皮肤固定型孢子丝菌病1例及其相关实验检查

患者男,50岁。左上臂皮肤溃疡2年。皮损组织病理示:炎性肉芽肿改变,PAS染色可见圆形孢子和星状体。皮损真菌培养阳性,菌种鉴定为球形孢子丝菌。确诊为皮肤固定型孢子丝菌病,给予患者口服伊曲康唑和特比萘芬联合治疗3个月,皮损部分改善。之后患者间断口服特比萘芬联合碘化钾治疗,一年半后复诊仍有局灶性皮损未愈。     

多发结节表现的孢子丝菌病1例

患者男，31岁。3个月前因外伤后左膝部出现许多小结节，表面呈疣状。皮损真菌镜检（-），37℃温箱真菌培养（-），25℃温箱培养有菌落生长，经鉴定为申克氏孢子丝菌。予碘化钾，伊曲康唑治疗，3周后皮疹好转。     

皮肤播散型孢子丝菌病

报告1例皮肤散播型孢子丝菌病。患者男,72岁。面部、躯干及四肢结节、溃疡5个月,发热、关节肿痛3个月。皮损组织病理呈感染性肉芽肿改变,PAS染色找到真菌孢子,组织培养见孢子丝菌生长。予碘化钾口服及萘替芬酮康唑乳膏外用,治疗5个月后皮损完全消退。     

山苍子油抗申克孢子丝菌的动物实验研究

目的探讨山苍子油灌胃治疗实验性小鼠皮肤孢子丝菌感染的疗效。方法制备小鼠皮肤孢子丝菌(包括临床分离固定株和淋巴管株)感染的动物模型,造模成功后给予山苍子油灌胃治疗,同时设10%K I治疗组和生理盐水治疗组(空白对照组),观察治疗前后皮损的直径变化。结果山苍子油灌胃治疗4周后,小鼠皮损明显缩小,甚至消退,其皮损直径变化与空白对照组比较差异有显著性,与10%K I治疗组比较差异无显著性。结论山苍子油灌胃治疗对小鼠皮肤孢子丝菌病有一定的疗效。     

孢子丝菌病的临床表现诊疗与变迁

孢子丝菌病是由申克孢子丝菌复合体感染皮肤、皮下组织、黏膜和局部淋巴系统所引起的慢性感染性疾病。临床表现多样,皮损主要表现为慢性炎症性肉芽肿损害。自1898年报道第一例孢子丝菌病后,对孢子丝菌病的认识越来越深刻,包括孢子丝菌病原体的变迁及其诊断和治疗方法的改进。病原体从申克孢子丝菌单一菌种到目前孢子丝菌复合体的认识。诊断方法包括真菌学检查、组织病理检查、孢子丝菌素以及分子生物学诊断;治疗方法包括碘化钾、伊曲康唑、特比萘芬、两性霉素B口服以及物理和手术疗法等。     

固定型皮肤孢子丝菌病:皮损内注射皮质类固醇引起少见的组织病理学改变

固定型皮肤孢子丝菌病由于其临床表现多种多样,皮损组织病理活检又很难检出申克氏孢子丝菌体,故难以诊断。作者报告了两名孢子丝菌病患者,由于皮损误诊为其它炎症性皮肤病而予皮质类固醇皮损内注射,结果在皮损内出现少见的组织病理学改变——见大量的酵母细胞。现报告如下。例1男、12岁,左手背见一环状斑块3个月。斑块系由数个鲜红色丘疹融合而成,诊断为环状肉芽肿。予去炎松0.3mI(5mg/ml)皮损内注射,3周     

孢子丝菌病的人与人相互传播问题

本文报告了一例托儿所保育员由于经常与患有孢子丝菌病皮损的息儿接触而发生相似皮损,两者的皮损真菌培养均为申克氏孢子丝菌.为证明这种孢子丝菌有直接传播的可能性,我们以有孢子丝菌病灶的小白鼠尾部与其它健康小白鼠尾部接触,后者无论皮肤有无外伤,均产生孢子丝菌性病灶.故我们认为该患者的发病是由于与患儿直接接触所致.     

