红色毛癣菌致皮下脓肿型Majocchi肉芽肿

目的:报告1例红色毛癣菌引起的皮下脓肿型Majocchi肉芽肿,并对国内报道的类似病例进行文献回顾。方法:对患者的临床资料、真菌学检查、分子生物学鉴定、组织病理及疗效进行分析,并对1998—2012年国内报道的16例红色毛癣菌肉芽肿进行分析比较。结果:患者为女性,23岁。患有特发性血小板减少性紫癜,长期应用糖皮质激素,左小腿出现结节、脓肿及溃疡4个月。溃疡表面分泌物真菌镜检菌丝阳性,真菌培养及分子生物学鉴定为红色毛癣菌。皮损组织病理可见真皮深层及皮下组织大片坏死,有较多中性粒细胞和少量多核巨噬细胞浸润,PAS染色可见菌丝。诊断为:红色毛癣菌皮下脓肿型Majocchi肉芽肿。伊曲康唑治疗3个月皮疹消退留有瘢痕,随访3个月无复发。文献回顾发现,红色毛癣菌肉芽肿病程长,大部分患者免疫功能正常,皮损多为结节、斑块,出现皮下脓肿较少见。应用伊曲康唑或特比萘芬治疗一般均有较好治疗效果。结论:红色毛癣菌致皮下脓肿型Majocchi肉芽肿较少见,及时足量应用伊曲康唑治疗,疗效确切。     

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。     

伴窦道形成的Majocchi肉芽肿

报告1例伴窦道形成的Majocchi肉芽肿。患者男,42岁。左小腿多发红斑及溃疡伴瘙痒2个月余。皮肤科检查：左小腿见边界欠清的水肿性红斑,表面有2处浅表性溃疡,直径分别约1 mm和5 mm。溃疡下方伴窦道形成,挤压窦道口可见清亮的渗出液。窦道周围皮肤见粟粒大红色丘疹、丘疱疹及水疱,疱壁薄,疱液清亮,部分破溃伴渗出。皮损组织病理：真皮内可见毛囊周围炎,真皮全层混合炎症细胞、组织细胞及多核巨细胞浸润,并伴上皮样细胞肉芽肿形成。过碘酸希夫染色可见孢子及菌丝。窦道渗出液直接镜检：见菌丝。窦道渗出液真菌培养：可见表面白色,背面浅红色羊毛样菌落。分子生物学鉴定：红色毛癣菌。诊断：红色毛癣菌致Majocchi肉芽肿。予伊曲康唑口服,疗效佳,随访至今未复发。     

须癣毛癣菌肉芽肿1例

患者女,76岁,左前臂斑块伴疼痛1年。皮肤科情况:左前臂远端皮肤见鹅蛋大小红色斑块,边缘肿胀,边界清楚,浸润感明显,有淡黄色分泌物渗出,表面皮温升高,触痛明显。皮损组织病理示:真皮内弥漫性的淋巴细胞、组织细胞、中性粒细胞及多核巨细胞呈肉芽肿样浸润;银染:可见分枝状菌丝和孢子。真菌培养分离出须癣毛癣菌。诊断:须癣毛癣菌肉芽肿。     

外阴Majocchi肉芽肿1例

患者女,20岁。耻骨区紫红色皮下结节伴疼痛17 d。皮肤科情况:耻骨区可扪及5 cm×8 cm大小的紫红色皮下结节,触之质韧,轻压痛,皮温稍高,无明显波动感;其表面可见少量粟粒大小的红色丘疹、丘脓疱疹。皮损组织病理示:表皮角化过度,棘层增生肥厚,表皮突伸长增宽。真皮全层及皮下脂肪内见大量密集的中性粒细胞、组织细胞、浆细胞、多核巨细胞、淋巴细胞及嗜酸性粒细胞浸润;并且可见多数孢子样结构。PAS染色:见较多孢子样结构。组织真菌培养为红色毛癣菌。诊断:Majocchi肉芽肿。治疗:伊曲康唑口服,4周后皮疹基本消退。     

须癣毛癣菌肉芽肿1例

患者女,39岁。右下肢红斑2个月,全身丘疹伴剧烈瘙痒2周。有动物接触史。真菌培养分离出须癣毛癣菌。皮损组织病理PAS染色在真皮中部毛囊和毛干内见菌丝结构。诊断为须癣毛癣菌所致皮肤癣菌肉芽肿。     

伊曲康唑治愈红色毛癣菌肉芽肿1例

伊曲康唑治愈红色毛癣菌肉芽肿１例王爱平，王端礼，李若瑜，周祖德，万喆我们应用伊曲康唑胶囊２００ｍｇ／天治愈１例红色毛癣菌肉芽肿，现报告如下。患者女性，２ｌ岁，待业，安徽人。因右腰部皮肤反复红斑鳞屑性损害２年余，局部皮肤肿物进行性增大１０个月，破溃流脓...     

