截肢后皮肤暗孢节菱孢感染一例

患者女，59岁，双下肢截肢39年，双下肢湿疹样改变20余年，慢性肉芽肿样损害伴疣状增生10余年。双下肢膝关节截肢面见大片增生性斑疹，周边红斑、增生，渗出及浸润。触之较硬，有触痛。取皮屑10％KOH真菌镜检阴性，沙氏培养基（SDA）3次培养均见同一种真菌生长，为正面白色背面橙黄色丝状菌落。小培养镜下见透明、线样的分生孢子梗从葫芦形的母细胞长出并产生侧生分生孢子，分生孢子眼晶状体黑棕色，具有一中纬部的线性芽裂，鉴定为暗孢节菱孢。组织病理PAS染色：角质层内可见散在的阳性菌丝。ITS区扩增片段测序与暗孢节菱孢99%符合。诊断：暗孢节菱孢引起的皮肤真菌感染。治疗：口服伊曲康唑胶囊200 mg/d，1个月后随访，疗效满意。

A case of cutaneous Arthrinium phaeospermum infection after lower limb amputation

Hu Suquan, Zhan Ping, Lyu Guixia, Mei Huan, Zeng Xuesi, Liu Weida Department of Mycology, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing 210042, China （Hu SQ, Lyu GX, Mei H, Liu WD）; Department of Pathology, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing 210042, China （Zeng XS）; Department of Mycology, Jiangxi Province Dermatosis Special Hospital, Nanchang 330000, China （Zhan P） Corresponding author: Liu Weida, Email: Liumyco@hotmail.com 【Abstract】 A 59-year-old female patient, who received bilateral lower limb amputation 39 years ago, presented with eczematoid changes in both lower limbs for over 20 years, and with chronic granuloma-like lesions complicated by verrucous hyperplasia for more than 10 years. There were large areas of infiltrative and proliferative lesions with exudation and peripheral erythema at the amputation sites in both knee joints. The lesions were hard with tenderness on palpation. Microscopic examination of lesional scales with 10% KOH showed negative results for fungi. However, three times of culture on the Sabouraud dextrose agar （SDA） medium all grew the same kind of fungus, and the front side and reverse side of its filamentous colony were white and orange yellow respectively. Microculture showed that linear hyaline conidiophores came out from lageniform mother cells with conidia ascending alongside. The conidia looked like dark brown eye lens, with an equatorial germ slit. Based on these findings, this fungus was identified as Arthrinium phaeospermum. Periodic acid-Schiff （PAS） staining showed scattered hyphae in the stratum corneum. The internal transcribe spacer （ITS） sequence of the isolated fungus showed 99% consistency with that of Arthrinium phaeospermum. The patient was diagnosed with cutaneous Arthrinium phaeospermum infection, and treated with oral itraconazole capsules 200 mg/d for 16 days. One month later, follow-up showed satisfactory outcomes.