Indian Journal of Dermatology
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CORRESPONDENCE
Year : 2022  |  Volume : 67  |  Issue : 2  |  Page : 169-170
Rare case of scrotal Candida albicans infection in an elderly man induced by urinary leakage


1 From the Department of Pathology, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, Tianjin, China
2 From the Department of Dermatology, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, Tianjin, China

Date of Web Publication13-Jul-2022

Correspondence Address:
Li-Tao Zhang
From the Department of Dermatology, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, Tianjin
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijd.ijd_881_21

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How to cite this article:
Gu AK, Kong XJ, Zhang LT. Rare case of scrotal Candida albicans infection in an elderly man induced by urinary leakage. Indian J Dermatol 2022;67:169-70

How to cite this URL:
Gu AK, Kong XJ, Zhang LT. Rare case of scrotal Candida albicans infection in an elderly man induced by urinary leakage. Indian J Dermatol [serial online] 2022 [cited 2022 Dec 6];67:169-70. Available from: https://www.e-ijd.org/text.asp?2022/67/2/169/350820




Sir,

An 80-year-old man presented with pruritic erythema on his scrotum for 2 months. In August 2017, he underwent a radical prostatectomy as treatment for prostate cancer in a local hospital. However, the urethral sphincter was damaged which resulted in the patient leaking urine repeatedly after the operation. The patient solved this difficulty by wearing plastic bags every day. In January 2021, the patient developed pruritic scrotal erythema and the lesion gradually extended. In February 2021, he visited our hospital.

Cutaneous examination revealed a bright erythema symmetrically distributed on the dorsal side of the penis and on both sides of the scrotal suture. The erythema covered an area of approximately 18 × 7 cm. The skin lesion was well defined, and the surface was moist with slightly powdery scales in the folds of the penis [Figure 1]. No similar lesions were found on any other part of the patient's body. No signs of angular cheilitis or glossitis were detected by examination. While the patient was taking antihypertensive drugs, he was otherwise healthy. The results of a routine complete blood cell count and a complete metabolic panel performed on the patient's blood were all within normal limits. An HIV test was negative.
Figure 1: A bright erythema symmetrically distributed on the dorsal side of the penis and on both sides of the scrotal suture

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A skin biopsy specimen revealed the presence of many elongated fungal hyphae in the stratum corneum and periodic-acid Schiff staining confirmed that result [Figure 2]a and [Figure 2]b. Direct microscopic examination of dander scraped from the scrotum revealed a significant number of slender, branching, and septate hyphae with a diameter of 2–4 μm. Cultures on Sabouraud agar grew characteristic creamy colonies after 7 days of incubation at 25°C [Figure 2]c. The isolated strains were grown on chromogenic medium for 48 h. These strains displayed a green color, which proved to be Candida albicans [Figure 2]d.
Figure 2: (a) Histopathology shows acanthosis and the superficial layers of the epithelium are infiltrated by large numbers of neutrophils (H and E, ×100). (b) Periodic-acid Schiff staining confirmed abundant yeast-like and pseudohyphal forms (×200). (c) Cultures on Sabouraud agar grew characteristic creamy colonies. (d) The isolated strains exhibit a green color on chromogenic medium

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The diagnosis of cutaneous candidiasis was made and we prescribed miconazole cream twice a day for 2 weeks and advised him to use adult diapers. After a 1-month follow-up visit, the lesion showed total recovery. There was no sign of recurrence.

Candida is a yeast-like fungus with budding and filamentous (pseudohyphal and hyphal) forms. There are several species, but C. albicans is by far the most common human pathogen.[1]

Candida infection involving mucocutaneous sites can be categorized as follows: oral candidiasis, cutaneous candidiasis, candidal vulvovaginitis, candidal balanitis, chronic mucocutaneous candidiasis, subcutaneous candidal abscess, and disseminated candidiasis. Cutaneous candidiasis tends to be confined to skin folds in the obese and to the genital mucous membranes. However, scrotal infections by dermatophytes and candidiasis are rare.[1] This result is attributed to capric acid, one of the fatty acids in the epidermal barrier, that is particularly abundant in scrotal skin and is thought to act as an antifungal factor.[2] Systemic diseases, hormones, antibiotics, and immunosuppressive drugs can reduce the body's resistance and increase the likelihood of development of candidiasis.[3] The major contributor to the invasion and rapid reproduction of C. albicans is a large amount of local sweat maceration, coupled with high temperature and humidity in young patients.[4] The case reported here is a rare case of scrotal C. albicans infection in an elderly man. The predisposing factors present in this patient were longstanding urine leakage and wearing plastic bags every day, which resulted in local cutaneous occlusion and maceration. Perkins et al.[5] reported that one case of 73-year-old man developed the extremely rare condition of Fournier gangrene after urinary incontinence by C. albicans infection. Therefore, we should keep in mind that patients with chronic urinary retention or urinary extravasation of various etiologies are often colonized with fungal species, specifically Candida. In terms of treatment, topical antifungal drugs have shown good therapeutic effects.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Aridogan IA, Izol V, Ilkit M. Superficial fungal infections of the male genitalia: A review. Crit Rev Microbiol 2011;37:237-44.  Back to cited text no. 1
    
2.
Hayama K, Takahashi M, Yui S, Abe S. Inhibitory effects of several saturated fatty acids and their related fatty alcohols on the growth of Candida albicans. Drug Discov Ther 2015;9:386-90.  Back to cited text no. 2
    
3.
McKay M. Cutaneous manifestations of candidiasis. Am J Obstet Gynecol 1988;158:991-3.  Back to cited text no. 3
    
4.
Yin S, Xie X, Li M, Zhou X, Wei L, Chen Z, et al. Prevalence of low inflammatory tinea genitalis in southern China. Mycoses 2019;62:284-90.  Back to cited text no. 4
    
5.
Perkins TA, Bieniek JM, Sumfest JM. Solitary Candida albicans infection causing fournier gangrene and review of fungal etiologies. Rev Urol 2014;16:95-8.  Back to cited text no. 5
    


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