伊曲康唑冲击治疗皮肤播散性红色毛癣菌病1例

伊曲康唑400mg/天，连续一周冲击治疗，辅以增强免疫功能及对症治疗，治愈皮肤播散性红色毛癣菌病一例。皮损和组织真菌镜俭和培养均为阴性。随访十月，未复发。     

女童患须癣毛癣菌肉芽肿1例

患儿女,10岁。面部斑块、丘疹、脓疱3个月,有宠物接触史。皮肤科情况:右额部见一5.0cm×3.0cm红色斑块,间以丘疹、少许脓疱。实验室检查:血CD413.6%(25.8%~41.6%),真菌培养分离出须癣毛癣菌。皮损组织病理:真皮及皮下脂肪内见中性粒细胞为主炎性细胞浸润,伴脓肿形成。诊断:须癣毛癣菌所致皮肤癣菌肉芽肿。     

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.     

Blastic plasmacytoid dendritic cell neoplasm presenting as fever with diffuse cutaneous nodules

A young man, presented with high-grade fever and disseminated asymptomatic skin lesions of 6-weeks duration. Cutaneous examination revealed multiple infiltrated monomorphic skin-colored papules and nodules upto 2×2 cm all over scalp, face, trunk and extremities. Light microscopy of nodules showed diffuse infiltration of dermis and subcutis by a tumor composed of medium to large cells with round to ovoid nuclei with fine chromatin, few with visible nucleoli and scanty to moderate amounts of eosinophilic cytoplasm. Tumor cells were positive for CD4, CD8, CD56 and negative for CD30, terminal deoxynucleotidyl transferase and Alk-1. Excised axillary lymph node showed similar morphologic and immunohistochemical findings. There was bone marrow involvement with infiltrate of large atypical/immature lymphoid cells. Diagnosis of blastic plasmacytoid dendritic cell neoplasm was made. This is a rare neoplasm. presenting commonly in the skin, with or without concurrent extracutaneous disease.     

Majocchi's granuloma of the face in an immunocompetent patient

Majocchi's granuloma is a condition with chronic erythematous and indurated plaques that is a result of the rupture of a dermatophyte-infected infundibulum as a result of trauma. It is frequently seen on the anterior aspect of the legs of women. Herein, we present a case of Majocchi's granuloma of face, a site rarely involved, in an immunocompetent patient. Diagnosis was confirmed by histological and mycological examination. Histological examination revealed hyphae and arthrospores in the hair follicles and in the dermis with a diffuse dermal infiltrate consisting of lymphoplasmacytic cells, and focal collections of epithelioid cells, neutrophils and mild interstitial edema. Mycological examination confirmed the presence of fungus, Trichophyton rubrum, and the diagnosis of Majocchi's granuloma of the face was made. No concrete predisposing factor was found to be associated with the occurrence of the lesions on the face. However, the history of prolonged veiling of the face by a cloth by the patient, perhaps contributing to the occurrence of lesions on face, is a point of dubious significance.     

网状红斑黏蛋白病并发蕈样肉芽肿1例

报告网状红斑黏蛋白病并发蕈样肉芽肿1例。患者女。42岁。因躯干、上肢红斑14年,皮损增多,加重5年就诊。6年前行皮损组织病理学检查示真皮乳头层及网状层有大量黏蛋白样物质沉积,诊断为网状红斑黏蛋白病,入院皮肤科检查：头部、面部、颈部、躯干、四肢见片状轻度浸润性红斑,部分融合成网状,腹部红斑上可见紫红色浸润性斑块。皮损组织病理检查：真皮肉淋巴细胞苔藓浸润,部分细胞异形,少量浸润细胞移入表皮,形成Pautrier样微脓种,免疫组化染色结果示：LCA（＋＋＋）,CD45RO（＋＋＋）,诊断。蕈样内芽肿。     

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.     

