A rare case report of genital dermatophytosis that clinically manifested similar to a wart: case report

Background: Dermatophyte is a group of keratinophilic fungi that cause various skin lesions depending on the affected area. Dermatophytosis is usually diagnosed by clinical manifestation and confirmed by direct microscopy or fungal culture. There might be diagnostic difficulty with the presence of atypical dermatophytosis. Atypical dermatophytosis presents with clinical appearances ranging from eczematous, psoriasiform, pustular lesions, and others, that interferes with early diagnosis and disturbs patient’s life quality. Genital dermatophytosis is an uncommon presentation of cutaneous fungal infection; moreover, its manifestation without the involvement of the inguinal area, and simulating wart is a rare sign. In this study, we introduce a rare case of dermatophytosis with a wart-like appearance that was restricted to the skin of the genitalia. Case Presentation: A 24-years-old woman was referred to the academic dermatology clinic of Boo- Ali SINA Hospital in Sari, Iran, in November 2019 with a 9-month complaint of verrucous and pruritic plaque in the genital area that previously misdiagnosed as wart with no response to treatment. The dermatologist requested a review of the previous pathology documents for diagnosing dermatophytosis. The pathologists reexamined the relevant paraffin-embedded skin tissue block of the patient. By Periodic acid-Schiff staining, some fungal elements had been found in the horny layers of the epidermis, so dermatophytosis was confirmed. Based on this diagnosis, terbinafine was prescribed and the patient responded well to this treatment after four weeks. Conclusion: Although the occurrence of genital dermatophytosis with the verrucous appearance and without involvement of groin is a rare finding, it should be considered in the differential diagnosis. In each case suspected of genital dermatophytosis, direct examination or fungal culture for definite diagnosis and prevention of delay in the appropriate treatment is required.