原发性皮肤黄曲霉病1例

报道1例黄曲霉引起的原发性皮肤曲霉病。患者女,53岁。右手背反复红斑、结节、破溃、结痂2年余。皮损处刮取物直接镜检见大量分枝分隔菌丝,培养示黄曲霉生长。患者经伊曲康唑治疗后基本痊愈。     

原发性皮肤黄曲霉病1例

报道1例黄曲霉引起的原发性皮肤曲霉病.患者女,53岁.右手背反复红斑、结节、破溃、结痂2年余.皮损处刮取物直接镜检见大量分枝分隔菌丝,培养示黄曲霉生长.患者经伊曲康唑治疗后基本痊愈.     

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.     

正常人皮肤黑素细胞分布的观察

利用表皮分离－多巴染色法对正常人体5个部位的53个皮肤标本表皮黑素细胞进行观察分析，发现黑素细胞存在明显的部位差异，但其数量不随年龄改变。颈、上肢和后背皮肤黑素细胞数量较多（均值分别为1780、1030、1025／mm^2)，染色深，有较多短而细的分枝；下肢和胸腹皮肤黑素细胞数量较少（均值分别为784、783／mm^2)，染色淡、分枝少、但胞体较大、分枝粗长、有多级分枝。黑素细胞数量的部位差异可能是出后生各部位紫外线照射程度不同、使黑素细胞分裂增殖量不等造成的；其功能活性和形态改变可能受紫外线、表皮黑素单位内角朊细胞的代谢功能、数量及其细胞动力学的影响。     

镰刀菌皮肤肉芽肿1例

报告1例镰刀菌皮肤肉芽肿。患者男,21岁。面部出现红斑、丘疹、溃烂、结痂20年,四肢皮肤疣状增生3年,面部遗留毁容性瘢痕及组织缺损。多次取不同皮损处皮屑作真菌培养,均见相同菌落生长,经菌种鉴定为镰刀菌属。皮损组织病理学检查示表皮乳头瘤样增生,表皮浅层见多量菌丝,菌丝有分隔。流式细胞仪检测发现患者细胞免疫功能低下。根据药敏试验结果采用特比萘芬治疗,其疗效正在进一步随访观察中。     

光老化皮肤的预防,减慢和康复

光老化皮肤表现为发黄、革样、松垂和起皱,其下结缔组织出现损伤以及发生各种良性、癌前期或恶性肿瘤。组织学改变在青年人皮肤弹性组织的纤维是纤细、分枝的、并有垂直纤维分枝上达表皮真皮交界处。老年非暴露的皮肤,弹力     

肺病镰刀霉引起皮肤透明丝孢霉病1例

报告1例茄病镰刀霉引起的皮肤透明丝孢霉病。从患者皮损取材作镜检、培养及组织病理学检查。结果，直接镜检及组织病理切片均发现真菌菌丝，4次培养均为同一菌株生长。镜下可见大分生孢子位于短的分枝的分生孢子梗上，基部细胞短、钝圆并伴有不明显的足细胞，小分生孢子丰富，位于长的分生孢子梗上呈假头状着生，厚壁孢子常见，单细胞或双细胞，顶生或间生，壁光滑或粗糙。根据以上特征，该菌鉴定为茄病镰刀霉。     

重症药疹继发少根根霉致皮肤接合菌病

报告1例少根根霉致皮肤接合菌病.患者男,76岁.因别嘌醇引起的大疱性表皮松解型药疹入院,治疗1周后右腮腺区出现坏死并迅速扩大.患者患高血压、多器官损害、糖尿病等.皮肤科检查:右腮腺区见7 cm × 7 cm的皮肤干性坏死区.皮肤真菌镜检及组织病理PAS染色见大量宽大无分隔垂直分枝的菌丝.培养2 d即可见棉絮状的菌落生长.菌种鉴定为少根根霉.诊断为原发性皮肤接合菌病.虽给予两性霉素B脂质体静脉滴注及伊曲康唑口服、坏死组织清创术等积极治疗,但于感染的第18天死于急性冠脉综合征及肺出血.     

