皮肤链格孢霉病1例

A case of cutaneous alternariosis

报告1例皮肤链格孢霉病。患者女,27岁。右颊部出现浸润性斑块,其中央形成溃疡8年。真菌学检查及扫描电镜观察,鉴定为交链链格孢。组织病理检查示:溃疡边缘伴有大量多核巨细胞肉芽肿;寄生形态苏木精-伊红染色表现为空泡样结构、棕色分隔菌丝或棕色孢子;PAS染色见大型圆形孢子和粗细不一的分隔菌丝。患者接受伊曲康唑200mg/d口服治疗,第9周溃疡结痂、愈合。复查组织病理仍见肉芽肿及真菌成分,分离培养未阴转。

A case of cutaneous alternariosis is reported. A 27-year-old female presented with infiltrative plaques on the right cheek and ulceration in the center 8 years ago. Alternaria alternata (Fr.) Keissler was identified by mycologic examination and scanning electron microscope. Histopathology showed granulomas with numerous giant cells at the margins of ulceration. Vacuole-like structures in the giant cells, brown septate hyphae and brown spores were also observed. PAS staining revealed irregular septate hyphae and large round spores. The patient had been treated with itraconazole, 200 mg daily, and ulcer was healed after 9 weeks. Histopathologic study was repeated and still manifested a granulomatous change and fungal elements. Fungal culture also showed colonies growing.