Majocchi's Granuloma in a High School Wrestler

A high school wrestler was initially misdiagnosed with eczema and treated with a topical steroid, which led to the development of Majocchi's granuloma, a fungal folliculitis. Despite a month of steroid treatment, the rash worsened, prompting a referral to dermatology where a punch biopsy and fungal culture identified Trichophyton tonsurans as the causative agent. The condition resolved after 3 months of oral antifungal therapy with terbinafine. The case highlights the importance of accurate initial diagnosis and treatment of dermatophyte infections to prevent complications like Majocchi's granuloma. Diagnostic options include potassium hydroxide (KOH) microscopy and culture, but these require specialized equipment and training, which may not be readily available in settings like high school athletic training rooms. The paper suggests that the decreased use of KOH microscopy may contribute to an increased incidence of Majocchi's granuloma.