Chronic mucocutaneous candidiasis: a case report.
CASE REPORT: A two month old male child was brought to us with a history of persistent erosions and pustules in the perianal area, and over the trunk, oral ulcers and nail changes. Her parents revealed that, when the baby was three days old, he started with some small vesicular lesions and pustular lesions in perianal area which increased in size and turned into erosions within a period of two weeks and lesions were persistent. After one month, patient started developing oral ulcers and swelling of the nail folds of all the digits of both hands. The patient was born out of a non-consanguineous marriage, after full term, by vaginal route, and the birth weight being 3kgs. There is history of vaginal candidiasis to the mother in the ante natal period.
On examination, there were vesicles, micropustules and perleche periorally. Oral thrush were present. Retroauricular erythema and fissures were present. Seborrhea capitis was seen on the occiput. Perianal erythema, erosions and maceration was present. There was yellowish discolouration, sub ungual hyperkeratosis, paronychia and, onycholysis bilaterally in both finger and toe nails. There was no localized or generalized lymhadenopathy. The general physical and systemic examination was normal. Ophthalmological examination was also noncontributory. Complete blood counts, liver function tests and kidney function tests were normal. Chest radiography and ultrasonography of abdomen were normal. Thyroid profile, parathyroid hormones, serum calcium, phosphate, uric acid and serum cortisol level were all within normal range. Scrapings from skin lesions and nail plates were subjected to potassium hydroxide examination and culture on Sabouraud's dextrose agar medium. Candida albicans was isolated from all the three sites. On the basis of history, clinical examination and investigations we made a diagnosis of isolated chronic mucocutaneous candidiasis. The patient was treated with topical clotrimazole and oral flucanazole, the lesions cleared completely in four weeks except nail changes.
DISCUSSION: Chronic mucocutaneous candidiasis (CMC) is a rare condition characterized by widespread and persistent infection of skin, mucosa, and nails caused by candida albicans. CMC is associated with defect in cell mediated immunity. Recent studies suggest that there is alteration in production of cytokines in response to candida antigens. These include decreased interleukin-2 and interferon-gamma levels (Th 1 cytokines) and increased interleukin-10 (Th2 cytokines).  CMC can be limited to skin and mucosa only or it may be associated with polyendocrinopathy, thymoma and KID (Keratitis, icthyosis, deafness) syndrome.  Hypoparathyroidisim and adrenal failure are the most common endocrine abnormalities associated with CMC.  Other infections like dermatophytosis, herpes simplex and disseminated mycobacterium avium infection are also reported to coexist with CMC.  Gastrointestinal and hematological dysfunctions are sometimes associated with CMC.  In our case only skin, mucosa and nails were affected and no systemic involvement was detected. There was no predisposing factor for oral candidiasis in our case. Current therapy for CMC mainly revolves around prolonged use of antifungal agents especially the azole group.  Depending upon the underlying immunologic nature of CMC, various treatments like bone marrow and thymus transplantation or transfusion with white blood cells and candida specific antigens have been attempted. [9,10] In our patient, the lesions cleared completely with topical clotrimazole and oral fluconazole 50mg in four weeks.
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C. Subhashini (1), S. Dhanyasree (2), V. Srilakshmi (3), C. Sravani Sudhakar (4), P. Anila Sunandhini (5)
(1.) C. Subhashini
(2.) S. Dhanyasree
(3.) V. Srilakshmi
(4.) C. Sravani Sudhakar
(5.) P. Anila Sunandhini
PARTICULARS OF CONTRIBUTORS:
(1.) Assistant Professor, Department of Dermatology, Andhra Medical College.
(2.) Assistant Professor, Department of Dermatology, Andhra Medical College.
(3.) Junior Resident, Department of Dermatology, Andhra Medical College.
FINANCIAL OR OTHER COMPETING INTERESTS: None
(4.) Junior Resident, Department of Dermatology, Andhra Medical College.
(5.) Associate Professor, Department of Dermatology, Andhra Medical College.
NAME ADDRESS EMAIL ID OF THE CORRESPONDING AUTHOR:
Dr. C. Subhashini, Assistant Professor, Department of Dermatology, Venereology & Leprosy, Andhra Medical College, Visakhapatnam. E-mail: email@example.com
Date of Submission: 09/07/2015.
Date of Peer Review: 10/07/2015.
Date of Acceptance: 11/08/2015.
Date of Publishing: 17/08/2015.
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|Title Annotation:||CASE REPORT|
|Author:||Subhashini, C.; Dhanyasree, S.; Srilakshmi, V.; Sudhakar, C. Sravani; Sunandhini, P. Anila|
|Publication:||Journal of Evolution of Medical and Dental Sciences|
|Article Type:||Clinical report|
|Date:||Aug 17, 2015|
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