萎缩性花斑糠疹

患者女,26岁。因胸腹部鳞屑性红斑伴萎缩近2年就诊。取皮屑直接镜检,见较多粗短的菌丝及成簇孢子。皮损组织病理检查,过碘酸雪夫（PAS）染色见角质层内较多菌丝和孢子。弹力纤维染色示弹力纤维减少,部分弹力纤维纤细、断裂。诊断：萎缩性花斑糠疹。治疗：口服伊曲康唑胶囊200mg/d共1周,外用2%舍他康唑乳膏4周,皮疹消退,真菌直接镜检复查阴性。     

特比萘芬和伊曲康唑治疗原发性皮肤曲霉病2例疗效观察

分别应用特比萘芬、伊曲康唑治疗2例皮肤曲霉病,并对其治疗前后真菌学和组织病理改变进行对比观察。例1,男,38岁,躯干部出现多发性坏死性溃疡2个月。通过真菌学、组织病理和扫描电镜观察确诊为黄曲霉所致原发性皮肤曲霉病。口服特比萘芬,500mg/d,治疗4周后治愈。例2,女,28岁,双手背、左跟腱部发生数个结节及坏死性溃疡8个月。实验室检查方法和诊断基本同例1。给予伊曲康唑口服,400mg/d,5周后显著好转,将剂量减至200mg/d,维持治疗至3个月后临床痊愈。例1、例2于治疗后做真菌分离培养均未见生长,组织病理复查病灶亦无真菌。     

双侧乳房皮肤垢着病1例

报告1例双侧乳房皮肤垢着病。患者女,14岁,双侧乳房褐色痂屑伴痒痛2个月。皮肤科检查:双侧乳房见以乳头为中心附着排列的油腻性褐色痂壳及鳞屑,大小不一,刮除痂屑可见正常皮肤。皮损处痂屑真菌镜检见簇集排列孢子。诊断:乳房皮肤垢着病。予盐酸布替萘芬乳膏、紫丙冬青油膏外用,每天早晚各1次,2周后原有皮疹基本消退,未见新发皮疹,刮取局部皮屑行真菌镜检未找到菌丝及孢子。     

阿维A有效治疗芽生菌病样脓皮病2例

病例1:患者男,51岁,左胫前增生性斑块2年。皮肤科情况：左胫前见3 cm×5 cm大小暗红色增生性斑块,边缘清楚并隆起,较厚褐色痂皮下可见糜烂面及脓性分泌物。皮损组织病理示：表皮假上皮瘤样增生,真皮浅中层弥漫淋巴细胞浸润。组织真菌及分枝杆菌培养(-),分泌物细菌培养示产气肠杆菌。诊断：芽生菌样脓皮病。治疗口服阿维A 20 mg, 1次/d, 1.5个月,头孢呋辛0.25 g, 2次/d, 2周,斑块消退,遗留淡红斑。病例2:患者男,53岁,右足跟上方斑块2年。皮肤科情况：右足跟上方见约4 cm×5 cm大小类圆形疣状斑块,局部见少量脓性分泌物及痂皮。组织真菌及分枝杆菌培养示(-),分泌物细菌培养示金黄色葡萄球菌。组织病理示：表皮呈假上皮瘤样增生,真皮浅层见少量中性粒细胞、淋巴细胞、浆细胞浸润。诊断：芽生菌病样脓皮病。治疗：口服阿维A 20 mg, 1次/d, 2个月后皮疹基本消退,留有褐色色素沉着。     

克柔念珠菌引起的皮肤念珠菌性肉芽肿一例国内首报

患者女,80岁,左手腕部3 cm×6 cm大小浸润性肿块,部分表面覆盖增厚焦痂.临床拟诊:皮肤真菌感染.皮损样本送真菌培养、组织病理检查及特殊染色.组织病理检查,真皮内有大量淋巴细胞、中性粒细胞及浆细胞浸润,特殊染色见有大量的真菌孢子及菌丝.真菌培养及鉴定证实为克柔念珠菌.给予伊曲康唑口服治疗5个月,皮损消退.     

