A new mutation in the SQLE gene of Trichophyton mentagrophytes associated to terbinafine resistance in a couple with disseminated tinea corporis

Hsieh, Aurélie; Quenan, Sandrine; Riat, Arnaud; Toutous Trellu, Laurence Marie; Fontao, Lionel

doi:10.1016/j.mycmed.2019.100903

Scientific article

Case report

English

A new mutation in the SQLE gene of Trichophyton mentagrophytes associated to terbinafine resistance in a couple with disseminated tinea corporis

Contributors

Hsieh, Aurélie; Quenan, Sandrine; Riat, Arnaud; Toutous Trellu, Laurence Marie

; Fontao, Lionel

Published in

Journal de mycologie médicale, vol. 29, no. 4, p. 352-355

Publication date

2019

Abstract

Trichophyton is the most common dermatophyte genus responsible for tinea corporis and topical treatment with terbinafine is effective for limited disease but extensive disease required systemic therapy. Failure of terbinafine therapy in patients infected with T. rubrum or T. mentagrophytes is associated with mutations in the gene encoding squalene epoxidase, the terbinafine target. We report two cases of tinea corporis resistant to systemic terbinafine in a 60-year-old man and his wife, a 51 year-old-woman. Both patients had multiple diffuse erythematous annular scaly plaques and T. mentagrophytes was isolated in culture. Systemic treatment with terbinafine in combination with topical terbinafine and then topical ketoconazole failed to improve the disease after 8 weeks. The broth microdilution tests performed to evaluate the antifungal sensitivity of the T. mentagrophytes isolate revealed a high MIC for terbinafine but a low MIC for posaconazole and itraconazole. An A1223T point mutation leading to a Q408L substitution was identified by DNA sequencing the SQLE gene of the isolate. Itraconazole 200mg daily was then introduced but stopped because of elevated liver transaminases in the man. Finally, complete healing was achieved only six months later for both patients and required a 3 and 2-week regimen of itraconazole with topical eberconazole in the man and woman respectively. We believe that a close monitoring and antifungal susceptibility tests should now be done more systematically in dermatophytic infections that do not respond to conventional treatment as terbinafine resistant strains are likely to spread worlwide.

Keywords

Antifungal Agents/pharmacology
Drug Resistance, Fungal
Female
Fungal Proteins/genetics
Humans
Male
Microbial Sensitivity Tests
Middle Aged
Point Mutation
Terbinafine/pharmacology
Tinea/diagnosis/drug therapy/microbiology
Trichophyton/drug effects/genetics/isolation & purification

UNIGE affiliation entities

Faculté de médecine / Section de médecine clinique / Département de médecine

UNIGE research groups

Inflammation cutanée (919)

Citation (ISO format)

HSIEH, Aurélie et al. A new mutation in the SQLE gene of Trichophyton mentagrophytes associated to terbinafine resistance in a couple with disseminated tinea corporis. In: Journal de mycologie médicale, 2019, vol. 29, n° 4, p. 352–355. doi: 10.1016/j.mycmed.2019.100903

Article (Published version)

Identifiers

PID : unige:138255
DOI : 10.1016/j.mycmed.2019.100903
PMID : 31611164

Additional URL for this publication

https://www.sciencedirect.com/science/article/pii/S1156523319301015

Journal ISSN

1156-5233

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Creation

19/06/2020 10:42:00

First validation

19/06/2020 10:42:00

Update

13/10/2025 17:15:37

Status update

24/01/2025 15:57:10

Last indexation

20/10/2025 22:02:05

A new mutation in the SQLE gene of Trichophyton mentagrophytes associated to terbinafine resistance in a couple with disseminated tinea corporis

Contributors

Published in

Publication date

Abstract

Keywords

UNIGE affiliation entities

UNIGE research groups

Citation (ISO format)

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Additional URL for this publication

Journal ISSN

Technical informations

Creation

First validation

Update

Status update

Last indexation