阿维A有效治疗芽生菌病样脓皮病2例

Two Cases of Blastomycosis-like Pyoderma:Successful Treatment with Acitretin

病例1:患者男,51岁,左胫前增生性斑块2年。皮肤科情况:左胫前见3 cm×5 cm大小暗红色增生性斑块,边缘清楚并隆起,较厚褐色痂皮下可见糜烂面及脓性分泌物。皮损组织病理示:表皮假上皮瘤样增生,真皮浅中层弥漫淋巴细胞浸润。组织真菌及分枝杆菌培养(-),分泌物细菌培养示产气肠杆菌。诊断:芽生菌样脓皮病。治疗口服阿维A 20 mg,1次/d,1.5个月,头孢呋辛0.25 g,2次/d,2周,斑块消退,遗留淡红斑。病例2:患者男,53岁,右足跟上方斑块2年。皮肤科情况:右足跟上方见约4 cm×5 cm大小类圆形疣状斑块,局部见少量脓性分泌物及痂皮。组织真菌及分枝杆菌培养示(-),分泌物细菌培养示金黄色葡萄球菌。组织病理示:表皮呈假上皮瘤样增生,真皮浅层见少量中性粒细胞、淋巴细胞、浆细胞浸润。诊断:芽生菌病样脓皮病。治疗:口服阿维A 20 mg,1次/d,2个月后皮疹基本消退,留有褐色色素沉着。

Case 1:A 53-year-old male presented with a hyperplastic plaque on the left anterior tibial for 2 years.Physical examination showed a dark red hyperplastic plaque of 3 cm×5 cm in size,with clear and raised edges.Erosion surface and purulent secretions were observed under the thick brown crusted skin.Histopathological examination revealed epidermal pseudoepitheliomatous hyperplasia and diffused lymphocytic infiltration in the superficial dermis.The cultures for fungi and mycobacterium were negative,and for bacteria identified Enterobacter aerogenes.Diagnosis:Blastomycosis-like pyoderma.Treatment and outcome:After oral administration of acitretin 20 mg once a day for 6 weeks and cefuroxime 0.25 g twice a day for 2 weeks,the plaque subsided and left slight erythema.Case 2:A 53-year-old male presented with a plaque above the right heel for 2 years.Physical examination showed a round wart-like plaque of about 4 cm×5 cm in size above the right heel,with a small number of purulent secretions and scabs.The cultures for fungi and mycobacterium revealed negative results,while the culture for bacteria showed Staphylococcus aureus.Histopathology identified epidermal pseudoepitheliomatous hyperplasia,with a few neutrophils,lymphocytes and plasma cells infiltrating the superficial dermis.Diagnosis:Blastomycosis-like pyoderma.Treatment and outcome:After oral administration of acitretin 20 mg once a day for 2 months,the skin rash subsided and left brown pigmentation.