DNA测序诊断孢子丝菌病三例

目的: 本文报道通过对组织分子鉴定明确病原菌的孢子丝菌病3例。方法: 提取3例怀疑孢子丝菌病患者活检组织中的真菌DNA,进行ITS区扩增、测序和比对;病变组织行组织病理学检测。,对脓液和组织进行真菌镜检及培养,对培养阳性菌落进行形态学、分子生物学、糖同化实验鉴定以及体外药敏检测。结果: 真菌镜检脓液见少量孢子、未见菌丝;病理检查提示感染性肉芽肿,抗酸染色及PAS染色均阴性;ITS区鉴定提示申克孢子丝菌;真菌培养、形态学及糖同化鉴定及calmodulin分子鉴定为球形孢子丝菌;药物敏感性检测显示其对特比萘芬高度敏感;口服特比奈芬250mg/d;舍他康唑乳膏外用,治疗后明显改善。结论: 直接提取病变组织DNA 进行早期DNA测序能够能尽早明确致病菌种并指导用药。     

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。     

皮肤淋巴管型孢子丝菌病1例

患者女,57岁。右拇指、腕部及前臂结节伴瘙痒和疼痛3月。右前臂皮损组织病理示:化脓性肉芽肿性改变。真菌培养见申克孢子丝菌生长。诊断:皮肤淋巴管型孢子丝菌病。     

氟康唑治愈孢子丝菌病1例

患者女 ,34岁 ,乡村教师 ,放暑假时下田干活 ,不慎将右小腿胫前皮肤划伤 ,当时未做任何处理 ,两周后在伤口处出现三个米粒大小红色丘疹 ,微痒 ,以后皮疹逐渐增多扩大 ,顶部结痂 ,痂下有脓性分泌物渗出 ,曾在当地医院对症治疗不见好转 ,三个月后经外院病理检查诊断为“孢子丝菌病” ,既往身体健康。查体 :系统检查无异常。皮肤科情况 :右小腿胫前下 1/3处皮肤见 5个黄豆及花生米大小暗红色半球形结节 ,上结褐色痂 ,痂下有脓性分泌物渗出。实验室检查 :血尿常规正常 ,肝功正常 ,取痂下脓液真菌培养有孢子丝菌生长。诊断 :孢子丝菌病。治疗 :氟…     

面部孢子丝菌病误诊为疖肿1例

患者,女,68岁。左眉外侧不规则暗红色斑块4个月,曾误诊为"疖肿"。真菌培养鉴定为申克孢子丝菌,诊断为孢子丝菌病。     

足菌肿1例

患者男,32岁。左底及足背起红斑结节斑块伴溢脓3年。皮损组织病理示:表皮呈假上皮瘤样增生,真皮可见大量混合炎细胞浸润,可见硫磺颗粒,未见菌丝及孢子。脓液及组织块真菌培养示:裴氏着色真菌;细菌培养示:猪红斑丹毒丝菌。诊断为足菌肿,给予克林霉素,伊曲康唑及特比萘芬,治疗好转,目前正在随访中。     

婴儿孢子丝菌病一例

患儿,女,10个月。右侧面部斑块8个月。皮肤科查体：右侧面部一横条状红色斑块,上可见黄白色鳞屑、少许褐色结痂。真菌培养阳性,形态学鉴定为孢子丝菌。诊断：固定型孢子丝菌病。治疗：给予盐酸特比萘芬片50 mg日1次口服,萘替芬酮康唑乳膏日2次外用,治疗12周后其上痂屑脱落,但斑块缩小不明显。     

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。     

皮肤播散型孢子丝菌病1例

患者男,28岁。采割芦苇划伤后四肢及面部出现多个红色结节,部分结节破溃、流脓。取脓汁真菌培养阳性,经鉴定为申克孢子丝菌,诊断为皮肤播散型孢子丝菌病。给予10%碘化钾、伊曲康唑治疗4周后破溃结节愈合,部分结节缩小。用药10周后,结节变平,真菌培养阴性。半年后随访仅留色沉及浅表瘢痕,无复发。     

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.     

