由胶孢镰刀菌所致足部皮肤无色丝孢霉病一例

目的 报道1例由胶孢镰刀菌所致足部无色丝孢霉病。方法 询问病史及体检，取右足内踝处皮损常规病理检查。取皮损分泌物行10% KOH真菌直接镜检和培养，鉴定菌种。结果 患者女，72岁，右足溃疡3年。检查见右足踝内侧皮肤约3 cm × 1.5 cm溃疡，基底暗红色肉芽组织增生，表面湿润，触痛明显。溃疡皮损组织病理检查，真皮浅层肉芽组织坏死，有细长、分隔、无色菌丝样结构物，其周围组织伴有慢性炎症细胞散在浸润，PAS染色显示腊肠样菌丝及散在卵圆形真菌孢子。皮损分泌物真菌镜检见分隔、分支无色菌丝。分离菌株经培养及鉴定为胶孢镰刀菌。本菌株对特比萘芬、制霉菌素及两性霉素B高度敏感。给予口服特比萘芬0.25 g，每日2次，2个月后病灶完全愈合。结论 本病例为胶孢镰刀菌所致足部皮肤无色丝孢霉病，特比萘芬治疗有效。     

儿童皮肤串珠镰刀菌病

报告1例儿童皮肤镰刀菌病。患儿女,15岁。面部浅表溃疡、小脓疱10年,自幼经常发热,肺部感染,存在细胞免疫功能低下。皮损痂皮和组织镜检、培养和组织病理学检查证实为串珠镰刀菌感染。诊断为限局性皮肤串珠镰刀菌病。经手术切除皮损联合口服特比萘芬治愈。     

慢性皮肤黏膜念珠菌病1例

患者男,3岁。头面部、手背、手指间皮疹伴口腔白膜2年。取病变部位鳞屑直接镜检可见菌丝和孢子,多个部位真菌培养均有奶油样菌落生长,镜下见成簇卵圆形孢子和假菌丝。组织病理见表皮内有菌丝和孢子,真皮组织内见大量淋巴细胞、组织细胞浸润。根据形态学,生化实验等诊断为白念珠菌感染引起的慢性皮肤黏膜念珠菌病。经口服伊曲康唑和外用抗真菌药治疗,皮损基本控制。     

足部皮肤镰刀菌病

目的:报告1例由茄病镰刀菌引起的足部皮肤镰刀菌病.方法:皮损分泌物直接镜检、真菌培养.活检皮损作组织病理学检查,培养、分离菌株行DNA序列分析和体外药敏试验.结果:皮损直接镜检见无色、分隔菌丝,组织病理显示真皮内菌丝和孢子.沙馒弱培养基(SDA)和马铃薯葡萄糖琼脂培养基(PDA)培养出厌白色棉絮状菌落,微量培养可见大、小分生孢子和厚壁孢子,具有镰刀菌样细胞结构特征.rDNA内转录间隔区(intemal transcribed spacer,ITS)序列分析符合茄病镰刀菌.对两性霉素B、制霉菌素、特比萘芬敏感.给予口服特比萘芬0.25 g,每天2次,治疗5个月后皮损完全愈合.结论:该例为由茄病镰刀菌感染引起的足部溃疡,特比萘芬治疗有效.     

面部裴氏着色芽生菌病

报告1例裴氏着色芽生菌所致的面部着色芽生菌病.患者男,54岁.面部反复浸润性斑块1年,表面覆有鳞屑及黑色痂皮.皮损组织病理检查见淡褐色厚壁孢子.痂皮直接镜检见圆形厚壁暗棕色孢子及棕色分隔菌丝.真菌培养出黑色菌落,小培养见喙枝孢型及瓶型分生孢子梗,鉴定为裴氏着色芽生菌.口服伊曲康唑,疗效良好.     

迟发性皮肤卟啉症

报告1例迟发性皮肤卟啉症.患者男,52岁.曝光部位出现红斑及水疱1年余.既往酗酒30年.皮肤科检查:面部、双手背红斑及多发色素沉着斑,左手背见花生米大水疱.皮损组织病理示表皮下水疱和毛虫小体;尿卟啉阳性;诊断为迟发性皮肤卟啉症.予保肝、戒酒及避光后皮损好转.     

