原发性皮肤隐球菌病1例

患者女,53岁,农民。左腹部无痛性包块3个月于2002年5月10日就诊。患者于3个月前发现左腹部长一包块,约1cm×2cm大,局部无疼痛及瘙痒。无腹胀、恶心、呕吐、发热、头晕头痛等症状。曾先后被多家医院诊断为“脂肪瘤”。随着时间的推移,包块逐渐增大至鸡蛋大,局部有轻度压痛,表面无破溃患者自起病以来精神及食欲好,体重无明显减轻。既往史:既往无结核、肝炎、艾滋病(AIDS)、肿瘤等疾病史。体检:一般情况好,心、肺、肝、脾检查未见异常,全身浅表淋巴结未触及。皮肤科情况:腹软,无腹壁静脉显露。左腹壁可触及一约3cm×4cm大的包块,质韧,活动度…     

氟康唑治愈皮肤隐球菌病1例

1　病例　患者 ,女 ,1岁 7月 ,江西奉新县宗毕乡人 ,其母代述 :患儿于 2 0 0 0年 1月因外伤后 ,右侧面部出现一粟粒大小丘疹 ,后变为脓疱 ,继而脓疱增多 ,扩大且溃烂 ,表面有粘性分泌物及结痂 ,自觉痒 ,曾多次在当地经抗炎治疗 ,疗效不显。查体 :发育正常 ,营养良好 ,系统检查无异常。专科情况 :双侧面颊 ,右下颌见 3块直径约 3cm～ 5cm溃疡面 ,左下颌见 2块黄豆至花生米大小的溃疡 ,表面有粘性分泌物及结痂 ,边缘隆起 ,其上有散在的水疱或脓疱 ,呈潜行性破坏 ,基度周围红晕 ,皮损孤立散在 ,境界清楚。实验室检查 :血尿常规 ,肝肾功能正常 ,…     

原发性皮肤隐球菌病继发隐球菌性脑膜炎1例

患者男,５７岁,果农。突发剧烈头痛伴发热３天入院。半年前患者右颧部出现一绿豆大红色结节,无痛痒,后形成溃疡,周边隆起,并向周围逐渐扩大。２月前出现间断头痛伴发热,体温３８℃左右,用抗生素治疗无效,经脑ＣＴ检查无异常发现。取面部病变组织活检,排除皮肤肿瘤,住某市医院按脑膜炎处理,治疗１月未见缓解。３天前患者突发剧烈头痛,伴发热３８．２℃～３９℃,恶心喷射状呕吐,视物不清。于１９９８年１１月３０日收我院内科诊治。入院后给磺胺嘧啶口服,甘露醇、速尿及先锋霉素Ⅴ、甲硝唑等静脉注射,剧烈头痛缓解,自觉头胀…     

皮肤隐球菌病1例

报告1例皮肤隐球菌病。患儿男，12岁。因肾病综合征给予大剂量甲泼尼龙及环磷酰胺冲击治疗，面部及前臂出现多发性传染性软疣样皮疹，真菌学和组织病理检查证实为皮肤隐球菌病，给予氟康唑治疗无效，患者9d后死于急性肾功能衰竭。     

原发性皮肤隐球菌病1例

1 病历摘要 患者女,67岁.因面部红斑、破溃及结痂1年,于2019年11月13日来河北北方学院附属第一医院皮肤科就诊.患者1年前因玉米秸秆划伤鼻尖后出现黄豆大结痂,无痒痛,未予诊治.皮损逐渐扩展至鼻翼两侧,伴疼痛,曾接受伊曲康唑、碘化钾及异烟肼等治疗,皮损时有好转,反复发作.患者发病以来精神状态良好,饮食及二便均正常...     

