淡紫拟青霉致原发性皮肤透明丝孢霉病一例

Cutaneous hyalohyphomycosis caused by Paecilomyces lilacinus：a case report

患者男,53岁,由于外伤引起左前臂起红斑脓疱,并缓慢扩大.刮取脓疱直接镜检见大量酵母样孢子.多次培养见淡紫色羊毛状菌落生长,小培养显微镜下见直立的分生孢子梗、顶端单轮生帚状支及大量柱状或分散柱状排列的椭圆形、近球形小分生孢子.组织病理：PAS染色可见真皮中层大量小型酵母样孢子.鉴定为淡紫拟青霉.体外药敏试验示其对特比萘芬敏感,对伊曲康唑、氟康唑及两性霉素B耐药.由淡紫拟青霉引起的皮肤透明丝孢霉病采用特比萘芬口服及外用治疗,临床疗效明显.

Cutaneous infection with Paecilomyces lilacinus is encountered worldwide, with most infections occurring either iatrogenically or in immunocompromised hosts. A case of cutaneous hyalohyphomycosis caused by P.lilacinus is reported in an immunocompetent individual. A 53-year-old-man presented with a 9-month history of a slowly enlarging erythematous and pustular lesion on the left forearm.Large quantity of yeast-like spores were noted on microscopic examination of pus from the lesion. Growth of the isolate on Sabouraud dextrose agar produced a slightly grayish lavender wooly colony. The microscopy following microculture of the isolate revealed erect conidiophores, single-whorl penicilli, and numerous ellipse or subsphaeroidal microconidiae arranged in prismatic or dispersed prismatic shape, which was characteristic of P.lilacinus. Histopathology and PAS staining showed lots of small yeast-like spores in mid dermis. The isolate,which was finally identified as P.lilacinus, showed sensitivity to terbinafine in vitro, but resistance to itraconazole, fluconazole and amphotericin B. Oml and topical terbinafine is effective for the treatment of cutaneous hyalohyphomycosis caused by P. lilacinus.