急性泛发性发疹性脓疱性皮病1例

报告1例急性泛发性发疹性脓疱病。患者女，75岁，躯干、四肢起红斑，部分融合成大片，其上密集分布粟粒至米粒大的脓疱，部分脓疱互相融合成“脓湖”，右下肢部分片状脱屑。组织病理示角层下脓疱。患者在发疹前2h使用过青霉素等药物。     

重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白联合治疗泛发性连续性肢端皮炎一例

患者,男性,16岁,右手指甲周皮肤起红斑、脓疱9年,右手第4和5指指节间关节畸形1年入院。皮肤科检查：右手掌背及第1、4和5指弥漫性红斑,表面散在或密集米粒大小脓疱,部分形成脓湖或脓痂,指甲脱失,手指末端变细;第4、5指指节间关节屈曲畸形,功能受限。四肢皮肤见散在分布少数浸润性红斑,表面有少量小脓疱。患者家族中无银屑病史及类似疾病史。实验室检查：血常规：WBC 7.77×109/L、中性粒细胞百分比57.6%、淋巴细胞百分比30.28%、RBC 4.75×1012/L、HGB 136g/L、PLT 278×109/L。肝功能检查：ALT 13 U/L、AST 17 U/L、ASP 160 U/L、γ-GT 17 U/L、TBIL 19.2 umol/L。抗核抗体(-)、抗dsDNA抗体（-）。梅毒螺旋体特异抗体和艾滋病抗体检测阴性。Hbs-Ag（-）,HCV-cAg（-）。脓疱细菌培养无细菌生长。结核菌素纯蛋白衍化物(PPD)试验（+）;胸部X片检查未见明显异常。心电图检查大致正常。诊断：泛发型连续性肢端皮炎。入院后予阿维A胶囊、火把花根片、复方甘草酸苷注射液等联合糠酸莫米松乳膏、莫匹罗星软膏及钙泊三醇倍他米松软膏治疗,经2周治疗皮损部分消退,偶有少量新脓疱形成,受累手指疼痛减轻,但病情仍继续进展,右手第2指和左手第5指亦受累。为遏制病情进一步发展,审慎地权衡利弊后,遂决定开始rhTNFR:Fc治疗。治疗12周后,四肢皮损消退,新脓疱形成停止,但手指畸形和功能无改善,治疗获得部分成功。     

Case of cutaneous Scedosporium apiospermum infection successfully treated with voriconazole

We report a case of cutaneous infection due to Scedosporium apiospermum in a 75-year-old immunocompromised male patient who had received long-term corticosteroid and immunosuppressant therapy for the treatment of nephrotic syndrome. The patient came to our department complaining of erythema with a number of pustules on the dorsal surface of the right hand. S. apiospermum was identified from a culture taken from the pus. After unsuccessful treatment with topical ketoconazole, oral itraconazole and oral terbinafine, the lesion quickly resolved with the daily administration of 400 mg voriconazole. No recurrence was observed despite discontinuation of voriconazole due to drug-induced hepatitis. Voriconazole holds out the promise of an effective treatment for invasive Scedosporium infection.     

表现为中毒性表皮坏死松解症的急性泛发性发疹性脓疱病

报告1例表现为中毒性表皮坏死松解症的急性泛发性发疹性脓疱病。患者男，36岁。因上呼吸道感染口服对乙酰氨基酚及静脉滴注头孢拉定，5d后全身起红斑，脓疱，多数脓疱融合成脓潮，表皮大片脱落，呈中毒性表皮不死松解症表现，组织病理检查符合急性泛发性发疹性脓疱病诊断，予以糖皮质激素及万古霉素等治疗后皮损痊愈。     