Deep dermatophytosis caused by Trichophyton rubrum

A 50-year-old man with hepatitis C virus infection and liver cirrhosis, who was awaiting transplantation, was admitted to the Transplant Surgery Service for treatment of a pleural effusion and an elevated ammonia level. Skin examination showed violaceous, firm nodules on the right thigh, which had been present for eight months. A fungal culture showed Trichophyton rubrum. The patient was started on itraconazole with improvement in the eruption.     

Recalcitrant trichophytic granuloma associated with NK-cell deficiency in a SLE patient treated with corticosteroid

Although deep trichophytic infection often occurs in immunocompromised patients, the immune deficiency in such patients has not been clarified. A 28-year-old man who suffered from recalcitrant trichophytic granuloma and tinea universalis during treatment for SLE with corticosteroid is described here to define the immunological abnormalities. In addition to routine immunological tests, we evaluated the patient's innate and specific immune functions to dermatophytes, including T cell, natural killer (NK) cell and neutrophil functions and activation of the complement cascade. We measured the minimum inhibitory concentration (MIC) of itraconazole for the isolated fungus and its concentrations in the patient's serum and pus. Trichophyton (T.) rubrum was constantly isolated from the exudates of the patient's skin lesions, although the concentrations of itraconazole in his serum (198 ng/ml) and lesions (210 ng/ml) were sufficient to inhibit the growth of the isolated fungus in vitro. Specific cell-mediated immune responses, determined by T cell stimulation and IFN-gamma production, were evoked following stimulation with trichophytic antigens. The patient's innate immunity, assessed by activation of the complement cascade and neutrophil-mediated phagocytosis, was not impaired. The number of circulating NK cells was markedly decreased (0.2% of the peripheral blood mononuclear cells), and was associated with low NK cell activity against K-562 cells even though lymphopenia had improved. The deficiency of innate immunity mediated by NK cells might be responsible for a part of the persistence of trichophytic granuloma in our case. Dermatophytes usually affect the horny layer of the skin and do not invade the living layers because the host immune system uses various mechanisms to eliminate the fungi. Both specific T cell-mediated immunity and nonspecific immunological mechanisms provide host defense against fungal infections. An adaptive immune response is usually preceded by innate immune responses mediated by neutrophils, NK cells, and circulating proteins such as complement components and anti-microbial peptides. However, in patients with localized or systemic immunological defects, granulomatous cutaneous infection of dermatophytes mostly caused by trichophytic fungi may occur [1]. Trichophytic granuloma includes Majocchi's granuloma [2] and disseminated trichophytic granuloma [3]. Recently, we experienced a patient with trichophytic granuloma and tinea universalis caused by Trichophyton (T.) rubrum infection during treatment with corticosteroid for systemic lupus erythematosus (SLE). We describe the clinical details of this patient, focusing on his immunological defects which led to the persistence of the fungal infection.     

石膏样毛癣菌致皮肤癣菌肉芽肿一例

患者,男,47岁。右手浸润性鳞屑性斑块2年,上覆脓疱、血痂。皮肤病理示感染性肉芽肿,真菌培养见石膏样毛癣菌。诊断为皮肤癣菌肉芽肿。口服伊曲康唑200 mg,每日2次,3周后明显好转。     

Invasive dermatophytosis with lymph node involvement in an immunocompetent patient

A 23-year-old man presented with annular and arcuate, hyperpigmented, itchy, scaly plaques over the trunk and lower extremities for 5 years progressing to verrucous papules and nodules for the last 1.5 years. He also had nontender, inguinal and axillary lymphadenopathy. Skin and lymph node biopsies showed granulomatous inflammation and special stains demonstrated long septate hyphae. Tissue cultures grew Trichophyton verrucosum. The patient was treated with itraconazole 100 mg twice daily for 8 months, resulting in complete clearance of the lesions.     

皮肤平滑肌瘤1例

报告1例多发性毛发平滑肌瘤。患者女，64岁。躯干出现皮疹3年，临床表现为躯干、四肢散在红褐色丘疹、结节。皮肤组织病理显示，真皮可见较多群集束关和团块状杂乱排列平滑肌束。免疫组化证实过度增生的纤维为平滑肌。