淋巴管型孢子丝菌病1例

患者男,40岁,农民。右下肢可见线状浸润性斑块、结节、溃疡和结痂4个月。右下肢皮损组织病理示表皮下淋巴细胞、浆细胞、中性粒细胞和组织细胞浸润,可见多核巨细胞,有大量红细胞外溢。真菌培养可见孢子丝菌。     

孢子丝菌病诊疗指南

孢子丝菌病（sporotrichosis）是由申克孢子丝菌复合体（Sporothrix schenckii complex）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,偶可播散全身,引起多系统性损害。皮损主要表现为慢性炎症性肉芽肿损害,可形成丘疹、脓疱、结节、斑块、溃疡、肉芽肿、结痂等改变,常累及面部、四肢等暴露部位……     

儿童孢子丝菌病3例

报告3例儿童孢子丝菌病。例1男,7岁,左眼外侧暗红色浸润斑块,表面浅溃疡,周围一黄豆大暗红色结节。例2女,6岁,左侧口角外侧一长形暗红结节及斑块,中央少许糜烂及脓性分泌物。例3男,3岁,左面颊两个暗红色结节,表面脓性分泌物及结痂。组织病理学均示真皮层大量混合炎细胞浸润及多核巨细胞,PAS染色见几个椭圆形真菌孢子及星状体,真菌培养为申克孢子丝菌,3例均诊断为固定型孢子丝菌病,予口服10%碘化钾溶液3～6个月后痊愈。     

几种地方性真菌病的临床研究进展

近年来由于对外开放及国际交流增多 ,我国医生见到地方性真菌病的机会也增多。地方性真菌主要包括 :皮炎芽生菌、荚膜组织胞浆菌、球孢子菌、副球孢子菌 ;其分布的地理区域特殊 ,并通过吸入途径或皮肤粘模的破损而感染人类 ,在免疫受损和免疫力正常者均可引起地方性真菌病。皮炎芽生菌病、荚膜组织胞浆菌病、球孢子菌病、副球孢子菌病 4种地方性真菌病的地域分布、临床特征、诊断和治疗方面的进展作一概述     

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。     

几种地方性真菌病的临床研究进展

近年来由于对外开放及国际交流增多，我国医生见到地方性真菌病的机会也增多。地方性真菌主要包括：皮炎芽生菌、荚膜组织胞浆菌、球孢子菌、副球孢子菌；其分布的地理区域特殊，并通过吸入途径或皮肤粘模的破损而感染人类，在免疫受损和免疫力正常者均可引起地方性真菌病。皮炎芽生菌病、荚膜组织胞浆菌病、球孢子菌病、副球孢子菌病4种地方性真菌病的地域分布，临床特征、诊断和治疗方面的进展作一概述。     

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。     

播散型皮肤红色毛癣菌肉芽肿一例

患者男,35岁,全身出现泛发红斑、斑块、结节伴瘙痒8年。皮肤科检查：头面部及躯干四肢大片丘疹、红斑、浸润性斑块及结节,部分皮损边界清,伴少量鳞屑、结痂、萎缩性瘢痕,双眼睑肿胀,右耳廓已破坏消失,左耳廓变形,头发、眉毛、睫毛稀疏脱落,指（趾）甲甲板均肥厚、变形、断裂。真菌学检查：取皮损处皮屑直接镜检示分枝分隔菌丝阳性,真菌培养鉴定为红色毛癣菌生长。皮损组织病理检查：表皮角化过度,棘层增生肥厚,真皮浅中层可见上皮样细胞团块,伴淋巴细胞、浆细胞为主的炎细胞浸润,散在嗜酸粒细胞及多核巨噬细胞。PAS和银染色均可见真皮浅中层散在分布分枝分隔菌丝。诊断为播散性皮肤红色毛癣菌肉芽肿。伊曲康唑治疗3个月后皮损消退,留有色素沉着及萎缩性瘢痕,真菌直接镜检及培养均示阴性,服药期间未见明显不良反应。     

误诊为坏疽性脓皮病的皮肤播散型孢子丝菌病1例

患者女,63岁,农民。胸腹部结节、斑块、溃疡2年半。曾被误诊为"坏疽性脓皮病",并予糖皮质激素、米诺环素等反复治疗1年余,用药时皮疹有所好转,停药后皮疹加重。皮损组织病理示:呈炎性肉芽肿改变,脓液真菌培养鉴定为孢子丝菌。诊断:皮肤播散型孢子丝菌病。予特比萘芬口服,治疗3个月后皮损明显好转,目前仍在随访治疗中。     

