CASE REPORT article
Front. Immunol.
Sec. Autoimmune and Autoinflammatory Disorders : Autoimmune Disorders
Volume 16 - 2025 | doi: 10.3389/fimmu.2025.1611893
This article is part of the Research TopicCase Reports in Autoimmune and Autoinflammatory Disorders: Volume IIView all 13 articles
Case Report: Facial Malassezia folliculitis following infliximab treatment in Crohn's disease
Provisionally accepted
- 1Second Clinical Medical College, Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
- 2College of Traditional Chinese Medicine, Hubei University of Chinese Medicine, Wuhan, Hubei Province, China
- 3Department of Gastroenterology, The Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
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Infliximab (IFX), a first-line treatment for moderate to severe Crohn's disease (CD), has immunomodulatory effects that increase the risk of opportunistic infections. Although IFX-associated invasive fungal infections have received widespread attention, IFX-associated superficial cutaneous fungal infections, such as Malassezia folliculitis (MF), have not been fully recognized. Herein, we present a case of a 19-year-old female patient with moderately active CD who rapidly developed facial erythema, inflammatory papules, and nodular lesions after treatment with IFX. Initially, she was diagnosed with acne vulgaris, but topical and oral antibiotic treatments were ineffective. After completing five IFX infusions, she not only had no relief of gastrointestinal symptoms, but also had progressive exacerbation of the cutaneous lesions. Fungal microscopy revealed abundant Malassezia spores, confirming the diagnosis of MF. Subsequently, IFX was discontinued, and treatment was switched to Ustekinumab (UST). Following this therapeutic adjustment, the patient demonstrated simultaneous resolution of both gastrointestinal and cutaneous symptoms. Notably, the facial lesions completely resolved after three UST infusions without the use of antifungal drugs. This case is the first report of MF induced by IFX therapy in a CD patient. It highlights that acneiform eruptions emerging during biologic therapy may represent cutaneous fungal manifestations. Early recognition and timely adjustment of treatment regimens are essential to prevent potential systemic fungal infections.
Keywords: inflammatory bowel disease, Crohn's disease, infliximab, Malassezia folliculitis, Adverse event, Fungal Infection, Biologic, Tumor Necrosis Factor-alpha
Received: 15 Apr 2025; Accepted: 24 Jul 2025.
Copyright: © 2025 Chan, Ma, Cheng, Zhang, Liu and Zhao. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Xiying Zhao, Department of Gastroenterology, The Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
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