疣状瓶霉引起皮肤暗色丝孢霉病一例

患者男，19岁，耳后、面部红斑、结节6年。取皮屑10％ KOH镜检，见有棕黄色分隔菌丝；沙堡弱培养基（SDA）培养出局限性、绒状、黑色菌落；马铃薯葡萄糖琼脂培养基（PDA）小培养，瓶梗生于菌丝顶端或侧生于菌丝上，领口结构清晰，顶端喇叭状，瓶孢子半内生呈圆形或椭圆形，由黏液包裹聚集于瓶梗顶端如花朵状。体外药敏实验对伊曲康唑、特比萘芬和两性霉素B敏感，对氟康唑耐药。皮损组织病理检查，PAS染色及银染色均见真皮内棕色菌丝和芽生酵母孢子。分子生物学检查与疣状瓶霉的ITS1-ITS4片段序列比对，结果98%符合。诊断：疣状瓶霉所致的皮肤暗色丝孢霉病。治疗：口服伊曲康唑胶囊400 mg/d有效。

Cutaneous phaeohyphomycosis caused by Phialophora verrucosa

A 19-year-old man was admitted to the hospital for erythema and nodules on the face and postauricular region for 6 years. Microscopic examination of lesion scrapings revealed brown septate hyphae. A restricted, velvety and black colony grew on Sabouraud's dextrose agar. Slide culture on potato dextrose agar plate showed flask-shaped phialides at the apex of or around the hyphae with clear collarettes and flaring apex,mucilage-encapsuled, round to oval, semi-endogenous phialosporae accumulating at the apex of the phialides,giving a flower-like appearance. Anti-fungal susceptibility test showed that the fungus was sensitive to itraconazole, terbinafine and amphotericin B, but resistant to fluconazole. Sequence analysis of the ITS1-ITS4 region revealed a 98% consistency with the reference sequence of ITS1-ITS4 of Phialophora verrucosa. On the basis of above findings, the patient was diagnosed with cutaneous phaeohyphomycosis. Clinical improvement was seen after treatment with oral itraconazole (400 mg/d).