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。     

皮肤镜观察成人胶样粟丘疹

报告1例成人胶样粟丘疹,并描述皮肤镜特点。患者女,51岁。双侧颧部淡黄色丘疹4年余,经皮损组织病理检查确诊为胶样粟丘疹。皮肤镜下可见棕黄色无结构团块被白色条纹分隔,呈橘瓣横截面样改变;团块间隔及周围有分枝样血管。进一步对皮肤镜下呈无结构团块的三种疾病(胶样粟丘疹、汗管瘤及皮脂腺腺瘤)的皮肤镜模式进行比较后发现其团块形状及血管分布等有所不同。皮肤镜检查在胶样粟丘疹诊断及鉴别诊断中有指导作用。     

皮肤链格孢霉病1例

报告1例皮肤链格孢毒病。患者女，27岁，右颊部出现浸润性班块，其中央形成溃疡8年，真菌学检查及扫描电镜观察，鉴定为交链链格孢，组织病理检查示：溃疡边缘伴有大量多核巨细胞肉芽肿；寄生形态苏木精—伊红染色表现为空泡样结构，棕色分隔菌丝或棕色孢子，PAS染色见大型圆形孢子和粗细不一的分隔菌丝，患者接受伊曲康唑200mg/d口服治疗，第9周溃疡结痂，愈合，复查组织病理仍见肉芽肿及真菌成分，分离培养未阴转。     

Cutaneous, pulmonary and bone aspergillosis in a patient presumed immunocompetent presenting subacute cutaneous lupus erythematosus

INTRODUCTION: We report a case of cutaneous, pulmonary and bone aspergillosis successfully treated after many years of progression in a patient presumed immunocompetent presenting subacute cutaneous lupus erythematosus. CASE-REPORT: A 43-year-old man, treated with thalidomide for subacute cutaneous lupus erythematosus, presented chest pain with haemoptysis and dyspnea. A pulmonary nodule was detected but the microbiological investigation was negative. The histological examination showed granuloma with round structures. No cause was found. Three years later, skin lesions appeared on the patient's face concomitantly with a pulmonary relapse. Histopathological examination of these lesions demonstrated septate hyphae. Aspergillus fumigatus was isolated in skin and lung. Disseminated aspergillosis was then diagnosed as spondylodiscitis developed. Treatment with combined voriconazole and caspofungin produced significant and rapid improvement of lesions. DISCUSSION: While aspergillosis is commonly seen in immunocompetent patients, angiotropic dissemination points to cellular immunodepression. Our patient, however, was not presenting immunodepression. We discuss the possible contributory role of thalidomide in dissemination of aspergillosis given that the literature to date contains only one reported case of cutaneous aspergillosis secondary to A. fumigatus in an immunocompetent patient. We would also point out the specific histopathological pattern of this disseminated aspergillosis with both septate hyphae and round structures. Invasive aspergillosis is highly lethal but the chances of recovery are now greater thanks to new antifungal agents.     

Pseudoepitheliomatous hyperplasia secondary to cutaneous aspergillus

Cutaneous aspergillosis commonly occurs in immunocompromised hosts and may also complicate burn wounds. Pseudoepitheliomatous hyperplasia (PH) is a histologic reaction secondary to a wide range of stimuli, including fungal infection. We describe a case of an 18-year-old man, status-post burns over 70% of his total body surface area, with cutaneous aspergillosis of the axilla and secondary PH. A single case of PH secondary to primary aspergillosis has been described in the larynx but, to our knowledge, has never been described cutaneously. Histologic examination of the lesion reveals an irregularly acanthotic epidermis with deep invaginations within the dermis. There is an intense inflammatory reaction within the superficial and deep dermis. Numerous fungal forms are identified within the dermis. Special stains demonstrate septate hyphae with dichotomous branching, which is morphologically consistent with Aspergillus. Therefore, we conclude that cutaneous aspergillosis should be included in the differential diagnosis of causes of PH, especially in a patient population at risk for this infection.     

