abscesses where antifungal diffusion is poor and functional discomfort is significant.
  • Published in:Journal of Surgical Case Reports,
  • Study Type:Case Report,
  • Source: PMID: 37426045, DOI: 10.1093/jscr/rjad388
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