皮肤隐球菌1例报道

患者男性，12岁，因肾病综合征给予大剂量甲基强的松及环磷酰胺冲击治疗，继发面及前臂的多发性传染性软疣样皮疹，真菌学检查和组织病理证实为皮肤隐球菌病，给予氟康唑治疗无效，患者9天后死于急性肾功能衰竭。     

原发性皮肤隐球菌病

病史：患儿男，7岁。面部、躯干、四肢广泛出现丘疹、溃疡、结痂3个月于1999年8月30入院。患儿于3个月前无明显诱因出现午后低热，体温37.2-37.5℃，伴有咳嗽、咳黏痰，同时在右侧头皮及肩部各出现一绿豆大丘疹，逐渐增多，并扩散至面部和四肢，皮疹黄豆至蚕豆大，并出现溃疡、结痂，皮疹不痛。     

伴皮肤损害的隐球菌病1例

报告1例伴皮肤损害的隐球菌病。患儿女,15岁。以发热伴脐周疼痛5天就诊。1周后出现皮肤损害,不痒。皮损真菌学检查证实为新型隐球菌感染,病理切片可见散在带厚荚膜的厚壁孢子;X线两肺野可见点、条状高密度棉絮状阴影;B超示肝脾肿大、腹主动脉旁多发淋巴结肿大;肝功能明显受损。     

原发性皮肤隐球菌病一例

报告1例自身免疫功能正常的原发性皮肤隐球菌病。患者因右腋窝肿块、进行性加重8个月就诊。皮肤科情况:右腋窝可见10 cm×2.6 cm隆起性肿块,质软、稍有波动感,边界清楚,活动度差;额部、前胸部散在米粒至黄豆大小丘疹及结节。根据其临床症状、组织病理检查、特殊染色及真菌学检查,确诊为原发性皮肤隐球菌病。经局部手术切除及口服伊曲康唑治疗痊愈。     

Disseminated cutaneous cryptococcosis in an immunocompetent elderly long-term pigeon fancier

Cutaneous cryptococcosis is classified as localized cutaneous cryptococcosis and cutaneous manifestations of disseminated cryptococcosis. The former presents as lesions, confined to isolated parts of the skin, which are neither systemically disseminated nor associated with cryptococcal fungemia or antigenemia. The latter presents as lesions through dissemination of Cryptococcus from visceral organs such as the lungs, with most cases being immunosuppressed hosts. We report the case of an immunocompetent elderly long-term pigeon fancier who presented with disseminated cutaneous cryptococcosis caused by Cryptococcus neoformans. Although the patient had been at risk of inhaling the pathogen by keeping pigeons for many years, and had been treated with topical steroids for a localized nodular lesion, the cause of development of multiple skin lesions could not be determined. The patient paradoxically showed no pulmonary or central nervous system symptoms, fungemia or glucuronoxylomannan antigenemia. Treatment with oral itraconazole 200 mg/day was not effective, but combination therapy of 5-fluorocytosine 200 mg/kg per day and fluconazole 100 mg/day resolved the disease.     

艾滋病合并新生隐球菌性脑膜炎41例临床分析

目的:探讨艾滋病合并新生隐球菌性脑膜炎患者的临床特征及疗效。方法:回顾性分析2011年4月——2018年6月该院收治的41例艾滋病合并新生隐球菌性脑膜炎患者的临床特点、实验室和辅助检查及疗效等。结果:所有患者中临床表现为发热者25例(61.0%),头痛者23例(56.1%),恶心呕吐者8例(19.5%)及颈项强直者29例(70.7%)。CD4⁺T淋巴细胞计数<100×10⁶个/L者40例(97.6%);脑脊液压力>180 mmH₂O者34例(82.9%),脑脊液墨汁染色阳性者34例(82.9%),脑脊液培养示新生隐球菌阳性者28例(68.3%),6例脑脊液隐球菌荚膜多糖抗原检查均阳性(100%),合并新生隐球菌败血症者23例(56.1%);头颅影像学检查异常者12例(29.3%)。经规范化抗隐球菌治疗,有效率为70.7%(29例),病死率为29.3%(12例),其中复发率为2.4%(1例)。结论:对疑似艾滋病合并新生隐球菌性脑膜炎感染患者应及时行腰椎穿刺术、脑脊液病原学检测及隐球菌荚膜多糖抗原检查,对疑似患者...     

Systemic lupus erythematosus‐associated cutaneous cryptococcosis treated successfully with an intermittent 3‐day on/off cycle of itraconazole

We describe a case of systemic lupus erythematosus (SLE)‐associated cutaneous cryptococcosis. A 32‐year‐old woman with SLE and lupus nephritis presented with the erythematous maculae on the chest and the extremities, in which encapsulated yeasts were revealed, and was diagnosed with secondary cutaneous cryptococcosis. We administered fluconazole (FLCZ) and then itraconazole (ITCZ) instead of amphotericin B (AMPH‐B) to avoid the risk of renal toxicity of AMPH‐B in the patient. While treatment with FLCZ was not particularly effective, repeated intermittent administration of ITCZ on a “3‐day on/off cycle” (i.e. medication on 3 consecutive days and suspension for the next 3 days in turn) achieved complete remission of the cryptococcosis.     

