Neonatal Dermatophytosis: Report of a Case and Review of the Literature

Tinea capitis is a common fungal infection in children but rare among neonates. We present a case of a 3-week-old infant with multiple scalp lesions for 1 week. A diagnosis of tinea capitis due to Microsporum canis was made based on clinical morphology, Wood's lamp, and biopsy with a positive PAS stain. She was effectively treated with oral griseofulvin and ketoconazole shampoo. CASE REPORT A 3-week-old female infant was brought to our clinic by her mother, an immigrant from Senegal, with a 1-week history of a widespread annular rash. The infant was born in the United States and had a normal delivery. She was breastfed and was otherwise thriving. Prenatal screening tests were all negative. No history of fever or other symptoms were confirmed for the infant. The in- fant was not exposed to any animals at home, and her mother and other household members were asymptom- atic. The patient's mother reported a history of the same symptoms in her elder daughter when approximately the same age. The patient's elder sister was born in Senegal, and her symptoms resolved following the administration of an herbal remedy. The sister did not have clinical le- sions upon the patient's presentation, nor during the follow-up visits. Upon exam, the patient had multiple erythematous scaly, occasionally annular patches associated with hair loss over the scalp but no evidence of scarring (Fig. 1). Similar lesions were also seen on the face, trunk, and bilaterally on the extremities (Fig. 2). No other systemic symptoms were elicited from the patient or her mother. The differential diagnosis included Langerhan's his- tiocytosis, neonatal lupus, secondary syphilis, seborrheic dermatitis, and erythema multiforme. Since neonatal lupus was strongly considered, a skin biopsy and sero- logical testing from the mother were done on the initial visit. Given the patient's young age, the possibility of a dermatophyte infection was absent on our differential, and a potassium hydroxide (KOH) test was not done. Testing the mother for antiSM, RNP, SSA, SSB, SCL70, Jo-1, and rapid plasma reagin (RPR) was negative. Biopsy results surprisingly showed numerous noninva- sive hyphae and spores overlying a mildly thickened