母婴同患孢子丝菌病2例

例1男,12个月。左侧颞部淡红斑块2个月,周边有卫星状丘疹,间断溢出黄白色液体。例2女,31岁。系例1母亲,于患儿发病1周后上唇右上方出现米粒大丘疹,渐发展为黄豆大淡红色疣状结节。2例经组织病理、PAS染色及真菌培养,均诊断为孢子丝菌病。     

儿童表皮痣综合征1例

 报告儿童表皮痣综合征1例。患儿女,6周岁,脚趾畸形6年,右侧下肢、腰部、肩部、项部及左侧脚背部散在红斑、丘疹5年余。患儿出生时右侧第2、3脚趾畸形,第3、4脚趾向内侧弯曲,右侧脚踝出现红色丘疹,丘疹逐渐增多并蔓延至整个右侧脚踝及脚背部;出生后2个月左右,右侧腰部、肩部、项部及左侧脚背开始出现红色丘疹,红色丘疹逐渐增多并融合,伴有明显的瘙痒感。皮肤科检查：右侧腰部、腹股沟、下肢及脚踝、脚背部红色疣状丘疹,伴有黄色鳞屑,部分融合成片状或线状;右侧肩部及项部肤色、棕色、红色丘疹;左侧脚背部线状红色斑块,皮疹沿Blaschko线分布。右侧第2、3脚趾畸形,第3、4脚趾向内侧弯曲。皮损组织病理示：表皮角化过度,表皮突下延,棘层肥厚,真皮浅层血管周围见少量炎性细胞浸润。诊断：表皮痣综合征。     

发疹型扁平苔藓1例

  报告1例发疹型扁平苔藓。患者男,69岁。全身暗红斑、丘疹伴瘙痒5个月。血糖升高9年余。皮肤专科检查：头面部、躯干及四肢可见暗红斑,部分融合成片,部分苔藓样肥厚明显,伴扁平丘疹及斑块,上覆细薄鳞屑,头部皮肤脱屑明显,未见束状发。口腔颊黏膜可见Wickham纹,生殖器黏膜见白色斑疹。皮损组织病理：表皮缺损,真皮浅层见带状的淋巴组织浸润,见色素失禁。PAS染色阴性。诊断:发疹型扁平苔藓;2型糖尿病。予小剂量激素联合羟氯喹治疗1个月后,遗留色素沉着斑,无新发皮疹。     

Acroangiodermatitis

A 26-year-old man with a history of chronic primary lymphedema of the left lower extremity presented with elephantiasis, confluent, violaceous, mascerated plaques, and ulcers on the dorsal aspects of the toes of the left foot. Histopathologic examination showed a proliferation of small blood vessels associated with extravasated erythrocytes and hemosiderin deposits consistent with the diagnosis of acroangiodermatitis. Treatment of the focal ulcers includes compression therapy, local wound care, and surgical elimination of the shunt if there is an associated arteriovenous malformation.     

Busse-Buschke型念珠菌性肉芽肿伴肺部感染一例

患儿男,14个月.因左侧颞、颈、胸部相继发生红斑片、丘疹、结节、脓肿、溃疡伴反复发热、咳嗽9个月,门诊疑诊皮肤结核、深脓疱疮、孢子丝菌病收住院.左上胸皮损组织病理检查,显示为炎性肉芽肿,PAS染片内有大量孢子和菌丝.左颈坏死组织压片PAS染色镜检,发现大量菌丝,真菌培养及鉴定均为白念珠菌.超敏C反应蛋白(14.4 mg/L)显著高于正常.总T细胞比例40.21%,CD3/CD4(26.41%)下降;抗获得性免疫缺陷病毒抗体阴性.胸部X线片及CT检查均显示双肺感染.先后给予氟康唑和伊曲康唑抗真菌治疗,经抗生素、免疫调节剂和支持治疗3个月皮损痊愈,伊曲康唑维持治疗8个月肺部炎症减轻.     

Punctate porokeratotic keratoderma]

A 39-year-old woman had numerous keratotic papules on the volar surface of the right palm, both soles, fingers and toes. There were some spiny plugs on the edges of her toes. Histologic examination revealed a cornoid lamella. "Punctate porokeratotic keratoderma" "porokeratosis punctata palmaris et plantaris" refer probably to related conditions "keratosis punctate palmaris et plantaris". We prefer the term "punctate porokeratotic keratoderma".     

