类风湿关节炎右小腿溃疡继发阿萨希毛孢子菌定植一例

65岁男性患者,类风湿关节炎病史20余年,4年前右小腿出现瘙痒性红斑、丘疹及斑块,2个月前斑块上出现疼痛性溃疡及结痂。皮肤科情况:右小腿下1/3处暗红色斑块、结痂及多个圆形溃疡。皮损组织病理示局部表皮坏死,坏死区真皮中、下层白细胞碎裂性血管炎,坏死区边缘表皮海绵水肿,真皮浅层毛细血管管壁增厚、数量增多。溃疡分泌物真菌学检查示阿萨希毛孢子菌阳性。皮损切片六铵银(GMS)染色浅表痂皮中见菌丝、孢子及芽生孢子。诊断:类风湿关节炎右小腿溃疡继发阿萨希毛孢子菌定植。口服伊曲康唑联合外用药及抗风湿治疗后溃疡愈合。

A case of Trichosporon asahii colonization within right lower leg ulcers secondary to rheumatoid arthritis

A 65-year-old man who was diagnosed with rheumatoid arthritis 20 years ago developed pruritic erythematous patches, papules and plaques on his right leg for 4 years, and painful ulcers and crusts on the plaques for 2 months. Physical examination revealed a dusky erythematous plaque, thick crusts and multiple round ulcers on the lower third portion of the right lower leg. Histopathological examination revealed leukocytoclastic vasculitis involving the vessels in the middle and lower dermis of necrotic area. Mycological examination, fungal culture and mass spectrometry identified Trichosporon asahii(T.asahii) within the ulcer exudations. Fungal hyphae, spores and budding spores were found in the superficial crust stained with Gomori-methenamine silver. The diagnosis of T.asahii colonization within right lower leg ulcers secondary to rheumatoid arthritis was established. The patient was successfully treated with oral administration of itraconazole combined with topical drugs and anti-rheumatic agents.