瘤型麻风伴梅毒非特异性抗体假阳性1例

患者男,46岁,面部、四肢、足侧缘斑块、结节2个月,躯干、四肢暗红色斑疹1个月。面部皮损组织病理示：表皮轻度萎缩,真皮内见由泡沫样组织细胞构成的结节状浸润,与表皮间有无浸润带,抗酸菌染色(4+)。足部皮损组织病理示：表皮轻度萎缩,真皮及皮下脂肪组织内见白色泡沫样组织细胞构成的结节状浸润,与表皮间有无浸润带,抗酸菌染色(4+)。躯干部皮损组织病理示：表皮轻度萎缩,真皮血管周围可见组织细胞、淋巴细胞浸润,部分组织细胞呈泡沫状,抗酸菌染色(2+)。面部皮肤组织涂片,抗酸杆菌阳性(4+)。甲苯胺红不加热血清试验(TRUST)阳性,TRUST半定量1∶1,梅毒螺旋体特异性抗体(TPPA)阴性。诊断：瘤型麻风伴梅毒非特异性抗体假阳性。于当地疾控中心接受麻风联合化疗(MDT-MB)方案治疗好转,目前随访中。     

SAPHO综合征1例

患者男,32岁,反复腰臀部、前胸疼痛1年,双手足红斑、脓疱,双小腿红斑、鳞屑,面部丘疹半年余。双小腿皮肤镜示:粉红色背景,表面白色鳞屑,可见均匀分布的点球状血管。左手掌皮损组织病理示:表皮角化过度,角质层下方表皮内见单房性脓疱,疱旁表皮棘层增生伴棘细胞间水肿,真皮浅层小血管周围少许淋巴细胞、中性粒细胞浸润。根据临床表现、皮肤镜及组织病理诊断:SAPHO综合征。     

奴卡菌性足菌肿

报告1例奴卡菌性足菌肿。患者男,56岁。左腹股沟术后出现皮肤红肿、破溃、脓液溢出半年。组织病理检查可见大量肉芽性炎性浸润,并见小脓肿形成,其内可见硫磺颗粒;分泌物涂片+抗酸染色镜检见阳性菌,菌丝内连串阳性颗粒;脓液培养见奴卡菌,诊断为奴卡菌性足菌肿。给予复方磺胺甲恶唑联合头孢曲松治疗,皮损完全消失。     

毛囊角化病合并皮肤蝇蛆病1例

报告毛囊角化病合并皮肤蝇蛆病1例.患者女,68岁,头面颈部毛囊性丘疹60年余,左耳后皮肤破溃3d.皮肤科检查:头面部可见弥漫分布粟粒至黄豆大小丘疹,部分融合成斑块,上覆黄色及棕褐色痂;左侧耳廓后见一长约10 cm溃疡,表面脓血性分泌物渗出,溃疡深部可见大量坏死组织及蛆虫.左面部皮损组织病理学检查示表皮角化过度、角化不全...     

Skin infection with Fusarium in an immunocompetent patient

Fusarium spp. are fungi found throughout the world and can cause a great variety of skin infections, mainly in immunodepressed individuals. We present a case of skin infection with Fusarium sp. which manifested as painful superficial ulcers on the legs of an immunocompetent female patient, who had applied as a for leg pain. The condition was cured with oral itraconazole and local treatments.     

茄病镰刀菌引起儿童角膜溃疡1例

报告茄病镰刀菌引起的儿童角膜溃疡1例。患儿男,7岁,学生。因右眼红肿、疼痛13天之主诉入院。从皮损处取材做真菌检查,直接镜检发现真菌菌丝,3次培养均为同一菌株生长,依据小培养镜下特征鉴定为茄病镰刀菌。依据临床表现及实验室检查诊断为茄病镰刀菌引起的真菌性角膜溃疡。     

The use of ITS DNA sequence analysis and MALDI-TOF mass spectrometry in diagnosing an infection with Fusarium proliferatum

Although mycoses are among the most common diseases worldwide, infections with Fusarium spp. occur only rarely. Mostly patients suffering from underlying immune deficiency are infected with this mould, resulting in a considerably decreasing prognosis. In immunocompromised patients, cutaneous manifestations are more often associated with Fusarium sp. than with Candida sp. or Aspergillus sp. We describe one patient with acute lymphoblastic leukaemia, who was first treated with chemotherapy after GMALL protocol 07/03. After relapse, the patient was successfully transplanted in second remission with a human leukocyte antigen (HLA)-matched unrelated peripheral blood stem cell graft. Ten months later, the patient died from respiratory insufficiency and recurrence of leukaemia. Previously, Aspergillus antigen was detected in blood. In the latter course, disseminated papules appeared. One of these was examined histologically and mycologically. Conventional cultural diagnostics led to the diagnosis of a fusariosis, further supported by internal transcribed spacer (ITS) sequencing and matrix assisted laser desorption/ionisation-time-of-flight mass spectrometry (MALDI-TOF) mass spectrometry, both determining the isolated strain as Fusarium proliferatum, which is a very infrequent pathogen within this genus. Our investigations underline the potential of MALDI-TOF MS based identification of Fusarium species as an innovative, time and cost efficient alternative to ITS sequencing.     