幼儿面部孢子丝菌病误诊为皮肤结核3例

例1　男,2岁。家住农村,其母代述。患儿面部起暗红色皮疹3月,先从右眼眶下起一米粒大小红色丘疹,逐渐长大,半月后右面部又出现同样的皮损,表面溃破结痂。外伤史不详,曾在外院诊断“皮肤结核”。口服异胭肼治疗1月无效,于1994年11月来我所就诊。体检:一般情况好,浅表淋巴结不肿大。皮肤科情况:右眼眶下有一豌豆大小暗红色结节,右面颊部一蚕豆大小暗红色结痂性斑块,高出皮面,触之有囊性感。取分泌物作真菌培养有申克孢子丝菌生长,诊断为孢子丝菌病。口服10%碘化钾液3ml,日3次,逐渐增至5ml,日3次。1月后皮疹明显消退,服药50天后痊愈。随访1年,…     

一株引起皮肤播散性孢子丝菌病的孢子丝菌临床分离株的基因型鉴定

孢子丝菌病是由申克孢子丝菌引起的常见深部真菌病,临床多见于淋巴管型及固定型,播散性孢子丝菌病少见.孢子丝菌进入人体后引起不同临床类型的孢子丝菌病与机体免疫状态有关^[1],但是否与菌型有关尚无定论.为此,我们从一皮肤播散性孢子丝菌病患者皮损中分离1株孢子丝菌菌株,利用常规真菌学和分子生物学方法对其进行鉴定,并探讨该菌株与皮肤淋巴管型孢子丝菌在基因水平上的异同.     

皮肤淋巴管型孢子丝菌病1例

患者女,57岁。右拇指、腕部及前臂结节伴瘙痒和疼痛3月。右前臂皮损组织病理示:化脓性肉芽肿性改变。真菌培养见申克孢子丝菌生长。诊断:皮肤淋巴管型孢子丝菌病。     

Minocycline hypersensitivity syndrome]

BACKGROUND: Drug-induced hypersensitivity syndrome is an uncommon drug reaction typically manifested by severe skin lesions, fever, nodal enlargement, blood eosinophilia and hepatitis. CASE REPORT: A 16-year-old female patient with acne was treated with minocycline 100 mg/d for one month. She developed a hypersensitivity syndrome with a generalized pustulous eruption. Prick tests with minocycline diluted in vaseline were positive at 48 hours. DISCUSSION: This case of minocycline-induced hypersensitivity illustrates that prick tests performed late after the initial event can reproduce the initial lesions. The causal role of several drugs, particularly anticonvulsants, has been demonstrated in drug-induced hypersensitivity syndrome. Several recent publications have implicated minocycline. Although such cases are uncommon, it would appear that cyclines, particularly minocycline, are the main cause of conditions such as drug-induced hypersensitivity syndrome, acute systemic lupus erythematosus, pulmonary eosinophil infiltration, and pseudo-serum sickness. Such secondary effects must be recognized. Patients should be advised to discontinue treatment and consult if signs such as fever, node enlargement, joint pain, or skin reactions reappear. It may be useful to perform prick tests with minocycline 4 to 6 weeks after an initial eruption.     

复发性皮肤坏死性嗜酸性血管炎1例

患者男,74岁。双小腿胫前红肿、水疱、大疱2个月,伴痒。皮肤科情况:双小腿胫前大片浮肿性紫红色斑片,其上可见大小不等的糜烂。皮损组织病理示:真皮全层弥漫性嗜酸性粒细胞为主的浸润,部分小血管壁纤维素样变性。诊断:复发性皮肤坏死性嗜酸性血管炎。治疗:口服米诺环素及小剂量糖皮质激素有效。     

