Infant progression of Tinea Capitis in its Kerion Celsi form associated with secondary cutaneous bacterial infection with positive blood culture for S. aureus – Case report

Objective: To report the case, still little described in the literature, of a child with Tinea Capitis (TC) with Kerion Celsi (KC) associated with the presence of bacteria due to local and systemic secondary contamination of Staphylococcus aureus. Case report: A 5-year-old female patient with congenital hypothyroidism starts with hyperemic, scaly and pruritic patches of centrifugal growth on the face, with the appearance of circular lesions and tonsured hair on the scalp that, after using an oral antifungal, evolves of the picture with acute inflammation and local secretion output . Despite independent treatment at home, with Betamethasone and Ketoconazole cream and Ketoconazole 2% shampoo, the result was involution of the facial lesion and enlargement of the area of alopecia. With medical evaluation and guidance, systemic treatment with Griseofulvin was initiated, followed by association with oral antibiotic therapy due to the secondary bacterial condition in the scalp. Approximately 15 days later, there was the appearance of cervical lymph node enlargement and intensification of pruritus and secretion of injuries. Therefore, was necessary hospitalization for clinical and laboratory analysis, with broad-spectrum intravenous antibiotic therapy: Ceftriaxone and Clindamycin. After culture of the lesion and blood culture were collected,was defined in both S. aureus. Due to bacterial resistance, antibiotics were switched to intravenous Cefazolin. Upon hospital discharge, the patient followed up with dermatological weekly support and Griseofulvin. During the treatment, the antifungal agent was replaced by Terbinafine due to acquired resistance to the antifungal drug that was being used previously. Discussion: The condition is considered atypical and rare because there is progression to secondary bacteremia. The alert for early diagnosis makes it possible to identify the etiological agent and provide adequate oral treatment, reducing the impact on quality of life and avoiding secondary bacterial contamination.