TNF-α拮抗剂治疗复发性疱疹样脓疱病一例

患者,女,31岁。妊娠期反复脓疱加重1个月。患者8年前妊娠期曾全身出现红斑、脓疱,产后皮损自行消失。根据患者既往病史、症状、体征及辅助检查,诊断“疱疹样脓疱病”,入院后予TNF-α拮抗剂皮下注射,辅以复方甘草酸苷、阿奇霉素抗炎及外用药治疗,1周后患者皮疹明显好转出院。     

重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白治疗疱疹样脓疱病一例并文献复习

患者,女,26岁。全身泛发性红斑、脓疱2个月,加重伴高热1周。银屑病病史13年,妊娠28周。外周血白细胞及中性粒细胞偏高,血及脓疱细菌培养阴性,根据临床表现及辅助检查可诊断为疱疹样脓疱病。入院后给予人免疫球蛋白20 mg,头孢曲松1.0 g,1次/日,治疗2周效果不佳,加用重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白25 mg,2次/周,2周后好转出院,新生儿健康。     

头皮糜烂性脓疱性皮病一例

患者,女,50岁。头皮红斑、脓疱伴疼痛6个月。皮肤科查体：头皮弥漫性分布紫红色浸润性斑片,其上见脓疱,局部见斑片状脱发区。实验室检查：取脓疱疱液多次行细菌及真菌培养均阴性。组织病理：表皮角化过度伴角化不全;真皮浅中层弥漫性淋巴细胞、浆细胞、中性粒细胞浸润。抗生素治疗效果不佳,口服糖皮质激素及外用他克莫司治疗后有效。诊断：头皮糜烂性脓疱性皮病。     

A case of pustulosis palmaris et plantaris that began as generalized pustular eruption

A 65-year-old woman suddenly developed a widespread sterile pustular outbreak with high pyrexia. Many pustules appeared on her hands, including both the dorsal and the palmer side, and a few pustule appeared on her trunk and arms in the pattern of acute generalized pustular bacterid. Histopathology of the eruption showed subcorneal pustules. The eruption and pyrexia did not resolve with any of several antibiotics and NSAIDs, but resolved with the oral etretinate. Thereafter, pustules and scaly erythema remained on the arch of the foot and thenar of the palm, typical of pustulosis palmaris et plantaris.     

Gnatophyma: a rare variant of phyma

We report a case of a 44-year-old woman with an 8-year history of gnatophyma. Rosacea is a facial dermatosis that may present as flushing, erythema, telangiectases, papules, pustules and phyma. Phyma is considered the final evolution stage of rosacea and is a rare variant. Treatment of phyma with atypical localization may be a challenge for dermatologists in clinical practice.     

Tinea corporis with acute inflammation caused by Trichophyton tonsurans

A 13-year-old Japanese boy presented with acute skin inflammation on the extremities. He belonged to a judo club of a junior high school in which club tinea capitis and tinea corporis seemed to be prevalent. Vesicles and pustules appeared on his right forearm and right leg. They increased in numbers and formed annular lesions. Pruritic erythema appeared surrounding these lesions. Direct microscopic examination of the lesions detected hyphae, and culture for the fungi yielded yellowish colonies. The result of culture from pustules revealed Staphylococcus aureus. At first, a topical antifungal drug and systemic antibiotics seemed to cure annular lesions, but pustules arose again. A large surrounding erythema was cured by topical treatment with a steroid agent. A biopsy specimen from a pustule showed hyphae of fungi within a hair shaft and in the bulb. The restriction fragment length polymorphism in the internal transcribed spacer regions of the ribosomal gene (polymerase chain reaction restriction fragment length polymorphism) revealed a banding pattern compatible with Trichophyton tonsurans. Treatment with systemic itraconazole was begun and lesions disappeared immediately. Systemic antifungal therapy was needed in our case. Tinea corporis with inflammation necessitates systemic antifungal therapy.