(BMJ)—A healthy 33-yo man presented w/ a 6-wk hx of a lesion on his R cheek. He had recently visited a farm but denied handling animals. Flucloxacillin had no effect, and he had partial response to fluconazole x2wk. Exam: crusted, inflammatory plaque. Wound cx confirmed the dx. What is it?
Orf virus
Arthroderma benhamiae
Anthrax
Majocchi granuloma
Impetigo
You are correct. Fungal cx isolated Arthroderma benhamiae, an emerging pathogen. In the U.K., guinea pigs have been the most common source of this zoophilic dermatophyte. Infections have been assoc w/ dogs, who likely acquired the fungus from rodents. This pt was successfully treated x4wk w/ oral terbinafine, 250 mg. This case highlights the need to consider fungal pathogens in lesions that are unresponsive to abx, even if the lesion is obviously impetiginized.

BMJ 2017;357:j2007