裴氏着色芽生菌致下肢皮肤感染一例

Cutaneous infection of the lower limb with Fonsecaea pedrosoi： a case report

患者女，53岁。右下肢条带状排列损害，反复起疹30余年。损害由结节和暗红色浸润斑块覆污秽色痂组成，部分损害表面有黑点。直接镜检和组织病理可见褐色厚壁孢子，真菌培养及分子生物学鉴定病原菌为裴氏着色芽生菌。体外真菌药敏试验显示对特比萘芬及伊曲康唑敏感。联合应用特比萘芬和伊曲康唑治疗，辅以手术切除和局部热疗。治疗10个月后，脓性分泌物消失，皮损面积缩小，治愈部位留下色素沉着。对着色芽生菌病联合特比萘芬和伊曲康唑口服，辅以红光热疗及手术切除，综合疗效较好。

A 53-year-old female patient presented with bandlike lesions on the right lower limb for 30 years. Physical examination revealed a chain of nodules and dull erythematous infiltrative plaques covered with dirty crusts. Black dots were observed on the surface of some lesions. Direct microscopic examination and histopathology showed brown ehlamydospores. The pathogenic strain was identified as Fonsecaea pedrosoi by fungal cuhure and molecular biology. Drug sensitivity test in vitro showed that the F.. pedrosoi strain was sensitive to itraconazole and terbinafine. The patient was managed with oral itraconazole and terbinafine plus surgical excision and local hyperthermia treatment. After 10-month treatment, purulent discharge disappeared and skin lesions diminished and terbinafine plus surgical excision and local management of chromoblastomycosis.