Majocchi's肉芽肿一例

患者,女,68岁。右侧腕部红斑、丘疹、结节伴疼痛1年半,加重2个月。组织病理学示肉芽肿性改变,HE荧光染色及真菌培养显示红色毛癣菌。诊断:Majocchi's肉芽肿。患者给予抗真菌治疗,皮疹痊愈,随访一年无复发。     

播散性皮肤组织胞浆菌病1例及文献复习

患者女,31岁。多发性骨关节疼痛伴发热8月,多发性皮肤脓肿4月。脓液及组织真菌培养可见双相真菌荚膜组织胞浆菌,经rDNA的ITS区鉴定该菌与荚膜组织胞浆菌荚膜变种高度同源。诊断:播散性皮肤组织胞浆菌病。予口服伊曲康唑0.2g(2次/d)和5-氟胞嘧啶1g(3次/d)治疗,5个月后患者病情明显好转。并对相关文献进行复习。     

游泳池肉芽肿一例及文献复习

报道一例游泳池肉芽肿并相关文献复习。患者,女,40岁。右手中指溃烂、手背多发性结节伴疼痛3个月,皮损及周围皮肤皮温不高,常规抗感染治疗无效,有右手中指鱼刺划伤史。结核菌纯蛋白衍生物（PPD）试验（-）,皮损真菌镜检（-）,真菌培养及抗酸染色（-）,组织病理示非特异性炎症。抗真菌治疗无效,给予抗分枝杆菌感染治疗3个月后痊愈。     

CD30+皮肤T细胞淋巴瘤并发大疱性类天疱疮

报告1例CD30+皮肤T细胞淋巴瘤并发大疱性类天疱疮.患者男,77 岁.因躯干四肢皮疹伴偶痒3 个月入院.皮损和淋巴结组织病理及免疫组化检查提示CD30+皮肤T细胞淋巴瘤.患者在入院期间出现局限性水疱,组织病理及免疫荧光检查证实为大疱性类天疱疮.给予泼尼松30 mg/d 口服;重组人干扰素α-2b 300万U 肌内注射,隔日1 次,皮损较前减轻.     

肢端Bowen病误诊10年1例

临床资料 患者男,53岁.右手中指背面皮肤红斑10年.患者10年前右手中指近端指-指关节背面皮肤曾有外伤史,之后外伤部位出现绿豆大红色丘疹,逐渐增大,无明显不适,冬季容易皲裂.近2年增长较前迅速,2007年曾在外院诊断为孢子丝菌病,予口服伊曲康唑0.1 g,1次/d,连续服用3个月,无效.继又服用碘化钾治疗(具体用量不详),皮疹仍无明显好转.2008年1月患者在某医院就诊,诊断为亚急性湿疹,给予口服泼尼松30 mg/d,连用2周,皮疹明显消退,之后减量为20 mg/d,连续2周,皮疹变平,患者自行停用药物.     

类似环状肉芽肿的面部皮肤型孢子丝菌病一例

患者,女,54岁。左面颊红斑、丘疹、结节1个月。皮肤科查体见左侧面部类似环状肉芽肿的簇集浸润性环状红色斑块。皮损组织病理检查及真菌培养,确诊为“面部皮肤型孢子丝菌病”。给予伊曲康唑胶囊口服治疗3个月,皮损消退,随访6个月无复发。     

Primary cutaneous cryptococcosis and Cryptococcus neoformans serotype D

We report a Healthy, 73-year-old Japanese woman who presented with primary cryptococcosis on the skin of both cheeks. She had initially developed an erythematous, partly ulcerated lesion on the right cheek 2 weeks earlier following an injury. There was no regional lymphadenopathy, and chest X-rays were normal. Histopathological findings showed granulomatous cell infiltration, Periodic acid Schiff staining revealed spores that were identified by the indirect immunoperoxidase staining method as Cryptococcus neoformans. The isolate was identified as C. neoformans var. neofarmans serotype D. The skin lesions healed in 1 month without antifungal therapy. A literature review indicates that this serotype tends to produce cutaneous lesions without systemic involvement.     

