Extensive Tinea Infection in a Post Covid 19 Patient of Type 2 Diabetes-A Case Study

Abstract

Introduction: Dermatophytes are the most common agents of superficial fungal infections worldwide, and especially widespread in the tropical and subtropical countries like India, where the environmental temperature and relative humidity are high. Corona virus disease-2019 (COVID-19) likely increases the risk for fungal infections because of its effect on the immune system and because the treatments for COVID-19 (like steroids and other drugs) can weaken the body’s defenses against fungi. The present case discusses extensive Tinea infection in post COVID-19 patient living with Type-2 Diabetes Mellitus (T2DM). Case presentation, diagnosis, and management: A 58-year-old male with history of T2DM for 27 years presented with progressively increasing skin lesions on his back, gluteal area and back of thigh over 2 months duration. Around 3 months back, he had developed RTPCR positive COVID-19 infection with involvement of lower respiratory tract with dip in peripheral oxygen saturation (SpO2). During hospitalisation, he received deflazacort 30mg once daily along with symptomatic treatment as per contemporary guidelines. At the time of presentation, the lesions were maculopapular with pigmentation and scaling. There were no definite ring lesions with central clearing, which is usually seen in fungal superficial skin infections. Few pustular lesions were also present in genital area. Nearly one month after discharge slightly elevated circular scaly lesions on his thighs with minimal itching developed which progressed involving back of thighs, gluteal areas, and the back. Diagnosed as Psoriasis, local steroid ointment along with Fexofenadine (antihistamine) was used. There was initial improvement in lesion and symptoms, however there was a flare up in lesion within 2 weeks and several satellite lesions appeared on all over back and gluteal region. Direct microscopic examination of scrapings from the skin lesion after treatment with 20% potassium hydroxide (KOH) was done. The scrapings were characterized by presence of refractile, long, smooth, undulating, branching, and septate hyphal filaments with or without arthroconidiospores confirming the diagnosis of dermatophytosis. Patient was put on local luliconazole 3% cream as it has anti-inflammatory properties along with strong antifungal effect. Looking at the extensive nature of his lesion, he was also started on systemic antifungal Itraconazole 200mg per day for 8 weeks. His insulin doses were modified to achieve a better glycaemic control while avoiding hypoglycaemic events. Conclusion: Tinea corporis is a common fungal infection and the differential diagnosis is broad and, at times, difficult due to the prior use of medications, such as calcineurin inhibitors or corticosteroids. Furthermore, diseases may present with bizarre morphology in immunocompromised patients. Physicians must be familiar with this condition so that an accurate diagnosis can be made, and appropriate treatment initiated.