Recalcitrant trichophytic granuloma associated with NK-cell deficiency in a SLE patient treated with corticosteroid

Although deep trichophytic infection often occurs in immunocompromised pati ents, the immune deficiency in such patients has not been clarified, A 28-y ear-old man who suffered from recalcitrant trichophytic granuloma and tinea universalis during treatment for SLE with corticosteroid is described here to define the immunological abnormalities. In addition to routine immunolo gical tests, we evaluated the patient's innate and specific immune function s to dermatophytes, including T cell, natural killer (NK) cell and neutroph il functions and activation of the complement cascade, We measured the mini mum inhibitory concentration (MIC) of itraconazole for the isolated fungus and its concentrations in the patient's serum and pus, Trichophyton (T.) ru brum was constantly isolated from the exudates of the patient's skin lesion s, although the concentrations of itraconazole in his serum (198 ng/ml) and lesions (210 ng/ml) were sufficient to inhibit the growth of the isolated fungus in vitro. Specific cell-mediated immune responses, determined by T c ell stimulation and IFN-gamma production, were evoked following stimulation with trichophytic antigens, The patient's innate immunity, assessed by act ivation of the complement cascade and neutrophil-mediated phagocytosis, was not impaired. The number of circulating NK cells was markedly decreased (0 .2% of the peripheral blood mononuclear cells), and was associated with low NK cell activity against K-562 cells even though lymphopenia had improved. The deficiency of innate immunity mediated by NK cells might be responsibl e for a part of the persistence of trichophytic granuloma in our case.