Deep (subcutaneous) dermatophyte infection presenting with unilateral lymphoedema.

Summary An unusual presentation of a common infection is described in a 17-year-old girl who had a 14-year history of chronic Trichophyton rubrum affecting both feet. This has persisted despite adequate systemic therapy with griscofulvin and ketoconale and had recently become more extensive with lymphatic spread to a secondary site of infection on her knee. She was not atopic but had depressed cell-mediated immunity with reduced lymphocyte transformation in autologous serum. She had antibodies to Trichophyton rubnum and defective fungal killing by neutrophils. She responded well to itrazole and, over the 12-month period of treatment, her cell-mediated and phagocytic function returned to normal.