皮肤接合菌病五例

Five cases of cutaneous zygomycosis

目的总结近3年收治的5例接合菌病的临床资料，探讨皮肤接合菌病的临床特征、真菌学特征和治疗。方法回顾分析我科近3年收治的5例皮肤接合菌病的临床资料。结果收治的5例皮肤接合菌病，发病年龄5—49岁，男1例，女4例；病程7个月至16年；表现为浅表型1例，坏疽型4例。发病前有外伤或手术史3例，无明显诱因2例。皮损位于面部2例，四肢3例。这5例患者均经过真菌学和（或）病理学确诊。致病真菌为多变根毛霉3例，未鉴定到种2例。治疗以抗真菌药物为主，4例给予两性霉素B治疗，1例给予氟康唑、伊曲康唑胶囊和注射液治疗，治愈2例，好转1例，疗效不佳1例，死亡1例。结论皮肤接合菌病是一种严重的毁容性深部真菌病，提高对本病的认识有助于早期诊断和治疗。治疗首选两性霉素B。

Objective To analyze the clinical characteristics, mycology and therapeutics of 5 cases of cutaneous zygomycosis collected in recent 3 years. Methods A retrospective study was performed using clinical data on 5 cases of cutaneous zygomycosis collected in recent 3 years. Also, previous reports of this entity were reviewed. Results There were 1 male and 4 females among the 5 patients with cutaneous zygomycosis confirmed by mycology and/or pathology. The onset of age varied from 5 to 49 years, and course of disease from 7 months to 16 years. Of the 5 patients, 1 presented with superficial cutaneous zygomycosis, and the other 4 with gangrenous cutaneous zygomycosis; 3 had a history of trauma or surgery, 2 had no obvious inducements. Eruptions were located in the face of 2 patients and in the extremities of 3 patients. The isolate was identified as Rhizomucor vadabilis in 3 cases, and species remained unclear in 2 cases. Four patients were treated by amphotericin B, and 1 by oral fluconazole as well as oral and injected itraconazole. Finally, 2 patients were healed, 1 was improved, 1 experienced no obvious improvement, and 1 died. Conelusions Cutaneous zygomycosis is a rare severe devastating deep fungal infection. The first choice of drug is amphoteracin B for it. To improve the understanding of this disease may benefit the early diagnosis and therapy of it.