总状毛霉千叶变种致原发皮肤毛霉病一例

目的 报道1例总状毛霉千叶变种引起的皮肤毛霉病。方法 患者女，22岁，左臀部结节，渐增大6年，巨大疣状增生1年。全面临床检查排除其他疾病，采取皮损组织镜检、培养、温度实验、皮肤病理检查、PAS染色，对分离出的菌株进行鉴定。结果 皮损病理检查显示呈嗜酸粒细胞增多为主的感染性肉芽肿，H-E染色、PAS染色和嗜银染色均可见真皮内粗大、无分隔的菌丝，镜检可见长而分支不分隔的菌丝。25 ℃培养7天，见丰富菌落呈黄色。该菌种鉴定为总状毛霉千叶变种。采用真菌性肉芽肿切除加中厚皮片移植，联合系统抗真菌药物治疗的方法，治疗1个月后，患者获临床、真菌学治愈。结论 本例为总状毛霉千叶变种引起的原发性皮肤毛霉病，采用外科手术及植皮手术，联合系统抗真菌药物治疗安全有效。

A case of primary cutaneous mucormycosis caused by Mucor racemosus Fres. var. chibinensis Schipper

Objective To report a case of primary cutaneous mucormycosis caused by Mucor race-mosus Fres. var. chibinensis Schipper . Methods The patient was a 22-year old woman, presenting with a nodule on the left hip, which had gradully enlarged for 6 years and exhibited verrucous proliferation for 1 year. Other possible diseases were ruled out by overall clinical examination. The isolate was identified via direct microscopic examination, culture, temperature test, pathological examinaiton and PAS staining. Results Pathological examination disclosed an infectious granuloma with the proliferation of eosinophils. Long, thick and nonseptate hypha were found by H&E staining, PAS staining, silver staining, and microscopic examina-tion. The culture （7 days, at 25 ℃） from the lesion yielded exuberant yellow colonies. The isolate was identified as Mucor racemosus Fres. var. chibinensis Schipper . The fungal granuloma was resected and the defect repaired with medium thickness skin flaps; the patient was also given systemic antifungal agents. One month later, the patient achieved clinical and mycological recovery. Conclusions This is a case of primary cutaneous mucormycosis due to Mucor racemosus Fres.var. chibinensis Schipper . Surgical resection and skin grafting combined with systemic antifungal agents are safe and effective for the management of this condition.