Majocchi Granuloma–like Deep Follicular Granulomatous Eruption Secondary to Aspergillus niger in an Immunocompetent Male

ABSTRACT: Majocchi's granuloma is a deep folliculocentric fungal infection characterized by suppurative and granulomatous inflammation, most commonly caused by dermatophytes. Non-dermatophytic molds, including Aspergillus species, are uncommon etiological agents. We report a 20-year-old immunocompetent male presenting with multiple dark red to brownish papules and nodules involving the groin, genitalia, buttocks, and lower abdomen for 6 months. Histopathological examination demonstrated a suppurative granulomatous infiltrate containing numerous fungal elements, with positive periodic acid-Schiff staining and direct microscopy using potassium hydroxide preparation. Fungal culture yielded Aspergillus niger, with species identification supported by characteristic morphology on lactophenol cotton blue preparation. The patient was treated with oral itraconazole 100 mg twice daily for 2 months, resulting in marked clinical improvement with flattening of the lesions and absence of new lesions. This case represents an uncommon A. niger-associated deep follicular granulomatous infection in an immunocompetent host and underscores the importance of histopathological and mycological evaluation in persistent or atypical papulonodular eruptions, particularly at unusual anatomical sites.