The use of tetracyclines for the treatment of sarcoidosis

BACKGROUND: To evaluate the safety and efficacy of minocycline in the treatment of sarcoidosis, a nonrandomized, open study was performed in patients with cutaneous sarcoidosis. OBSERVATIONS: Twelve patients with cutaneous sarcoidosis were treated with minocycline, 200 mg/d, for a median duration of 12 months. Three patients had extracutaneous lesions at the time of the study. The median follow-up was 26 months. A clinical response was observed in 10 patients, consisting of complete responses in 8 patients and partial responses in 2 patients. A progression of skin lesions was observed in 1 patient, and lesions remained stable in another patient. Adverse effects were minimal, except in 1 patient, who developed hypersensitivity syndrome. A slight hyperpigmentation occurred in 2 patients at the site of previous lesions, which completely disappeared after minocycline use was discontinued. A relapse of skin symptoms occurred after minocycline withdrawal in 3 patients, who further received doxycycline, 200 mg/d, allowing a complete remission of lesions. CONCLUSIONS: These results support that minocycline and doxycycline may be beneficial for the treatment of cutaneous sarcoidosis. Randomized controlled studies are warranted for the evaluation of the true efficacy of tetracyclines in these patients.     

Intravenous immunoglobulin treatment in laryngeal pemphigoid

We report a 29‐year‐old white woman who presented with oral involvement and subsequently developed severe and extensive laryngeal involvement with mucous membrane pemphigoid. She could not tolerate systemic corticosteroids due to side‐effects. Dapsone improved only the oral disease, but the laryngeal disease remained active and progressive. She refused immunosuppressive agents, because she wanted to conceive. The acute severe widespread laryngeal pemphigoid was accompanied by severe relentless coughing and dysphonia. The patient was treated with intravenous immunoglobuln (IVIg) as monotherapy, which led to complete resolution of the symptoms and the laryngeal lesions, as seen on repeated direct laryngoscopies. The normal anatomy and function of the larynx was restored, and scarring did not occur. The patient did not develop any side‐effects to the IVIg treatment, which led to disease remission. While on IVIg treatment, she delivered a healthy child. She remained in remission after 5 years of follow‐up.     

蜱咬伤致多脏器功能衰竭一例

患者，男，58岁。5天前胸部皮肤被蜱咬伤后出现红斑、丘疹、肿胀伴痒，2天前前胸皮损出现边缘肿胀，伴胸闷气短，高热、寒战，恶心伴呕吐及阵发性晕厥急诊入院。D二聚体、血清肌酐、磷酸肌酸激酶明显异常，布尼亚病毒核酸检查阴性。诊断：(1)蜱咬伤；(2)多脏器功能障碍综合征。治疗给予糖皮质激素，创面处理等，20余天后患者好转出院。     

Epidermodysplasia verruciformis: association with isolated IgM deficiency and response to treatment with acitretin

We describe a 25-year-old woman, who had extensive, large viral warts consistent with epidermodysplasia verruciformis (EV) since she was 6-year-old. Laboratory studies revealed an isolated IgM-deficiency, but the patient demonstrated no other abnormalities. She was treated with oral acitretin (0.5-1 mg/kg/day) for six months and her skin lesions improved slightly. However, after discontinuing the treatment, the lesions came back but she declined further treatment.     

Lymphocutaneous type of nocardiosis caused by Nocardia brasiliensis: a case report and review of primary cutaneous nocardiosis caused by N. brasiliensis reported in Japan

