葡萄状维朗那霉致皮肤暗色丝孢霉病的临床研究

Clinical analysis of cutaneous phaeohyphomycosis caused by Veronaea botryosa

目的暗色丝孢霉病是由多种暗色孢科真菌感染引起的真菌性皮肤病。由葡萄状维朗那霉引起的暗色丝孢霉病少见,文中报道1例葡萄状维朗那霉所致的皮肤暗色丝孢霉病。方法取患者皮损进行真菌镜检、培养及组织病理检查,并对分离菌种行rDNA ITS测序鉴定。结果显微镜下见大量有隔分枝的菌丝,棕褐色,侧面及末端可见分生孢子,分生孢子呈直线型,偶见分枝,壁光滑。培养见大量毛绒状暗色菌落。皮损组织病理显示慢性肉芽肿性炎,组织中可见有隔的分枝或不分枝的褐色菌丝。PAS和吉姆萨染色阳性。分子测序鉴定为葡萄状维朗那霉。确诊后伊曲康唑加热疗等综合治疗取得良好效果。结论该病例致病菌为葡萄状维朗那霉,选用伊曲康唑加热疗治疗有效。

Objective Phaeohyphomycosis is a fungal dermatopathy caused by a variety of dematiaceous fungi,and Veronaea botryosa is a rare agent of human phaeohyphomycosis.This article reports a case of cutaneous phaeohyphomycosis caused by Veronaea botryosa.Methods The patient was a 16-year-old girl,presented with crusted verrucous lesions initially on the left ear and later on the left buttock within 2-5 months after receiving an ear piercing.Smear,fungal culture and histopathologic examination were carried out on the specimens collected from the patient's lesions,and rDNA ITS sequence analysis was performed for the identification of the isolated strains.Results Microscopy demonstrated numerous septate,branched and yellowish-to-brownish hyphae with lateral and terminal conidiophores.The conidiophores were erect,straight or flexous,occasionally branched,rarely geniculate,smooth walled,septate,and pale brown.Lots of velvety,olivaceous gray colonies grew on the PDA culture medium.Microscopic examination of the H&E-stained tissue slides revealed a chronic granulomatous inflammation.Septate,branched or unbranched pale brown hyphae of various lengths were observed in the tissue examined.PAS and Gomori methenamine silver stains also showed positive septate hyphae.The strain was identified as Veronaea botryosa by ITS sequence analysis.Itraconozole combined with thermotherapy produced satisfactory results.Conclusion The pathogen of this case of cutaneous phaeohyphomycosis was Veronaea botryose,which responded well to traconozole plus thermotherapy.