播散型皮肤红色毛癣菌肉芽肿一例

A case of disseminated cutaneous granuloma caused by Trichophyton rubrum

患者男，35岁，全身出现泛发红斑、斑块、结节伴瘙痒8年。皮肤科检查：头面部及躯干四肢大片丘疹、红斑、浸润性斑块及结节，部分皮损边界清，伴少量鳞屑、结痂、萎缩性瘢痕，双眼睑肿胀，右耳廓已破坏消失，左耳廓变形，头发、眉毛、睫毛稀疏脱落，指（趾）甲甲板均肥厚、变形、断裂。真菌学检查：取皮损处皮屑直接镜检示分枝分隔菌丝阳性，真菌培养鉴定为红色毛癣菌生长。皮损组织病理检查：表皮角化过度，棘层增生肥厚，真皮浅中层可见上皮样细胞团块，伴淋巴细胞、浆细胞为主的炎细胞浸润，散在嗜酸粒细胞及多核巨噬细胞。PAS和银染色均可见真皮浅中层散在分布分枝分隔菌丝。诊断为播散性皮肤红色毛癣菌肉芽肿。伊曲康唑治疗3个月后皮损消退，留有色素沉着及萎缩性瘢痕，真菌直接镜检及培养均示阴性，服药期间未见明显不良反应。

A case of disseminated cutaneous granuloma due to Trichophyton rubrum is reported. A 35- year-old man presented with generalized pruritic erythema, plaques and nodules for 8 years. Dermatological examination revealed patchy papules, erythema, infiltrated plaques and nodules on the scalp, face, trunk and limbs, and some of the lesions were slightly scaling and crusting with clear borders and atrophic scar. Also, his bilateral eyelids were swollen, right auricle was impaired, left auricle was deformed, hair, eyebrows and eyelashes were lost, and nails of the fingers and toes were thickened, impaired and even broken. Direct microscopic examination of scrapings from skin lesions showed the presence of branched and septate hyphae, and fungal culture grew Trichophyton rubrum. Skin biopsy specimen revealed epidermal hyperplasia, stratum spinosum hyperplasia and thickening, epithelioid granuloma in the superficial and mid dermis consisting mainly of lymphocytes and plasmocytes with scattered eosinophils and muhinucleated giant cells. Periodic acid-Schiff （PAS） and silver stain both showed branched and septate hyphae within the upper dermis. A diagnosis of disseminated cutaneous granuloma caused by Trichophyton rubrum was made. After 3 months of treatment with itaconazole, the lesions subsided with hyperpigmentation and atrophic scar left, and both microscopic examination and fungal culture turned negative. No side effects were observed during the treatment.