SYSTEMIC KETOCONAZOLE TREATMENT FOR FUSARIUM LEG ULCERS

Fusarium oxysporum was isolated from a large foot ulcer in an otherwise healthy 69-year-old man. Although tissue invasion could not be proven histologically, systemic antifungal treatment was administered with satisfactory response. Fusarium species are common soil-inhabiting organisms and plant pathogens. In humans, Fusarium is considered an opportunistic agent in skin ulcers, interdigital spaces, and burned skin, but can also cause mycotic keratitis, onychomycosis, and rarely deep-seated or disseminated infections, especially in an immunocompromised host. The distinction between skin infection and saprophytic growth, as well as optimal treatment regimens for the two types of infection, have not been clearly defined. We describe a case of leg ulcers caused by Fusarium oxysporum in a 69-year-old man treated successfully with oral ketoconazole. "Silent" immunologic disturbances were found in this apparently healthy patient. The case illustrates a relatively benign infection caused by Fusarium that responded to systemic antifungal drug treatment.     

Disseminated Fusarium solani Infection With Cutaneous Nodules in a Bone Marrow Transplant Patient

Fusarium is a ubiquitous fungus that commonly colonizes ulcerated, burned, or traumatized skin and may cause keratitis and onychomycosis in healthy hosts. Serious disseminated infection due to Fusarium has been reported with increasing frequency in immunocompromised patients. We describe a bone marrow transplant patient who developed fungal septicemia and disseminated skin nodules due to Fusarium solani. Fusarium should be recognized as a potential cause of deep fungal infection in immunocompromised patients.     

Fusarium skin infection: a case report

A 65-year-old man presented with an irregular ulcer with a black eschar on his forehead associated with severe headache. A subcutaneous nodule with a necrotic center was present on the left knee. The diagnosis of Fusarium infection was made and confirmed by biopsy and culture. The patient had a history of bronchial asthma for which he was on inhalational steroids for 5 years. It is unclear if this treatment was related to the disseminated Fusarium infection. The patient received oral itraconazole for 3 months with good improvement but met with an unexpected sudden death.     

我国首例皮肤瘰疬分枝杆菌病报告

我们所见的一例女性患者,面部红斑7、8年不愈,近两年皮损逐渐扩大隆起,有时伴有渗出及结痂,但不破溃.皮损为3×4.5cm红色斑块,微黄色无溃疡及疤痕.病人一般情况好.临床皮损及组织病理变化似结节病和皮肤结核,经杆菌培养,于3~4周时可见大头针针头大小黄色菌落.重复培养成功,并均能连续传代,菌株代号S17,鉴定结果见附表.S17属Runyon氏分类第2组,其特性与瘰疬分枝杆菌完全一致,故诊断为皮肤瘰疬分枝杆菌病.     

INVASION OF THE SKIN BY FILAMENTOUS NON-DERMATOPHYTE FUNGI

SUMMARY. —Four cases of invasion of the glabrous skin by filamentous, non-dermatophyte fungi are described. Aspergillus niger was found in the toewebs of 1 patient and Allescheria boydii in those of another. Fusarium solani and F. oxysporum var. redolens were colonising necrotic skin in 2 diabetic patients.
It was concluded that in all these cases the fungal invasion was purely saprophytic in nature. The difficulty of discriminating between contamination and saprophytic invasion of the skin by non-dermatophytes is discussed and criteria for making the distinction are suggested.     

类风湿性嗜中性皮炎

报告1例类风湿性嗜中性皮炎.患者女,60岁.因腰腹部风团样红斑、丘疹及结节伴瘙痒1个月就诊.患者有10年类风湿关节炎病史,类风湿因子阳性.皮肤科检查:腰、背、腹部密集红色或肤色丘疹、结节,或风团样红斑,直径2～4mm,未见糜烂、坏死及结痂.皮损组织病理检查:真皮中性粒细胞呈带状浸润,核尘明显,无血管炎改变.10d后皮损自行消退.