表现为皮肤溃疡和骨髓炎的播散性隐球菌病一例研究

目的 报告一例播散性隐球菌病的临床、实验研究和治疗结果。方法和结果 患者女,33岁。1年前上臂、肩、臀及大腿长结节,此间怀孕并早产。产后半个月新发结节泛发全身。3个月前诊断为“血源播散性肺结核”,但抗结核治疗无效。体检发现面部、牙龈、躯干、臀部及四肢共39个结节和溃疡,左胫、腓骨骨质破坏及窦道。脓涂片及病理活检见脓液和坏死组织内有大量真菌孢子,培养酵母样菌落生长,尿素酶及咖啡酸试验阳性。经API酵母菌反应条和血清学鉴定为新生隐球菌血清型A.将菌种接种于大小鼠后发现脑、肺、肝等易受累。临床分离株核糖体内转录间隔2区序列分析法鉴定为新生隐球菌新生变种。停抗结核药,用抗真菌药治疗。强化段用两性霉素B和氟康唑,维持段口服伊曲康唑。局部用两性霉素B.30d后结节消失,200d后溃疡和窦道全部愈合,277d时停抗真菌药,患者痊愈。     

多变根毛霉引起原发皮肤毛霉病1例

报告1例由多变根毛霉引起的皮肤毛莓病。患者男．33岁。右上肢外伤后弥漫性斑块伴肿胀、化脓7年余。免疫功能检测CD4^ T细胞略低(28％)，皮损组织病理检查示真皮中下层有炎细胞及多核巨细胞浸润，并见粗大较短的无隔菌丝经真菌培养菌种鉴定为多变根毛霉患者曾接受伊曲康唑、特比荼芬和氟康唑等抗真菌药物治疗．均无满意疗效．最后经用两性霉素B治疗痊愈．随访6个月未复发。     

A case of cutaneous localized cryptococcosis

A 65-year-old Japanese male with cutaneous localized cryptococcosis, which was developed as an erythematous infiltrated plaque on the right side of the face, was reported. The biopsy specimen taken from the lesion showed a granulomatous change with many spores in the dermis. Culture of the biopsy specimen gave Cryptococcus neoformans serotype D. There were no cryptococcal infections in the other organs. The skin lesion was improved by a systemic administration of miconazole. This patient was unusual since the cryptococcal lesion was limited to the skin, nevertheless he was under a severe cellular immunity deficiency. The reason for this may be that the infected C. neoformans strain belonged to serotype D.     

原发性皮肤毛霉病

报告1例原发性皮肤毛霉病.患者男,57岁.右前臂埋置静脉套管针17 d后局部出现红肿,迅速坏死并扩大.患者患2型糖尿病及慢性肾功能不全.皮肤科检查示右前臂大片坏死区,上覆黑色焦痂及渗出.取黑痂及渗液行真菌镜检,镜下可见大量粗大、无分隔、垂直分枝的菌丝,培养第2天即有棉花糖样菌落生长,初步诊断为皮肤毛霉病.皮损行组织病理检查,PAS染色示真皮及皮下组织可见较多粗大、无分隔菌丝,确诊为皮肤毛霉病.给予两性霉素B脂质体泵入、坏死组织清创术、术后外敷两性霉素B脂质体溶液及外用人成纤维细胞生长因子.患者伤口愈合良好,随访4个月无复发.     

Primary cutaneous cryptococcosis: the importance of early diagnosis

The species of the Cryptococcus neoformans complex show different epidemiological patterns in the infection of immunosuppressed or immunocompetent individuals, and a common tropism peculiarity for the central nervous system. Primary cutaneous cryptococcosis is a rare clinical entity, with manifestations that are initially restricted to the skin through fungal inoculation, and the absence of systemic disease. The authors report in the present study the case of a 61-year-old immunocompetent man, with a rapidly evolving mucoid tumor on abrasions in contact with bird droppings on the forearm. The early identification of the polymorphic skin manifestations and treatment are crucial for the favorable prognosis of the infection, which can be life-threatening.