系统性红斑狼疮伴棘状外瓶霉所致暗色丝孢霉病一例

患者女，27岁，右下肢结节、溃疡6个月，有系统性红斑狼疮病史2年。皮损脓液直接镜检可见分支、分隔链状菌丝和孢子，组织病理检查显示棕黄色菌丝、孢子。沙氏葡萄糖琼脂培养基（SDA）培养出深绿色绒状菌落，微量培养可见分支、分隔菌丝和棘状环痕孢梗，DNA序列分析属于棘状外瓶霉。菌株不能液化明胶，可在25 ~ 39 ℃环境下生长，对伊曲康唑、两性霉素B、特比萘芬敏感。动物实验发现免疫抑制小鼠感染比正常对照组严重。依据临床特征、组织病理学检查、真菌培养及基因鉴定结果，该例患者确诊为系统性红斑狼疮伴棘状外瓶霉所致的暗色丝孢霉病。

Phaeohyphomycosis caused by Exophiala spinifera in a patient with systemic lupus erythematosus

A 27-year-old woman who suffered from a 2-year history of systemic lupus erythematosus (SLE) presented with a 6-month history of nodules and ulcer on the right lower extremity. Direct microscopic examination of the pus showed branched and septate hyphae and spores in a chain-like arrangement.Histopathological examination revealed yellowish brown hyphae and spores. Dark green velvety colony grew on Sabouraud dextrose agar (SDA). Slide culture showed branched, septate hyphae and spine-like annellated conidiophores. The isolate was identified as Exophiala spinifera by DNA sequence analysis. The strain was unable to liquefy gelatin, could grow at 25 ℃ to 39 ℃, and was sensitive to itraconazole, amphotericin B and terbinafine. Animal test revealed that the infection induced by Exophiala spinifera in immunocompromised mice was more severe than that in normal controls. Based on the clinical features, histopathological, fungal culture and DNA sequencing results, the patient was diagnosed with systemic lupus erythematosus accompanied by subcutaneous phaeohyphomycosis caused by Exophiala spinifera.