Solitary embolic cutaneous aspergillosis in the immunocompromised patient with acute myelogenous leukemia - a propos another case caused by Aspergillus flavus

A 68-year-old male with acute myelogenous leukemia was admitted for consolidation chemotherapy. The in-hospital course was complicated by neutropenia, fever and nodular pulmonary opacities suggestive of multifocal pneumonia. The patient subsequently developed a single, solitary necrotic crusted nodule on the right cheek. Skin biopsy demonstrated embolic vascular invasion with septate hyphae, dichotomous branching and minimal inflammation. Tissue culture revealed Aspergillus flavus . Despite systemic antifungal therapy with amphotericin B and granulocyte transfusions, the patient developed respiratory failure and died of disseminated aspergillosis, sepsis and renal failure. The clinical presentation of disseminated infection with Aspergillus flavus as a solitary embolic cutaneous lesion is extremely rare. We have reviewed other cases described in the literature and suggest this pattern of cutaneous involvement as more typical of disseminated infection with Aspergillus flavus .     

Primary cutaneous granulomatous alternariosis

We report on a case of primary cutaneous granulomatous alternariosis on the forearm of a 65-year-old man who is otherwise in a good health. Histological examination revealed a predominantly histiocytic granuloma with numerous large cells containing fragments of fungi. The granuloma contained septate fungal hyphae and macroconidiospores. By means of macro- and micro-cultures the fungus was identified as an Alternaria species.     

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。     

Human immunodeficiency virus-related primary cutaneous aspergillosis

A 31-year-old Caucasian man with AIDS developed a crusted violaceous plaque under adhesive tape near a central venous catheter insertion site. Histological examination demonstrated a ruptured hair follicle containing collections of fungal hyphae typical of Aspergillus spp. A culture of the biopsy material grew Aspergillus fumigatus. The patient responded to removal of the catheter and the occlusive dressing, in addition to itraconazole therapy. Aspergillosis must be considered in the differential diagnosis of cutaneous lesions in human immunodeficiency virus-infected patients, in particular when the lesion occurs under adhesive tape or an occlusive dressing.     

Post‐filarial cutaneous aspergillosis

Background  Aspergillus species are widely distributed in nature; however, cutaneous infections due to A. terreus are particularly rare. In this report, we describe a very uncommon case of primary cutaneous aspergillosis presenting as cauliflower‐like skin lesions caused by A. terreus in a patient with preexisting bilateral filarial elephantiasis of the legs. Materials and methods  Histopathological examination of the lesions revealed narrow, septate, branching, acute‐angled hyphae with delicate chitinous walls and multinucleated giant cells in the dermis. Results  The fungal isolate was identified as A. terreus using standard laboratory procedures. Conclusion  Here we report an extremely rare and unusual manifestation of primary cutaneous aspergillosis.     

疣状瓶霉致暗色丝孢霉病一例

患者男,16岁,右面颊红斑、结痂,渐扩展11年。体检：右面颊6 cm × 10 cm形状不规则暗红斑和斑块,轻度疣状增生,皮疹边界清晰,边缘见条索状瘢痕,上部见多处约0.5 ~ 1 cm大小的破溃、结痂,痂皮较硬,压片未见果酱色小结节。多处痂皮下刮片直接镜检,见淡棕色、粗细不等、分支分隔的菌丝。25 ℃和35 ℃沙氏葡萄糖琼脂培养基或马铃薯葡萄糖琼脂培养基培养形成黑绿色绒毛状菌落,镜下见具领状结构的瓶形产孢细胞和花朵样排列的小分生孢子。组织病理学检查,PAS染色见大量分支分隔菌丝、假菌丝和酵母样细胞。rDNA种特异性序列与疣状瓶霉标准株CDC-B2152具有99.73%的相似度。诊断：疣状瓶霉引起的面部暗色丝孢霉病。治疗：两性霉素B、伊曲康唑治疗有效,停药后复发,目前应用伊曲康唑和特比萘芬继续治疗。