特比萘芬成功治愈误诊为曲霉感染的皮肤利什曼病一例

A case of cutaneous leishmaniasis misdiagnosed as cutaneous aspergillosis and successfully treated with terbinafine

患儿女，5岁，内蒙古人。左面颊皮疹10个月。起病前数周局部曾被犬抓伤，初起为无症状小红丘疹，渐扩大。皮屑镜检见分支分隔菌丝，皮屑培养示阿姆斯特丹散囊菌（曲霉有性期），初诊为皮肤曲霉感染。给予伊曲康唑200mg，d治疗2个月，疗效欠佳。组织病理检查及瑞氏-吉姆萨染色，见真皮及皮下组织细胞内外大量利-杜小体，PAS染色未见真菌成分，组织真菌培养阴性，确诊为皮肤利什曼病。给予特比萘芬125mg／d治疗2个月后皮疹痊愈。

A 5-year-old Mongolian girl from Inner Mongolia presented with a painless, round skin lesion on the left cheek for 10 months. Several weeks prior to the development of lesions, her left cheek was scratched by a dog. Subsequently, small asymptomatic erythematous papules developed at the scratched site and gradually enlarged. Direct microscopy of scales from the lesions revealed septate, branching hyphae and fungal culture grew Eurotium amstelodami （perfect stage of aspergillus）. She was initially diagnosed as cuta- neous aspergillosis and treated with itraconazole 200 mg per day for 2 months, but limited improvement was achieved. Histopathologieal examination with Wright-Giemsa staining of skin biopsies revealed abundant leishman l）onovani bodies intracellularly and extracellularly in the dermis and subcutaneous tissue; PAS staining of tissue specimens showed no fungal element and fungal culture was negative. She was finally diagnosed with cutaneous leishmaniasis. After treatment with terbinafine 125 mg per day for 2 months, the lesion subsided.