Cutaneous fungal infection masquerading as a gyrate erythema

This is tinea corporis on the upper chest of a man in his 50s (fig 1).bmj;378/sep14_3/e064678/F1F1f1Fig 1The patient presented to Partners in Hope, a healthcare organisation in Lilongwe, Malawi, with a three month history of a pruritic rash on his arms and chest. Polycyclic annular eruptions with erythematous, raised scaly borders were seen on examination. No peripheral neuropathy or loss of sensation was evident.The patient had advanced HIV disease (CD4 cell count: 370×106/L). He was receiving antiretroviral therapy and prophylactic cotrimoxazole, which had not changed. The rash failed to improve on initial treatment with hydrocortisone 1% cream.Differential diagnoses include tinea corporis, cutaneous larva migrans, erythema multiforme, syphilis, tuberculoid leprosy, and granuloma annulare.As tinea corporis was suspected because of the time course and appearance of the lesions—superficial, gyrate (ring-shaped)—oral fluconazole was started. Noticeable improvement in the lesions and the pruritus confirmed the diagnosis of tinea corporis. When further testing is unavailable,…
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