Segmental haemangioma of infancy of the lower limb with skeletal overgrowth

A female infant presented at 3 months of age with vascular lesions involving the left lower limb and left side of the vulva. At birth, the left leg was thinner than the right, but equal in length. She had macular, reticulate, bluish discolouration covering most of the skin of the involved leg with superimposed cherry-red papules, most dense over the proximal portion. The macular component showed evidence of improvement within the first few months of life. Papular and nodular components over the leg and the vulva progressively increased in size and thickness until the age of 10 months. These elements had the appearance and behaviour typical of haemangioma of infancy. Regression of these lesions started at the age of 15 months. By the age of 6.5 months, the involved leg was no longer thinner than the right, but the left leg and foot had grown longer. Leg length discrepancy peaked at 2.4 cm at the age of 2 years. The most rapid phase of relative growth discrepancy of left and right leg bones was contemporaneous with the growth phase of the haemangioma. Radiological investigations and histopathology have been consistent with haemangioma of infancy. GLUT-1 immunostaining of the lesion was positive.     

Fungal infections of the mucous membrane

A clinical review of three potentially severe fungal diseases, which are characterized in many cases by mucosal involvement, is presented. They are paracoccidioidomycosis, histoplasmosis, and mucormycosis. Mucosal involvement for paracoccidioidomycosis and rhinocerebral mucormycosis is frequent. Thus, oral involvement may provide early clue for diagnosis. In paracoccidioidomycosis, the mucosal lesion classically shows superficial ulcers with granular appearance and hemorrhagic points, usually on lips, palate, and jugal mucosa. In mucormycosis, necrosis of the palate followed for purulent discharge is a hallmark of rhinocerebral disease. Treatment with amphotericin B desoxycholate or the new second‐generation triazoles is highly efficacious.     

Digital ulcers and necroses: novel manifestations of angiocentric lymphoma

We describe a patient with angiocentric lymphoma whose presenting features were multiple areas of digital ulceration and necrosis, including deep ulcers on both great toes. He lacked the lateral halves of both earlobes because of multiple ulcers. Skin biopsy revealed a patchy and diffuse infiltrate of lymphoid cells with nuclear atypia in the dermis and subcutaneous tissue. Angiocentric and angiodestructive features of the lymphoid cells, a prominent histiocytic infiltrate and some epithelioid cell granulomas were found. The results of immunohistochemical staining showed a T-cell phenotype, and showed positive staining for apoptosis. He died in July 1999. Peripheral vascular disturbances including Raynaud's phenomenon, digital skin ulcers and necroses are novel clinical symptoms in patients with angiocentric lymphoma, which should be added to the differential diagnosis in patients with peripheral vascular disturbances.     

慢性皮肤黏膜念珠菌病

报告1例白念珠菌引起的皮肤黏膜念珠菌病，患儿女，7岁，全身散在丘疹5年，加重伴指疣状增生1年，同时出现口腔黏膜，皮肤及甲板损害，双手掌疣状赘生物，手指末节残缺，变形。口腔黏膜白斑，北部皮损组织及粪便真菌培养均为白念珠菌生长。皮肤组织病理改变为表皮角化明显，角质层中查见大量真菌菌丝。经伊曲康唑，制霉菌素等药治疗后，皮损逐渐好转。     

Cutaneous side effects in non-small cell lung cancer patients treated with Iressa (ZD1839), an inhibitor of epidermal growth factor

We report the cutaneous side effects of Iressa (ZD1839), a new anti-cancer agent that acts by inhibiting epidermal growth factor receptor signal transduction. The most common cutaneous adverse effect was the development of an acneiform eruption on the face, anterior trunk and back (39%). The second most common side effect was xerosis or desquamation of the face, body or distal parts of the fingers or toes (36%). Additional cutaneous side effects included multiple ingrown paronychial inflammation of the toes and fingers (6%), small ulcers of the oral mucosa or nasal mucosa, and urticaria. The cutaneous adverse effects of Iressa are similar to those of other epidermal growth factor receptor-targeted agents and result from direct interference with the functions of epidermal growth factor receptor signalling in the skin. Iressa-induced acne may be related to excessive follicular hyperkeratosis, follicular plugging, obstructions of the follicular ostium and alteration of hair cycle progression, which lead to an inflammatory response. Xerosis or desquamation reflects a disturbance of the equilibrium between proliferation and differentiation of epidermis. The mechanism by which Iressa leads to the development of paronychia and ingrown nail remains unclear.