Nocardiosis is a mixed suppurative and granulomatous inflammatory disease caused by infection with Nocardia organisms, a group of aerobic actinomycetes. We recently encountered a 25-year-old woman with posttraumatic nocardiosis of the lower extremities. The clinical symptoms noted during her first visit included erythematous swelling of the right knee accompanied by white maceration of the center of the knee and erosions, shallow ulcers and satellite pustules. In addition, multiple erythematous areas (up to the size of the tip of the thumb) were linearly distributed on the right thigh. These lesions were painful, and right inguinal lymphadenopathy was also noted. No lesion was found in internal organs such as the lungs. Histopathologically, signs of nonspecific granulomatous inflammation were observed, as well as several filamentous branching bacilli positive on Grocott stain. The organisms isolated from culture of pus were acid-fast, Gram-positive long rods. The isolated strain was finally identified as Nocardia brasiliensis. The patient was therefore diagnosed with lymphocutaneous type of primary cutaneous nocardiosis caused by N. brasiliensis. Drip infusion of flomoxef sodium was initially performed to treat her condition. Because of exacerbation of erythematous swelling of the right knee and an increase in number of pustules, treatment was switched to oral minocycline hydrochloride therapy. The disease healed 9 weeks after the start of oral minocycline hydrochloride therapy. Our patient was free of systemic immunosuppression and was neither under 10 nor over 65 years of age. She may therefore be considered a rare case of lymphocutaneous type of nocardiosis. We present this case and discuss reported cases of primary cutaneous nocardiosis due to N. brasiliensis in Japan.     

A study into minocycline as a treatment for papulopustular rosacea

Papulopustular rosacea is a disease that causes redness and inflammtory lesions (patches) on the face. It is thought to affect about 16 million Americans and 34 million people worldwide. Rosacea may impact patients in different ways, such as itching, stinging, or embarrasment and self-consciousness, or it may impact leisure or social activites. Minocycline, as a pill, has been shown to be an effective treatment for the inflammatory lesions of rosacea. However, there may be side effects to using minocycline pills. This study evaluated the clearing of inflammatory lesions on the face of patients with rosacea after using a topical minocycline gel. The study was done at 26 clinics in the U.S.A. 270 people applied either 1% minocycline gel, or 3% minocycline gel, or just the vehicle gel (no medicine) to the face at bedtime for 12 weeks. Dermatologists were asked to count the number of inflammatory lesions on the face and the severity of disease before starting the study, and then throughout the 12 weeks of treatment. The authors found that the gels were generally safe and well tolerated. They also found that there was a greater reduction of inflammatory lesions in both the 1% and 3% minocycline groups compared to the vehicle gel group, and a higher percentage of people achieved clear or almost clear skin after 12 weeks of treatment for the 3% minocycline group. This indicates that a topical minocycline gel may be a safe and effective treatment for the inflamamtory lesions of papulopustular rosacea. Linked Article:   Webster et al. Br J Dermatol 2020; 183 :471–479 .     

Topical metronidazole for severe and recalcitrant rosacea: a prospective open trial

Nineteen patients with severe or recalcitrant rosacea were treated twice daily with 0.75 percent metronidazole topical gel in an open label study. Sixteen of the patients (84 percent) showed 50 percent or greater reduction in inflammatory lesions, while fifteen (79 percent) demonstrated a reduction in erythema severity and an improvement when evaluated by the investigator global assessment. No positive response was recorded for any patient prior to topical medication, whereas six of nine patients previously treated with tetracycline/minocycline demonstrated improvement. Seven of these nine patients responded to topical metronidazole treatment. One additional patient who did not respond to minocycline or desonide treatment showed a good response to topical metronidazole. Only one patient reported local irritation after using metronidazole. These results demonstrate that topical metronidazole gel is safe and effective for the treatment of severe or recalcitrant rosacea.     

Pyoderma gangrenosum associated with sclerosing cholangitis, type 1 diabetes mellitus and ulcerative colitis.

We describe the case of a 22-year-old black female with type 1 diabetes mellitus diagnosed when she was 12 years old. She first presented (March 1994) with pustules and ulcerations on the upper and lower limbs, trunk and scalp at the age 17. The diagnosis of pyoderma gangrenosum was made. Since presentation, changes in liver function were detected and subsequent study led to the diagnosis of sclerosing cholangitis. The diagnosis of ulcerative colitis was made after colonoscopy. Partial response was obtained with minocycline and clofazimine, but treatment with 5-aminosalicylic acid achieved no improvement of the ulcerations. Liver transplantation, followed by immunosuppressive therapy led to complete regression of the cutaneous lesions.