A case of systemic osteomyelitides due to Mycobacterium avium

A case of multiple osteomyelitides due to Mycobacterium avium (M. avium) infection with osteosclerotic bone lesions is reported. A 67-year-old male had been suffering from persistent fever and back pain since October 1999, and 20.0-2.5 mg prednisolone per day was prescribed for continuous inflammatory symptoms in January 2000. Six months later, computed tomography revealed osteosclerotic lesions in the left femur and thoracic vertebrae, but no skin lesion associated with mastocytosis or internal malignancy was identified. In September of 2002, a dome-shaped, soft subcutaneous tumor developed on the upper sternum. Histopathological findings revealed subcutaneous adipose tissue with several foci of tiny abscesses. Two weeks later, creamy pus was discharged through a draining sinus at the center of the wound. M. avium was demonstrated in the pus by Zeel-Nielsen staining and microplate hybridization.     

Alopecia areata associated with regression of cutaneous melanoma

A 41-year-old white female with a past medical history of hypothyroidism and alopecia universalis presented on January 24, 2002 with a recently changing mole. She indicated changes in size and color of the superior aspect of a mole that had been present for more than 8 years. She had approximately 20 lifetime peeling sunburns due to being a lifeguard. No family or previous personal history of skin cancers, including melanoma or atypical nevi, was reported. Her history of alopecia universalis began 12 years previously and has partially resolved with remaining patchy alopecia of the scalp and eyebrows. On diagnosis of alopecia universalis, she was initially treated with oral prednisone for 1 year and topical minoxidil for 3 months. Currently, she is not being treated for this condition. She denied other previous skin conditions. She had a surgical history of tonsillectomy at the age of 7 years. Her current medication includes levothyroxine (0.015 microg) for hypothyroidism diagnosed 12 years previously. She reported no known drug allergies. During the initial physical examination, she presented with phototype II skin with two adjacent pigmented lesions on her left foot within a 1.3 cm square. The first lesion on the left posterior distal heel was an irregular, brown-black, 0.5 x 0.6 cm macule. The second lesion, on the left posterior proximal heel, was an irregular, brown, speckled, 0.3 x 0.4 cm macule (Fig. 1). The patient had ophiasis of the scalp and total alopecia of the bilateral eyebrows. In keeping with the patient's wishes, alopecia lesions were not biopsied and clinical photographs of the alopecia are not included in this article. Two 3 mm punch biopsies were performed within each lesion. The left posterior proximal lesion showed malignant melanoma, with a Breslow depth of 0.4 mm, anatomic level II, marked lymphocytic response and partial regression (Fig. 2). The left posterior distal lesion showed malignant melanoma in situ, arising in a lentiginous compound nevus, with architectural disorder and cytological atypia. These two lesions were concluded to be one lesion with clinical regression. She underwent local excision with 1-cm margins and sentinel lymph node biopsy owing to the presence of regression, which showed no evidence of metastatic melanoma. Lactate dehydrogenase and chest X-ray were within normal limits. The alopecia areas were not biopsied previously or at that time.     

面部毛霉病一例

目的报道1例因多变根毛霉引起的面部感染。方法经真菌镜检、培养和病理诊断为面部多变根毛霉病。结果患者5岁,因摔跤行鼻骨复位术后,面部出现红色丘疹,斑块,肉芽肿,2003年来我院诊断为面部毛霉病。2004年2月根据药敏试验选择酮康唑200 mg／d治疗2个月好转。因其他原因停止治疗,7个月后病情恶化,面部浸润性斑块,坏死,结黑色痂,脓性分泌物,上唇和上腭部分缺失,再次真菌镜检和培养鉴定为多变根毛霉。2004年12月给予两性霉素B治疗2个月,总剂量为50 mg／kg,明显好转,加用伊曲康唑 100 mg／d治疗。结论多变毛霉可引起皮肤组织浸润性感染,两性霉素B治疗有效。     

Cutaneous sporotrichosis with refractory and reinfectious lesions in a healthy female

We report a 71-year-old Japanese healthy female with an unusual clinical course of sporotrichosis; she developed infectious lesions on the face and the left upper limb at different periods. The initial lesion appeared on her right cheek and nose in 1992. Histopathologic and fungal examinations comfirmed the diagnosis of sporotrichosis. She was treated with oral potassium iodide and/or itraconazole and topical heat therapy. She had three recurrences and her facial plaque, which was resistant to several conventional treatments, was eventually excised and then grafted in 1996. After the surgical procedure, oral medication was continued for two months. In 2001, new lesions appeared on her left hand and forearm, which were anatomically different from the former lesions. Based on histopathologic and mycological findings, we confirmed reinfection with sporotrichosis. She was again treated with potassium iodide. The cutaneous lesions completely resolved after 26 weeks without surgical treatment.     

