A 30-year-old woman presents with several firm, perifollicular papules and small nodules over her anterior shins, present for two months after regular leg shaving. Skin scrapings from the surface are negative for fungus on KOH. A biopsy shows a granulomatous infiltrate around hair follicles with fungal hyphae within the follicle. What is the most likely diagnosis?
- A Sporotrichosis
- B Majocchi granuloma ✓
- C Staphylococcal folliculitis
- D Cutaneous sarcoidosis
Correct answer: B. Majocchi granuloma
Explanation
Majocchi granuloma is a deep follicular and perifollicular dermatophyte infection, classically caused by Trichophyton rubrum at sites of minor trauma such as shaving. Because the fungus sits inside the follicle, superficial KOH scraping is often negative and biopsy is needed to show hyphae with granulomatous inflammation. Sporotrichosis produces a linear nodular chain after plant injury, and staphylococcal folliculitis is pustular and KOH negative.
Reference: Rook's Textbook of Dermatology, 9th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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