Abstract: Objective: To report a case of Majocchi's granuloma caused by Nannizzia gypsea in a heart transplant recipient in our hospital, and the influence of onychomycosis and immune status on its pathogenesis was discussed combined with the literature. Methods: We describe a case of Majocchi's granuloma in the right forearm caused by Nannizzia gypsea in a heart transplant patient. The characteristics of Majocchi's granuloma cases retrieved from the PubMed database were analyzed, including patient age, infection site, types of pathogenic fungi, treatment methods and efficacy. Single factor analysis of variance and chi-square test were used for data analysis. Results: A total of 41 patients were analyzed, including 12 organ transplant patients, 10 patients with long-term immunosuppression and 19 immunocompetent patients. The results of single factor analysis of variance showed that the average age of patients in the organ transplant group and the long-term immunosuppression group was significantly higher than that in the immunocompetent group (F=5.20, P＜0.05). The incidence of onychomycosis in organ transplant group was 58.3%, while the incidences of onychomycosis in the long-term immunosuppression group and the immunocompetent group were 30% and 21.1% respectively. The incidence of onychomycosis in organ transplant patients was significantly higher than that in other groups, and the difference was statistically significant (χ2=8.34, P＜0.05). The infection rates of Trichophyton rubrum in organ transplant group, immunosuppression group and immunocompetent group were 83.3%, 63.3% and 25.6%, respectively. The infection rate of Trichophyton rubrum in organ transplant group and immunosuppression group was significantly higher than that in immunocompetent group (χ2=16.63, P＜0.01). Conclusion: Among organ transplant patients with Majocchi's granuloma, the incidence of onychomycosis is significantly higher than that in patients with long-term immunosuppression and immunocompetent patients.

Key words: Majocchi’s granuloma, Nannizzia gypsea, transplant patients, onychomycosis