河南不规则毛霉致原发性皮肤毛霉病一例

【摘要】 患者女,50岁。右上肢皮肤结节、斑块、红肿、溃烂6年,右臀部斑块2年,右面颊斑块1年。曾单独口服特比萘芬、伊曲康唑治疗无效。右上肢及臀部皮损组织病理及PAS染色均可见真皮内宽大呈直角分支菌丝。真菌培养及分子生物学鉴定为不规则毛霉。联合伊曲康唑和特比萘芬治疗2个月仍无效,改为静脉滴注两性霉素B（总量1 060 mg）治疗,患者右面颊、右臀部斑块肿胀逐渐消退,右上肢包括右手背斑块、红肿、坏死、黑痂消退,皮损愈合成瘢痕,取右上肢皮肤组织再次行真菌培养阴性。随访1年未复发。     

Partial lipodystrophy in a patient with systemic lupus erythematosus

A 54-year-old woman developed partial lipodystrophy on the left side of her face. She had been suffering from systemic lupus erythematosus (SLE) since 1985 when she was 45 years old, and she had been treated with 30 mg/day of oral prednisolone as an initial dose. Partial lipodystrophy appeared on her left lower jaw in 1994 when the SLE was inactive, and the dose of prednisolone was reduced to 5 mg/ 3 days. Gradually, the lipodystrophy spread toward her left cheek and her left forehead without any preceding skin symptoms. Histological examination showed a loss of fat tissue and mild lymphocytic infiltrations mainly around cutaneous appendages and vessels in the dermis and subcutaneous tissue. The dose of prednisolone was increased to 10 mg/day and the lesions stopped spreading. Such partial lipodystrophy is distinct from lipoatrophy of lupus profundus.     

Recurrent Scedosporium apiospermum mycetoma successfully treated by surgical excision and voriconazole

Scedosporium apiospermum is an emerging opportunistic fungus that can cause localized infection in healthy hosts or severe disseminated disease in immunocompromised hosts. Most cases are reported in Western Europe, Australia, and North America. We report a 52-year-old immunocompetent Taiwanese woman who presented with a 6-year history of recurrent asymptomatic papulonodular lesions on her right foot after minor trauma. Deep fungal infection caused by Scedosporium sp. was diagnosed after a skin biopsy with fungal culture of the skin specimen. She underwent two surgical excisions, each followed by a 4-month course of oral itraconazole and intralesional injections of amphotericin B as well, but similar lesions recurred at the same location 1 year later. She had another surgical excision and the pathological findings showed mycetoma. The fungus was identified as S. apiospermum by PCR assay of fungal culture specimen using the internal transcriber spacers (ITS1, similarity 99.4%; ITS2, similarity 100%) and the D1–D2 (similarity 99.0%) regions of the ribosomal operon. After 4 months of oral voriconazole (400 mg/day), no recurrence was noted in the subsequent 2 years.     

Primary cutaneous cryptococcosis in a patient with systemic immunosuppression after liver transplantation

We report a 36-year-old woman who slowly developed an ulceration on the left thigh 2 years after transplantation for Budd-Chiari syndrome. At this time point, the patient was treated with prednisone, tacrolimus and azathioprine for immunosuppression and with phenprocoumon and low-dose aspirin for anticoagulation in the presence of polycythemia vera. A biopsy of the skin lesion was obtained and revealed encapsulated yeast that was identified by microbiological and serological methods as Cryptococcus neoformans serotype D. The patient had no signs of systemic infection and a therapy with fluconazole (200 mg/day) was started. The lesion healed within 8 weeks and fluconazole was stopped after 3 months. Due to interactions between fluconazole, tacrolimus and phenprocoumon, the latter drugs were decreased to prevent toxicity. So far, 1 month after stopping fluconazole, no recurrence of skin lesions has been observed.